The utility of diagnostic tests for enteric fever in endemic locations

Figures & data

Table 1. Results of selected studies investigating the sensitivity and specificity of serology assays on blood from patients with suspected enteric fever.

Age group	Suspected enteric fever cases studied (n)	Nonenteric fever controls studied (n)	Test	Test positive in suspected enteric fever cases (sensitivity, %)	Test negative in controls (specificity, %)	Ref.
Child	42 BC ST pos18 BC neg	49 febrile	Typhidot^®	41/42 (98) BC ST pos17/18 (94) BC neg	49/49 (100)	[105]
All	21 BC ST/Widal pos	68 febrile	Typhidot	19/21 (90) BC ST/Widal pos	62/68 (91)	[106]
NS	14 BC ST pos11 BC neg	65 nonfebrile13 febrile	Tubex™	14/14 (100) BC ST pos11/11 (100) BC neg	78/78 (100)	[108]
Child	46 BC ST pos25 BC neg	26 febrile	TyphidotTyphidot-M^®	43/46 (93) BC ST pos7/25 (28) BC neg39/46 (84) BC ST pos13/25 (52) BC neg	20/26 (77)23/26 (88)	[119]
Child	28 BC/stool pos34 BC neg	72 febrile	TyphidotTyphidot-M	25/28 (89) BC ST pos31/34 (91 BC neg25/28 (89) BC ST pos31/34 (91) BC neg	67/72 (93)67/72 (93)	[107]
Child	64 BC ST pos	63 febrile	RTI LPS IgM DipTubex	35/45 (77) BC ST pos56/64 (87) BC ST pos	36/38 (95)48/63 (76)	[87]
NS	91 BC/BM ST pos36 BC/BM neg	80 febrile	RTI LPS IgM Dip	70/91 (77) BC ST pos4/36 (11) BC neg	77/80 (96)	[111]
ND	50 BC ST pos50 BC neg	44 febrile (21 due to nontyphoidal Salmonellae)	TyphidotTyphidot-MPanBio ELISA	41/50 (82) BC ST pos18/50 (36) BC neg49/50 (98) BC ST pos39/50 (78) BC ST pos12/50 (24) BC neg	32/44 (73)38/44 (86)	[115]
All	112 BC ST pos6 BC SPA pos61 BC neg	64 febrile633 nonfebrile	RTI LPS IgM Dip	73/112 (65) BC ST pos4/6 (67) BC pos SPA8/61 (13) BC neg	64/64 (100)631/633 (99)	[112]
NS	25 BC ST pos	55 febrile (25 BC pos Brucella spp.)	RTI LPS IgM Dip	22/25 (88) BC ST pos	53/55 (96)	[120]
All	59 BC ST pos	20 febrile	Dip-S-Ticks IgGTyphidotTubex	51/57 (89) BC ST pos46/58 (79) BC ST pos43/55 (78) BC ST pos	9/18 (50)17/19 (89)17/18 (94)	[116]
Community	103 BC ST pos	113 febrile	TubexTyphidot-M	58/103 (56) BC ST pos41/87 (47) BC ST pos	99/113 (88)33/40 (83)	[121]
ND	39 BC ST pos506 BC neg	ND	Typhidot	36/39 (92) BC ST pos42/545 (8) BC neg	ND	[122]
All	73 BC ST pos3 BC pos SPA	254 febrile	RTI LPS IgM LA	31/73 (43) BC ST pos1/3 (33) BC SPA pos42/95 (44) BC neg	246/254 (97)	[113]
AllCommunity	13 BC ST pos21 BC SPA pos1698 BC neg	ND	TubexTyphidot-M	9/13 (69) BC ST pos1/21 (5) BC SPA pos88/1698 (5) BC neg7/13 (54) BC ST pos2/21 (10) BC SPA pos146/1698 (9) BC neg	ND	[123]
All	75 BC ST pos	102 febrile	TubexTyphidot-MSD Bioline-IgMMega-Salm IgM	71/75 (95) BC ST pos41/55 (55) BC ST pos4//58 (69) BC ST pos68/75 (91) BC ST pos	82/102 (80)66/102 (65)73/92 (79)50/102 (49)	[118]
Child	34 BC ST pos209 BC neg	57 nonfebrile	Tubex™	31/34 (91) BC ST pos37/209 (18) BC neg	51/57 (90)	[124]
AllCommunity	43 BC ST pos800 BC neg	24 febrile	TubexTyphidot	26/43 (60) BC ST pos163/800 (20) BC neg29/43 (67) BC ST pos192/800 (24) BC neg	14/24 (58)13/24 (54)	[125]
ND	54 BC pos62 BC neg	93 febrile	RTI LPS IgM ICT	32/54 (59) BC ST pos40/62 (65) BC neg	91/93 (98)	[114]
All	58 BC SPA pos14 BC ST pos	53 nonfebrile	Tubex-PATM	47/58 (81) BC pos SPA7/14 (50) BC ST pos	52/53 (98)	[110]
Child	41 BC pos64 BC neg	ND	Typhidot-M	38/41 (93) BC ST pos24/64 (38) BC neg	ND	[126]

BC: Blood culture; BM: Bone marrow; Dip: Dipstick; ICT: Immunochromatographic test; LA: Latex agglutination; LPS: Lipopolysaccharide antigen; ND: Not done; Neg: Negative; NS: Not stated; Pos: Positive; RTI: Royal Tropical Institute of The Netherlands; SPA: Salmonella enterica serovar Paratyphi A; ST: Salmonella enterica serovar Typhi.

Table 2. Results of selected studies investigating the sensitivity and specificity of nucleic acid amplification on blood from patients with suspected enteric fever.

Age group	Suspected enteric fever cases studied (n)	Nontyphoid controls studied (n)	Test	Target	PCR positive in suspected enteric fever cases (sensitivity)	PCR negative in controls (specificity)	Ref.
NS	12 BC ST pos4 BC neg	10 febrile	Nested PCR	fliC-d	11/12 (92%) BC ST pos4/4 (100%) BC neg	10/10 (100%)	[140]
NS	21 BC ST pos63 BC neg	20 nonfebrile	PCR	fliC-d	21/21 (100%) BC ST pos4/63 (6%) BC neg	20/20 (100%)	[144]
ND	82 (28 BC ST pos)	20 nonfebrile	PCR	ND	59/82 (72%)	20/20 (100%)	[145]
NS	20 BC ST pos20 BC neg	ND	Nested PCR	fliC-d	20/20 (100%) BC ST pos12/20 (60%) BC neg	ND	[146]
All	10 BC ST pos63 BC neg	ND	PCR	fliC-d	10/10 (100%) BC ST pos36/63 (57%) BC neg	ND	[147]
All	34 BC ST pos3 BC neg	ND	PCR	hilA	34/34 (100%) BC ST pos3/3 (100%) BC neg	ND	[148]
Child	17 BC ST pos46 BC neg	25 nonfebrile	Nested PCR	fliC-d	17/17 (100%) BC ST pos36/46 (78%) BC neg	25/25 (100%)	[149]
Child	26 BC ST pos177 BC neg	ND	PCR	viaB	10/26 (38%) BC ST pos12/177 (5%) BC neg	ND	[141]
All	68 BC ST pos51 BC neg	12 febrile	Nested PCR	fliC-d	67/68 (99%) BC ST pos26/51 (51%) BC neg	12/12 (100%)	[150]
Child	14 BC ST pos38 BC neg	11 febrile8 nonfebrile	Nested PCR	fliC-d	14/14 (100%) BC ST pos29/38 (76%) BC neg	19/19 (100%)	[151]
NS	8 BC ST pos47 BC neg	26 nonfebrile	TaqMan^®RT-PCR	fliC-d	8/8 (100%) BC ST pos40/47 (85%) BC neg	26/26 (100%)	[152]
All ages	33 BC pos broths	40 BC neg broths	PCR	ST-50	29/33 (88%)	40/40 (100%)	[153]
All ages	16 BC ST pos1 BC SPA pos43 BC neg	ND	Nested multiplexPCR	tyvprtfliC-dfliC-aviaB	16/16 (100%) BC ST pos1/1 (100%) BC SPA pos25/43 (58%) BC neg	ND	[142]
NS	51 BC ST pos7 BC neg	ND	PCR	STY-0312/SPA-2476STY-0313-0316	48/58 (83%)	ND	[154]
All ages	6 BC ST pos285 BC neg	10 febrile	Nested	fliC-d	6/6 (100%) BC ST pos8/285 (3%) BC neg	10/10 (100%)	[155]
NS	13 BC ST pos	2 febrile3 nonfebrile	PCR	ratAviaBtyv	13/13 (100%) BC ST pos	5/5 (100%)	[156]
All ages	78 BC ST pos742 BC neg	ND	PCR	fliC-d	73/78 (94%) BC ST pos95/742 (13%) BC neg	ND	[157]
All ages	54 BC ST pos46 BC SPA pos50 BC neg28 BM ST pos	25 febrile	Multiplex RT-PCR	STY0201SSPA2308	23/54 (42%) BC ST pos18/46 (39%) BC SPA pos0/50 (0%) BC neg28/28 (100%) BM ST pos	25/25 (100%)	[158]

BC: Blood culture; BM: Bone marrow; ND: Not done; Neg: Negative; NS: Not stated; Pos: Positive; RT-PCR: Real-time PCR.

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