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Open Access Highly Accessed Research article

Assessment and comparative analysis of a rapid diagnostic test (Tubex®) for the diagnosis of typhoid fever among hospitalized children in rural Tanzania

Benedikt Ley18*, Kamala Thriemer1, Shaali M Ame2, George M Mtove34, Lorenz von Seidlein145, Ben Amos46, Ilse CE Hendriksen47, Abraham Mwambuli4, Aikande Shoo46, Deok R Kim1, Leon R Ochiai1, Michael Favorov1, John D Clemens1, Harald Wilfing8, Jacqueline L Deen14 and Said M Ali2

Author Affiliations

1 Translational Research Division, International Vaccine Institute, Seoul, Korea

2 Laboratory Division, Public Health Laboratory (Pemba) - Ivo de Carneri, Chake Chake, Tanzania

3 Amani Centre, National Institute for Medical Research, Tanga, Tanzania

4 Joint Malaria Program, Tanga, Tanzania

5 Asia Pacific Malaria Elimination Network (APMEN), Menzies School of Health Research, Casuarina, Australia

6 Teule Hospital, Muheza, Tanga, Tanzania

7 Oxford Research Unit, Mahidol University, Bangkok, Thailand

8 Biocenter, University of Vienna, Vienna, Austria

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BMC Infectious Diseases 2011, 11:147  doi:10.1186/1471-2334-11-147

Published: 24 May 2011

Abstract

Background

Typhoid fever remains a significant health problem in many developing countries. A rapid test with a performance comparable to that of blood culture would be highly useful. A rapid diagnostic test for typhoid fever, Tubex®, is commercially available that uses particle separation to detect immunoglobulin M directed towards Salmonella Typhi O9 lipopolysaccharide in sera.

Methods

We assessed the sensitivity and specificity of the Tubex test among Tanzanian children hospitalized with febrile illness using blood culture as gold standard. Evaluation was done considering blood culture confirmed S. Typhi with non-typhi salmonella (NTS) and non - salmonella isolates as controls as well as with non-salmonella isolates only.

Results

Of 139 samples tested with Tubex, 33 were positive for S. Typhi in blood culture, 49 were culture-confirmed NTS infections, and 57 were other non-salmonella infections. Thirteen hemolyzed samples were excluded. Using all non - S. Typhi isolates as controls, we showed a sensitivity of 79% and a specificity of 89%. When the analysis was repeated excluding NTS from the pool of controls we showed a sensitivity of 79% and a specificity of 97%. There was no significant difference in the test performance using the two different control groups (p > 0.05).

Conclusion

This first evaluation of the Tubex test in an African setting showed a similar performance to those seen in some Asian settings. Comparison with the earlier results of a Widal test using the same samples showed no significant difference (p > 0.05) for any of the performance indicators, irrespective of the applied control group.

Keywords:
Salmonella; Tubex®; Widal; Africa; Rapid Diagnostic Test