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. 2000 Feb;76(892):80–84. doi: 10.1136/pmj.76.892.80

Widal agglutination test − 100 years later: still plagued by controversy

L Olopoenia 1, A King 1
PMCID: PMC1741491  PMID: 10644383

Abstract

We review the significance of the Widal agglutination test in the diagnosis of typhoid fever. Over 100 years since its introduction as a serologic means of detecting the presence of typhoid fever, the Widal test continues to be plagued with controversies involving the quality of the antigens used and interpretation of the result, particularly in endemic areas. Areas of concern with clinical and laboratory significance discussed in this review include: the techniques of test performance, interpretation of results, limitation of the value of the test results in endemic typhoid areas, the quality of the antigens used, and alternative diagnostic tests.


Keywords: Widal agglutination test; typhoid fever

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Selected References

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  1. Aquino R. L., Lansang M. A., Quimpo V. S., Sombrero L. T., Saniel M. C. Evaluation of a single Widal test in the diagnosis of enteric fever. Southeast Asian J Trop Med Public Health. 1991 Sep;22(3):375–379. [PubMed] [Google Scholar]
  2. Choo K. E., Razif A. R., Oppenheimer S. J., Ariffin W. A., Lau J., Abraham T. Usefulness of the Widal test in diagnosing childhood typhoid fever in endemic areas. J Paediatr Child Health. 1993 Feb;29(1):36–39. doi: 10.1111/j.1440-1754.1993.tb00437.x. [DOI] [PubMed] [Google Scholar]
  3. DeVillier A. B., Deupree R. H., Dickinson C., Beeler M. F. Comparative study of typhoid O antigens. Am J Clin Pathol. 1965 Oct;44(4):410–412. doi: 10.1093/ajcp/44.4.410. [DOI] [PubMed] [Google Scholar]
  4. Gaultney J. B., Wende R. D., Williams R. P. Microagglutination procedures for febrile agglutination tests. Appl Microbiol. 1971 Oct;22(4):635–640. doi: 10.1128/am.22.4.635-640.1971. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Geddes A. M. Imported infections. Unexplained fever. Br Med J. 1974 Nov 16;4(5941):397–398. doi: 10.1136/bmj.4.5941.397. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Gilman R. H., Terminel M., Levine M. M., Hernandez-Mendoza P., Hornick R. B. Relative efficacy of blood, urine, rectal swab, bone-marrow, and rose-spot cultures for recovery of Salmonella typhi in typhoid fever. Lancet. 1975 May 31;1(7918):1211–1213. doi: 10.1016/s0140-6736(75)92194-7. [DOI] [PubMed] [Google Scholar]
  7. Gopinath R., Keystone J. S., Kain K. C. Concurrent falciparum malaria and Salmonella bacteremia in travelers: report of two cases. Clin Infect Dis. 1995 Mar;20(3):706–708. doi: 10.1093/clinids/20.3.706. [DOI] [PubMed] [Google Scholar]
  8. Hoffman S. L., Flanigan T. P., Klaucke D., Leksana B., Rockhill R. C., Punjabi N. H., Pulungsih S. P., Sutomo A., Moechtar M. A. The Widal slide agglutination test, a valuable rapid diagnostic test in typhoid fever patients at the Infectious Diseases Hospital of Jakarta. Am J Epidemiol. 1986 May;123(5):869–875. doi: 10.1093/oxfordjournals.aje.a114316. [DOI] [PubMed] [Google Scholar]
  9. Jhaveri K. N., Nandwani S. K., Mehta P. K., Surati R. R., Parmar B. D. False positive modified Widal test in acute malaria. J Assoc Physicians India. 1995 Nov;43(11):754–755. [PubMed] [Google Scholar]
  10. Khubnani H., Phalke D., Khubnani A. H., Jain R. C. Coexistence of anti-Salmonella agglutinins in falciparum malaria. J Assoc Physicians India. 1995 Aug;43(8):585–586. [PubMed] [Google Scholar]
  11. Koul P. A., Waheed A., Shah P. A., Iqbal J., Aslam K. Malaria and Widal reaction. J Assoc Physicians India. 1993 Sep;41(9):617–618. [PubMed] [Google Scholar]
  12. Kumar A., Katiyar G. P. Mixed infection with Plasmodium-vivax and Salmonella typhi in an infant. Indian Pediatr. 1995 Feb;32(2):243–244. [PubMed] [Google Scholar]
  13. Levine M. M., Grados O., Gilman R. H., Woodward W. E., Solis-Plaza R., Waldman W. Diagnostic value of the Widal test in areas endemic for typhoid fever. Am J Trop Med Hyg. 1978 Jul;27(4):795–800. doi: 10.4269/ajtmh.1978.27.795. [DOI] [PubMed] [Google Scholar]
  14. Mohammed I., Chikwem J. O., Gashau W. Determination by Widal agglutination of the baseline titre for the diagnosis of typhoid fever in two Nigerian states. Scand J Immunol Suppl. 1992;11:153–156. doi: 10.1111/j.1365-3083.1992.tb01640.x. [DOI] [PubMed] [Google Scholar]
  15. Pang T., Puthucheary S. D. Significance and value of the Widal test in the diagnosis of typhoid fever in an endemic area. J Clin Pathol. 1983 Apr;36(4):471–475. doi: 10.1136/jcp.36.4.471. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Rasaily R., Dutta P., Saha M. R., Mitra U., Bhattacharya S. K., Manna B., Mukherjee A., Chakravorty S., Pal S. C. Value of a single Widal test in the diagnosis of typhoid fever. Indian J Med Res. 1993 May;97:104–107. [PubMed] [Google Scholar]
  17. Reynolds D. W., Carpenter R. L., Simon W. H. Diagnostic specificity of Widal's reaction for typhoid fever. JAMA. 1970 Dec 21;214(12):2192–2193. [PubMed] [Google Scholar]
  18. Samal K. K., Sahu C. S. Malaria and Widal reaction. J Assoc Physicians India. 1991 Oct;39(10):745–747. [PubMed] [Google Scholar]
  19. Sansone P., Saslaw M. S., Hennekens C. H., Jr High titer Widal reaction. JAMA. 1972 Jun 19;220(12):1615–1616. doi: 10.1001/jama.1972.03200120063022. [DOI] [PubMed] [Google Scholar]
  20. Schroeder S. A. Interpretation of serologic tests for typhoid fever. JAMA. 1968 Oct 21;206(4):839–840. [PubMed] [Google Scholar]
  21. Singh P. S. Two hundred false Widal positive cases from eastern U.P. J Assoc Physicians India. 1996 Nov;44(11):842–842. [PubMed] [Google Scholar]
  22. Somerville P. C., Lewis M., Koornhof H. J., Alberts M., Alberts H. W., Raymond R. The Widal test in the diagnosis of typhoid fever in the transvaal. S Afr Med J. 1981 Jun 6;59(24):851–854. [PubMed] [Google Scholar]
  23. Welch H., Lee Mickle F. A Rapid Slide Test for the Serological Diagnosis of Typhoid and Paratyphoid Fevers. Am J Public Health Nations Health. 1936 Mar;26(3):248–255. doi: 10.2105/ajph.26.3.248. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Wicks A. C., Cruickshank J. G., Musewe N. Observations on the diagnosis of typhoid fever in an endemic area. S Afr Med J. 1974 Jul 6;48(32):1368–1370. [PubMed] [Google Scholar]
  25. Zenilman J. M. Typhoid fever. JAMA. 1997 Sep 10;278(10):847–850. [PubMed] [Google Scholar]

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