Diagnostic Value of the Widal Test in Areas Endemic for Typhoid Fever

Myron M. LevineDivision of Infectious Diseases, University of Maryland School of Medicine, Instituto Nacional de Salud, Baltimore, Maryland 21201, Peru

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Oscar GradosDivision of Infectious Diseases, University of Maryland School of Medicine, Instituto Nacional de Salud, Baltimore, Maryland 21201, Peru

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Robert H. GilmanDivision of Infectious Diseases, University of Maryland School of Medicine, Instituto Nacional de Salud, Baltimore, Maryland 21201, Peru

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William E. WoodwardDivision of Infectious Diseases, University of Maryland School of Medicine, Instituto Nacional de Salud, Baltimore, Maryland 21201, Peru

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Rene Solis-PlazaDivision of Infectious Diseases, University of Maryland School of Medicine, Instituto Nacional de Salud, Baltimore, Maryland 21201, Peru

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William WaldmanDivision of Infectious Diseases, University of Maryland School of Medicine, Instituto Nacional de Salud, Baltimore, Maryland 21201, Peru

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The usefulness of a single Widal test to diagnose typhoid fever in endemic areas was investigated. Reciprocal Salmonella typhi O and H titers ⩾40 and ⩾80, respectively, occurred in approximately 90% of 42 Mexican patients with bacteriologically-confirmed typhoid fever at the time of presentation to hospital and, by day 4 to 5 of clinical illness, in 70% of U.S. adult volunteers who developed typhoid fever in the course of vaccine efficacy trials but in only 0.7% (O) to 3% (H) of 275 healthy individuals from a non-endemic area. Healthy Peruvians from areas endemic for typhoid fever commonly had antibody which was age-related. Peak prevalence was found in 15- to 19-yr-olds in whom 29% had O titers ⩾40 and 76% had H titers ⩾80. A single Widal test in an unvaccinated individual showing elevated O and H titers is strongly suggestive of typhoid fever if the person comes from a non-endemic area or is a child less than 10 yr of age in an endemic area. Because of the high prevalence of antibody amongst healthy individuals over 10 yr of age in endemic areas, a single Widal test offers virtually no diagnostic assistance in adolescents and adults.

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