Use of Typhidot in the Diagnosis and Treatment of Typhoid Fever

Use of Typhidot in the Diagnosis and Treatment of Typhoid Fever,Adrian C. Peña,Edwin Pasumbal

Use of Typhidot in the Diagnosis and Treatment of Typhoid Fever   (Citations: 1)
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A retrospective study was conducted at the St. Luke's Medical Center to determine how physicians utilize the typhidot test and how the results affect their medical intervention and final diagnosis. All requests for typhidot test and results from January 1999 to December 2000 were obtained and the charts of the patients who were 18 years old and above were reviewed. The patients were grouped into 4 based on the results of the typhidot tests: Group I, IgM+/IgG+; Group II, IgM+/IgG-; Group III, IgM -/IgG+; and Group IV, IgM -/IgG-. The following data were also reviewed: blood culture requests and results, antibiotic and other medical interventions and final diagnoses. A total of 88 patients, 51 males and 37 females had requests for typhidot test. Only 44 (50%) of these patients had concomitant blood culture requests and in only 3 were organisms isolated. Salmonella typhi grew out in 1/3 and 1/2 blood culture requests in Groups I (3 patients) and II (3 patients). S. aureus grew out in 1/34 in Group IV (77 patients). All patients in Groups I and II were treated as typhoid fever consistent with the interpretation of the presence of IgM with or without the presence of IgG and were treated correctly. In Group III (5 patients) where only IgG was present, 4 patients were given a final diagnosis of enteric/typho id fever with one patient being diagnosed with concomitant amoebic colitis. The antibiotics given for this patient, however, did not contain an anti-typhoid drug. The 5th patient had a final diagnosis of acute appendicitis and managed as such. Despite the absence of both IgG and IgM and absence of growth in 8 blood cultures, 10 of the 77 patients in this group were still treated as enteric/typhoid fever based on clinical grounds. The rest were given non-typhoidal final diagnoses with majority being given adequate treatment consistent with their diagnoses. It is therefore recommended that the typhidot test should not be used as a screening test for all fevers and requests should be limited to fevers where there is a high clinical suspicion of enteric/typhoid fever. (Phil J Microbiol Infect Dis 2002; 3(4):161-164)
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