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Nurmawati S, Alam A, Djauhari H, Merati TP, Sudarmono P, Setiawaty V, Arlinda D, Sugiyono RI, Arief M, Hadi U, Aman AT, Lokida D, Gasem MH, Tjitra E, Liang CJ, Neal A, Kosasih H, Karyana M, Lau CY, Alisjahbana B. Clinical characteristics of enteric fever and performance of TUBEX TF IgM test in Indonesian hospitals. PLoS Negl Trop Dis 2024; 18:e0011848. [PMID: 39052692 DOI: 10.1371/journal.pntd.0011848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 06/26/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Accurate diagnosis of enteric fever is challenging, particularly in low- and middle-income countries, due to the overlap of clinical and laboratory features with other pathogens. To better understand the difficulties in enteric fever diagnosis, we evaluated the characteristics of patients clinically diagnosed with enteric fever and the real-world performance of TUBEX TF, one of the most used tests in Indonesia. METHODOLOGY/PRINCIPAL FINDINGS Patients were recruited through the AFIRE (Etiology of Acute Febrile Illness Requiring Hospitalization) study at eight Indonesian hospitals. Blood culture was performed for all patients, and TUBEX TF was performed for suspected enteric cases. Salmonella PCR and ELISA tests were performed at a reference lab. Sensitivity and specificity of TUBEX TF and IgM and IgG anti-S. Typhi ELISA were determined. Of 301 patients clinically diagnosed with enteric fever, 50 (16.6%) were confirmed by blood culture and/or PCR. Confirmed cases were mostly school-aged children presenting with fever, anorexia, dizziness and/or abdominal pain with normal leukocyte count or leukopenia. TUBEX TF demonstrated a sensitivity of 97.6% to 70.7% and specificity of 38.3% to 67.2% at cutoffs of 4 and 6, respectively. Acute IgG demonstrated the best sensitivity and specificity, at 90.7% and 82.7%, respectively, and the best ROC characteristics. CONCLUSIONS/SIGNIFICANCE A substantial proportion of enteric fever was misdiagnosed at all study hospitals, likely due to the overlap of clinical characteristics and lab parameters with those of other common pathogens. The TUBEX TF rapid serological assay demonstrated suboptimal performance in our setting and tended to over-diagnose enteric fever. The role of IgG from acute specimens for identification of enteric fever cases merits additional consideration.
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Affiliation(s)
- Syndi Nurmawati
- Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
| | - Anggraini Alam
- Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia
- Pediatric Department, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Hofiya Djauhari
- Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
| | - Tuti P Merati
- Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia
- Faculty of Medicine, Udayana University, Denpasar, Indonesia
| | - Pratiwi Sudarmono
- Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia
- Faculty of Medicine, Universitas Indonesia, Central Jakarta, Indonesia
| | - Vivi Setiawaty
- Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia
- Prof. Dr. Sulianti Saroso Infectious Disease Hospital, North Jakarta, Indonesia
| | - Dona Arlinda
- Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia
- Health Policy Agency, Ministry of Heath, Central Jakarta, Indonesia
| | - Retna Indah Sugiyono
- Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia
- Health Policy Agency, Ministry of Heath, Central Jakarta, Indonesia
| | - Mansyur Arief
- Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia
- Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
| | - Usman Hadi
- Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Abu Tholib Aman
- Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia
- Dr. Sardjito General Hospital/Faculty of Medicine, Universitas Gadjah Mada, Sleman, Indonesia
| | - Dewi Lokida
- Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia
- Tangerang General Hospital, Tangerang, Indonesia
| | - M Hussein Gasem
- Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia
- Dr. Kariadi General Hospital/Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
| | - Emiliana Tjitra
- Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia
- Health Policy Agency, Ministry of Heath, Central Jakarta, Indonesia
| | - C Jason Liang
- Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia
- National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Aaron Neal
- Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia
- National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Herman Kosasih
- Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia
| | - Muhammad Karyana
- Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia
- Health Policy Agency, Ministry of Heath, Central Jakarta, Indonesia
| | - Chuen-Yen Lau
- Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia
- National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Bachti Alisjahbana
- Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin Hospital, Bandung, Indonesia
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Kariuki S, Onsare RS. High burden of typhoid disease in sub-Saharan Africa calls for urgent roll-out of typhoid conjugate vaccines. Lancet Glob Health 2024; 12:e537-e538. [PMID: 38485416 DOI: 10.1016/s2214-109x(24)00079-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 03/19/2024]
Affiliation(s)
- Samuel Kariuki
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi 00200, Kenya; Drugs for Neglected Diseases initiative Eastern Africa, Nairobi, Kenya.
| | - Robert S Onsare
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi 00200, Kenya
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Meiring JE, Khanam F, Basnyat B, Charles RC, Crump JA, Debellut F, Holt KE, Kariuki S, Mugisha E, Neuzil KM, Parry CM, Pitzer VE, Pollard AJ, Qadri F, Gordon MA. Typhoid fever. Nat Rev Dis Primers 2023; 9:71. [PMID: 38097589 DOI: 10.1038/s41572-023-00480-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 12/18/2023]
Abstract
Typhoid fever is an invasive bacterial disease associated with bloodstream infection that causes a high burden of disease in Africa and Asia. Typhoid primarily affects individuals ranging from infants through to young adults. The causative organism, Salmonella enterica subsp. enterica serovar Typhi is transmitted via the faecal-oral route, crossing the intestinal epithelium and disseminating to systemic and intracellular sites, causing an undifferentiated febrile illness. Blood culture remains the practical reference standard for diagnosis of typhoid fever, where culture testing is available, but novel diagnostic modalities are an important priority under investigation. Since 2017, remarkable progress has been made in defining the global burden of both typhoid fever and antimicrobial resistance; in understanding disease pathogenesis and immunological protection through the use of controlled human infection; and in advancing effective vaccination programmes through strategic multipartner collaboration and targeted clinical trials in multiple high-incidence priority settings. This Primer thus offers a timely update of progress and perspective on future priorities for the global scientific community.
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Affiliation(s)
- James E Meiring
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
| | - Farhana Khanam
- International Centre for Diarrhoel Disease Research, Dhaka, Bangladesh
| | - Buddha Basnyat
- Oxford University Clinical Research Unit, Kathmandu, Nepal
| | - Richelle C Charles
- Massachusetts General Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - John A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | | | - Kathryn E Holt
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Samuel Kariuki
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Emmanuel Mugisha
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Christopher M Parry
- Department of Clinical Sciences and Education, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases and Public Health Modelling Unit, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Firdausi Qadri
- International Centre for Diarrhoel Disease Research, Dhaka, Bangladesh
| | - Melita A Gordon
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi.
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.
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Shakoor S, Dittrich S. Better diagnostic tools needed to distinguish typhoid from other causes of acute febrile illness. Bull World Health Organ 2023; 101:683-683A. [PMID: 37961063 PMCID: PMC10630729 DOI: 10.2471/blt.23.290678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Affiliation(s)
- Sadia Shakoor
- Department of Pathology and Laboratory Medicine, Aga Khan University, Stadium Road, PO Box 3500, Karachi74800, Pakistan
| | - Sabine Dittrich
- European Campus Rottal Inn, Deggendorf Institut of Technology, Pfarrkirchen, Germany
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Mohamed AA, El Monem Ebeid BA, Abdellatif RAR, Malak M. Use of onsite typhoid IgG/IgM combo test as rapid diagnostic test for typhoid fever. BENI-SUEF UNIVERSITY JOURNAL OF BASIC AND APPLIED SCIENCES 2023; 12:52. [DOI: 10.1186/s43088-023-00391-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/16/2023] [Indexed: 09/02/2023] Open
Abstract
Abstract
Background
The incidence of typhoid fever is increasing in Egypt. The Widal test is the evaluation most widely used in Egypt for diagnosis, but it has many drawbacks; therefore, new diagnostic tools are needed. Our aim was to evaluate the diagnostic accuracy of the onsite typhoid IgG/IgM combo rapid test in diagnosing typhoid fever.
Method
Blood specimens were collected from 90 patients (of all ages) who presented with fever of more than 4 days’ duration. The OnSite Combo test and the Widal test were performed for all patients.
Results
The OnSite Combo test results were positive in approximately 24% of all patients; the Widal test results were positive in 18.9%; and typhoid was diagnosed through blood culture in 32.2%. The OnSite Combo test had 72.4% sensitivity, 98.4% specificity, a positive predictive value of 95.5%, and a negative predictive value of 88.2%. In contrast, the Widal test had 51.7% sensitivity, 69.7% specificity, a positive predictive value of 88.2%, and a negative predictive value of 80.8%.
Conclusions
The onsite combo test was more efficacious than the Widal test in diagnosing typhoid fever.
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Russell AL, Hampton LM, Sinha A, Luquero FJ, Abdelwahab J. Progress in the Typhoid Conjugate Vaccine Program Rollout Supported by Gavi During the COVID-19 Pandemic and the Path Forward. Open Forum Infect Dis 2023; 10:S13-S16. [PMID: 37274531 PMCID: PMC10236508 DOI: 10.1093/ofid/ofad042] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Gavi supports countries to introduce typhoid conjugate vaccine (TCV) with catch-up campaigns. Available TCVs are highly efficacious, equity-focused, and critical to curbing the expansion of antimicrobial resistance. Four Gavi-supported countries have introduced TCVs since 2018. In the wake of the COVID-19 emergency, momentum is building to scale up TCV introduction worldwide, supported by global partners and Gavi's funding for improved typhoid diagnostics.
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Affiliation(s)
- Allyson L Russell
- Correspondence: Allyson L. Russell, MSPH, Vaccine Programs, Gavi, The Vaccine Alliance, Chemin du Pommier 40, 1218 Le Grand-Saconnex, Geneva, Switzerland (); or Francisco J. Luquero, MD, PhD, Vaccine Programs, Gavi, The Vaccine Alliance, Chemin du Pommier 40, 1218 Le Grand-Saconnex, Geneva, Switzerland ()
| | - Lee M Hampton
- Vaccine Programs, Gavi, The Vaccine Alliance, Geneva, Switzerland
| | - Antara Sinha
- Vaccine Programs, Gavi, The Vaccine Alliance, Geneva, Switzerland
| | - Francisco J Luquero
- Correspondence: Allyson L. Russell, MSPH, Vaccine Programs, Gavi, The Vaccine Alliance, Chemin du Pommier 40, 1218 Le Grand-Saconnex, Geneva, Switzerland (); or Francisco J. Luquero, MD, PhD, Vaccine Programs, Gavi, The Vaccine Alliance, Chemin du Pommier 40, 1218 Le Grand-Saconnex, Geneva, Switzerland ()
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Sapkota J, Roberts T, Basnyat B, Baker S, Hampton LM, Dittrich S. Diagnostics for Typhoid Fever: Current Perspectives and Future Outlooks for Product Development and Access. Open Forum Infect Dis 2023; 10:S17-S20. [PMID: 37274534 PMCID: PMC10236505 DOI: 10.1093/ofid/ofad120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Typhoid is an enteric disease caused by Salmonella Typhi. Like many febrile illnesses, typhoid presents with nonspecific symptoms. In routine healthcare settings in low- and middle-income countries, typhoid fever is suspected and treated empirically. Though many diagnostic tests are available for typhoid diagnosis, there are currently no diagnostic tests that meet ideal requirements for sensitivity, specificity, speed, and cost-effectiveness. With introduction of typhoid conjugate vaccine, it is essential to explore the current and future typhoid approach in the context of use case and access to ensure their utilization for disease control.
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Affiliation(s)
- Jyotshna Sapkota
- FIND, the Global Alliance for Diagnostics, Geneva, Switzerland
- Department of Microbiology, Nepal Medical College, Kathmandu, Nepal
| | - Tamalee Roberts
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Buddha Basnyat
- Oxford University Clinical Research Unit, Kathmandu, Nepal
| | - Stephen Baker
- University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | | | - Sabine Dittrich
- FIND, the Global Alliance for Diagnostics, Geneva, Switzerland
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Deggendorf Institute of Technology, European Campus Rottal-Inn, Pfarrkirchen, Germany
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