Widal, Not Valid Test For Typhoid — Doctors

Image credit: Karnataka Antibiotics & Pharmaceuticals Limited

Medical doctors have said that Widal test, a popular laboratory investigation prescribed by many hospitals for the diagnosis of typhoid in Nigeria, is no longer valid for the clinical diagnosis and treatment of the disease.

The Punch/GRAPHITTI NEWS report continues:

According to the experts who spoke to our correspondent on Monday, 70 per cent of typhoid cases treated in Nigeria are as a result of misdiagnosis.

To accurately diagnose typhoid, a General Physician, Dr. James Atanda, noted that in addition to other clinical evaluations, patients must have their fecal and sometimes blood culture tests done.

“Typhoid is an illness you cannot just diagnose from a Widal test. It is not a valid test for diagnosing typhoid but many Nigerians don’t know this. The diagnosis of the disease involves a lot of clinical parameters and tests, including a culture of the patients’ waste products,” Atanda said.

The Medical Director of Daysprings Hospitals, Ikotun, Lagos, Dr. Samuel Adebayo, also raised the alarm that many Nigerians had been made to believe that prolonged fever or malaria infection was typhoid.

According to the physician, typhoid, an enteric fever that affects the intestine and the guts occurs when the bacteria ‘Salmonella Typhi’ or its other specie gains entrance into the body through the drinking of unhygienic water or unhygienic food preparation.

He maintained that the disease could only be diagnosed after a thorough clinical examination and consideration of the patients’ history.

Adebayo said, “There is no direct symptom of typhoid. All symptoms are suggestive. Some typhoid cases do not even show in the Widal test that is being used by quacks to diagnose the disease. It is dangerous to use these results to treat a patient for typhoid. Most doctors are aware of this, especially those who work in teaching hospitals that is why we don’t use it.

“Patients also want to hear that they have typhoid. I have had to convince patients who believed that they had typhoid even after thorough clinical evaluations suggested that they did not have it.”

Also, the Medical Director, Sanomens Hospital, Ejigbo, Lagos, Dr. Marcus Eruaga, said it was high time the public was enlightened on the fact that Widal test was not a conclusive test for the diagnosis of the disease as it was prone to error due to the complexity of the test results.

Eruaga said, “The Widal test is laden with errors, but the public carry it as evidence. Some conditions could increase one’s titre value from the Widal test. The result is nothing without a medical examination. It does not mean you have active typhoid,” he added.

Speaking on the consequences of wrong diagnosis, Adebayo noted that many Nigerians with serious illnesses had been sent to their early graves due to self or wrong medication.

 He said, “Some patients have died from liver and kidney failures because they were told that they had typhoid. If you ask them who confirmed that they had typhoid, you get replies like ‘my neighbour’, ‘the chemist’, or ‘my mother’. It is always a little too late for them when they realize that the symptoms they were treating was of another ailment.”

Eruaga, however, noted that in order to check the confusion clouding the diagnosis of typhoid in the country, the public should be enlightened through advertorials and stiffer penalties should be meted out to health workers who dabbled into areas beyond their specialty.

“Typhoid is not prolonged malaria. It is caused by different organisms. It is only a doctor that can determine a fever typical of typhoid or malaria. Meeting with an expert is inevitable. You cannot put the cart before the horse,” he added.

However a Pharmacist and consultant who spoke on the condition of anonymity with the GRAPHITTI NEWS correspondent said it was lamentable the leadership of the Pharmaceutical Society of Nigeria (PSN) the umbrella professional body for all practicing Pharmacists in the country (akin to the Nigerian Medical Association) and other Pharmacists had not taken the lead in debunking the use of Widal test for diagnosis of Typhoid in Nigeria. He told GRAPHITTI NEWS that the average Pharmacist in Nigeria by his or her training in Pharmacy School can advise that Widal test is not a confirmatory test but rather after a series of testings the rising titre value from the Widal test could be a strong indicator of the presence of Salmonella spps (Salmonella typhi bacteria or Salmonella paratyphi bacteria) as well as other factors. Then you proceed to do a confirmatory test on stool samples. If a test result is not clear, blood samples will be taken to make a diagnosis.

The Pharmacist, a graduate of Nigeria’s premier university, asserted that it was these kinds of slips whereby Pharmacists are not proactive and seize opportune moments to make significant contributions through making public health education information widely available which make other health professionals not fully appreciate the role of Pharmacists within the health sector.

He further charged that Pharmacists were there when the widespread misdiagnosis of Typhoid fever led by doctors began and they did not step to the plate and counter the scourge. He added that Typhoid fever is treated with several antibiotics but that Chloramphenicol was the original drug of choice for many years. He added that because of rare serious side effects, Chloramphenicol has been replaced by other effective antibiotics. The choice of antibiotics is guided by identifying the geographic region where the infection was contracted and treating accordingly. For those traveling to high-risk areas, vaccines are now available.