synopsis rinkal

7/28/2019 Synopsis Rinkal

1/6

Comparative study between IGM detection by

Immunochromatography and WIDAL test in enteric fever

NAME OF THE, STUDENT :RINKAL PATEL

NAME OF THE SUPERVISOR(S):____________

PLACE OF WORK :MUMBAI

DATE (MONTH AND YEAR) OF SUBMISSION:_________________


2/6

TOPIC

Comparative study between IGM detection by Immunochromatography and WIDAL test

in enteric fever.

Introduction

Typhoid fever continues to be a global health problem, especially in tropics and

subtropics(1-4) Typhoid fever remains a significant health problem in many developing

countries.Early and accurate diagnosis is necessary for prompt and effective treatment.Classically, typhoid fever is considered a disease of multiple stages: 1) the first week is

characterized by progressive elevation of the temperature, followed by bacteremia; 2)

the second week comes with rose spots in the skin, abdominal pain, and splenomegaly;

3) the third week marks a more intensive intestinal inflammatory process, particularly in

the Peyers patches, and complications may develop as digestive bleeding and

intestinal perforation. The patients may have clinical recovery afterwards. However,

some patients may die after a progressive clinical worsening not responsive to the

treatment with antibiotics against Salmonella enterica subsp. enterica serovar Typhi

(S.Typhi). As the clinical picture of typhoid fever is often unspecific, misdiagnosis and

insufficient or inadequate treatment are potential risks associated with the disease.One

has to rely on serological diagnosis since many diagnostic laboratories in

developing countries do not have facilities for blood culture (4,5,6).

Estimates suggest an incidence rate of more than 21.5 million cases globally in the year

2000.Widal test is the mainstay in the diagnosis of typhoid fever in most laboratories but

it has drawbacks(7-11). Culture may take up to seven days and requires a well-run and

equipped laboratory, which is often not available in settings with endemic typhoid fever.

The widely in use Widal test provides a cost efficient alternative for serological

diagnosis, however its performance remains unsatisfying in early diagnosis. 12 The test

further requires the establishment of a local cut off titer prior to use which is


3/6

complicated. Agglutination is a classic serologic reaction that results in clumping of a

cell suspension by a specific antibody, directed against a specific antigen. Such tests

have been widely used for detection of antibodies against various disease-producing

micro-organisms in serum for a long time. The Widal agglutination test, developed by F

Widal in 18961 to aid in the diagnosis of typhoid fever, utilises a suspension of killed

Salmonella typhias antigen, to detect typhoid fever in serum from suspected S typhi-

infected patients who present with febrile illness. The value and clinical application of

the Widal test in developed countries has diminished considerably in recent years2 and

a large number of antigenically related determinants of both typhoid and non-typhoid

Salmonella organisms are now recognised. Therefore, a rapid test with a performance

comparable to that of blood culture would be desirable.A rapid diagnostic test for

typhoid fever are commercially available detect immunoglobulin M (IgM) directedtowards Salmonella spp antigen in patient sera. Performance of such tests has

previously been evaluated in a number of studies in many developing countries and

gainiNg its own diagnostic importance in clinical practise.13,14.

Objectives

Considering the fact that enteric fever is endemic in developing country like India and its

public health problem is evident in literature published worldwide its early and accurate

diagnosis will be important for its treatment and prognosis.The objective of the study will

be to study the tests results obtained from blood samples from suspected patients with

enteric fever using serological diagnostic tests like conventional widal agglutination test

and rapid IgM detection by Immunochromatography tests. The results will be compared

for their ability of early diagnosis in such patients,the principle, time, sensitivity and

specificity of the test.


4/6

Plan Of Work And Methodology

A prospective study will be undertaken over a period of 6 months in serological section

of a clinical diagnostic laboratory. Following investigations will be done on the collected

blood sample: Enterocheck-WB(ICT) & Widal test and then results will be compared

after completion of the study.

Inclusion criteria:

Venous blood samples will be collected from patients peripheral vein in who

presented with fever > 5 days or more with clinical symptoms and signs

suggestive of typhoid fever. Whole blood,serum,plasma will be used for

performing the test.

Informed consent from the all the patients will be taken.

All cases will be subjected to a detailed history and thorough clinical examination

through referring clinician.

Exclusion criteria:

Patients with co-infection of malaria ,dengue or any other illness known to cross

react with results of tests will be excluded.

Patients already on antibiotic treatment.

Methodology

Widal test is a tube agglutination test The test is based on demonstrating the presence

of agglutinin (antibody) in the serum of an infected patient, against the H (flagellar) and

O (somatic) antigens ofSalmonella typhiand AH and BH antigens ofSalmonella

paratyphi A and B respectively. Demonstrating a positive agglutination during the acute

and convalescent period of infection with evidence of a four-fold rise of antibody titre

with be suggestive of typhoid fever.Cut off titre will be decided considering localgeographical titre and semiquantitative dilutions prepared as per kit literature provided.

Enterocheck-WB(ICT) This is rapid serological test used to enteric fever diagnosis

based on principle of immunochromatography.This test raidly detects IgM class of

antibodies to LPS lipopolysaccharide specific to Salmonella typhiin human

serum,plasma or whole blood specimens.


5/6

Methodology and instructions will be followed as per the kit literature provided with the

Enterocheck-WB(ICT) and Widal test.Standard reference textbooks and literature will

also be considered.

All the statistical analysis will be done later for interpretation of results.

References/Bibliography

1. Cleary TG, Salmonella. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson

Textbook of Pediatrics, 17th edition. Philadlphia: Saunders Publishers; 2004. p.

912-918.

2. Ivanoff B, Levine MM, Lambert PH. Vaccination against typhoid fever: presentstatus. Bull World Health Organ 1994; 72: 957-971.

3. Rajivi K, Gupta N, Shalini. Multidrug resistant typhoid fever. Indian J Pediatr

2007; 74: 39-42.

4. Jesudason M, Esther E, Mathai E. Typhidot test to detect IgG and IgM antibodies

in typhoid fever. Indian J Med Res 2002: 116; 70-72.

5. Ananthanarayan R, Panikar CKJ. Text Book of Microbiology, 6th edition;

Chennai: Orient Longman; 1999.

6. Dahir Ramos de ANDRADE & Dahir Ramos de ANDRADE JNIOR REVIEW

TYPHOID FEVER AS CELLULAR MICROBIOLOGICAL MODELRev. Inst. Med.

trop. S. Paulo 45(4):185-191, July-August, 2003

7. Nsutebu EF, Ndumbe PM, Shiro K. The increase in occurence of typhoid fever in

Cameroon: Overdiagnosis due to misuse of the Widal test?Trans R Soc Trop

Med Hyg 2002; 96: 64-67.

8. Olopoenia LA , King A. Widal agglutination test 100 years later: still plagued by

controversy. Postgrad Med J 2000; 76: 80-84.

9. Parry CM, Hoa NT, Diep TS, Wain J, Chinh NTVinh H, et al. Value of a single

tube Widal test in diagnosis of typhoid fever in Vietnam. J Clin Microbiol 1999;

37: 2882-2886.


6/6

10..Narayanappa D, Sripathi R, Jagdishkumar K, Rajani HS.Comparative study of

dot enzyme immunoassay (Typhidot-M) and Widal test in the diagnosis of typhoid

fever.Indian Pediatr. 2010 Apr;47(4):331-3. Epub 2009 Apr 15.

11.Crump JA, Luby SP, Mintz ED: The global burden of typhoid fever. Bulletin of the

World Health Organization 2004, 82(5):346-353.

12.Sur D, Manna B, Sen B, Deb AK, Deen JL, Wain J, von Seidlein L, Ochiai

RL,Clemens JD, Bhattacharya SK: Evaluation of a new-generation serologic test

for the diagnosis of typhoid fever: data from a community based surveillance in

Calcutta, India. Diagnostic Microbiology and Infectious Disease 2006, 56:359-

365.

13.Benedikt Ley, Kamala Thriemer, Shaali M Ame, George M Mtove, Lorenz von

Seidlein,Ben Amos, Ilse CE Hendriksen,Abraham Mwambuli,AikandeShoo,Deok R Kim, Leon R Ochiai, Michael Favorov,John D Clemens,Harald

Wilfing, Jacqueline L Deen,and Said M Ali. Assessment and comparative

analysis of a rapid diagnostic test (Tubex) for the diagnosis of typhoid fever

among hospitalized children in rural Tanzania.BMC Infect Dis. 2011; 11: 147.

14. Lateef A Olopoenia, Aprileona L King. Widal agglutination test - 100 years later:

still plagued by controversy. Postgrad Med J2000;76:8084.
http://www.ncbi.nlm.nih.gov/pubmed?term=Narayanappa%20D%5BAuthor%5D&cauthor=true&cauthor_uid=19430063http://www.ncbi.nlm.nih.gov/pubmed?term=Sripathi%20R%5BAuthor%5D&cauthor=true&cauthor_uid=19430063http://www.ncbi.nlm.nih.gov/pubmed?term=Jagdishkumar%20K%5BAuthor%5D&cauthor=true&cauthor_uid=19430063http://www.ncbi.nlm.nih.gov/pubmed?term=Rajani%20HS%5BAuthor%5D&cauthor=true&cauthor_uid=19430063http://www.ncbi.nlm.nih.gov/pubmed/19430063http://www.ncbi.nlm.nih.gov/pubmed/?term=Ley%20B%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Thriemer%20K%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Ame%20SM%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Mtove%20GM%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=von%20Seidlein%20L%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=von%20Seidlein%20L%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Amos%20B%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Hendriksen%20IC%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Mwambuli%20A%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Shoo%20A%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Shoo%20A%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Kim%20DR%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Ochiai%20LR%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Favorov%20M%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Clemens%20JD%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Clemens%20JD%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Wilfing%20H%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Wilfing%20H%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Deen%20JL%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Ali%20SM%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=Narayanappa%20D%5BAuthor%5D&cauthor=true&cauthor_uid=19430063http://www.ncbi.nlm.nih.gov/pubmed?term=Sripathi%20R%5BAuthor%5D&cauthor=true&cauthor_uid=19430063http://www.ncbi.nlm.nih.gov/pubmed?term=Jagdishkumar%20K%5BAuthor%5D&cauthor=true&cauthor_uid=19430063http://www.ncbi.nlm.nih.gov/pubmed?term=Rajani%20HS%5BAuthor%5D&cauthor=true&cauthor_uid=19430063http://www.ncbi.nlm.nih.gov/pubmed/19430063http://www.ncbi.nlm.nih.gov/pubmed/?term=Ley%20B%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Thriemer%20K%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Ame%20SM%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Mtove%20GM%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=von%20Seidlein%20L%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=von%20Seidlein%20L%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Amos%20B%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Hendriksen%20IC%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Mwambuli%20A%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Shoo%20A%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Shoo%20A%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Kim%20DR%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Ochiai%20LR%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Favorov%20M%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Clemens%20JD%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Wilfing%20H%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Wilfing%20H%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Deen%20JL%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Ali%20SM%5Bauth%5D

synopsis rinkal

Documents