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Duodenal string test in typhoid fever
T J Antony1, A K Patwari, V K Anand
1Department of Pediatrics, Lady Hardinge Medical College, New Delhi.
Insights
The duodenal string-capsule culture (DSCC) is a practical and sensitive method for diagnosing enteric fever in children. This non-invasive test, when combined with blood cultures, significantly improves pathogen detection rates.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Gastroenterology
Background:
- Enteric fever, primarily caused by Salmonella Typhi, remains a significant public health concern, particularly in children.
- Accurate and timely diagnosis is crucial for effective treatment and preventing complications.
- Conventional diagnostic methods like blood, urine, and stool cultures have limitations in sensitivity and practicality.
Purpose of the Study:
- To evaluate the practicality and sensitivity of the duodenal string-capsule culture (DSCC) for diagnosing enteric fever in hospitalized children.
- To compare the diagnostic yield of DSCC with conventional culture methods (blood, urine, stool).
Main Methods:
- A study involving 25 children (4-12 years) diagnosed with enteric fever.
- Successful insertion of the duodenal string-capsule in 18 patients (72%).
- Comparison of DSCC results with blood culture (BC), urine culture (UC), and stool culture (SC).
Main Results:
- DSCC successfully isolated Salmonella Typhi in 11 out of 13 confirmed cases (84.6%), demonstrating high sensitivity.
- DSCC identified the pathogen in approximately 30% more cases than blood cultures alone (61.5%).
- DSCC insertion failure occurred in 7 patients (28%), exclusively in those younger than 6 years.
Conclusions:
- Duodenal string-capsule culture is a simple, non-invasive, and reliable diagnostic tool for enteric fever in children.
- Combining DSCC with blood cultures enhances the overall detection rate of enteric fever, regardless of fever duration or prior antibiotic use.
- The DSCC method shows promise for improving the diagnosis of enteric fever, especially in pediatric populations.
Abstract:
Twenty five children between 4-12 years of age hospitalized with a clinical diagnosis of enteric fever were studied for evaluating the practicality and sensitivity of duodenal string-capsule culture (DSCC) and compared with conventional cultures from blood (BC), urine (UC) and stool (SC). Duodenal string capsule (DSCC) was successfully inserted in 18 patients (72%). Insertion of DSCC failed in 7 patients (28%) and all of them were below 6 years of age. Salmonella typhi was isolated from DSCC and/or BC in 13 cases (72.2%). DSCC was positive in 11 out of 13 confirmed cases of typhoid fever (84.6%). BC was positive in 8 cases (61.5%). DSCC was successful in isolating the organism in about 30% more cases than BC. Duodenal string test was a simple, non-invasive and a reliable test which when used in combination with BC could identify almost all cases of enteric fever irrespective of duration of fever and prior use of antibiotics.