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Enteric fever – Part 2 – Typhoid / Enteric fever Diagnosis, Widal test, Its Procedure and Interpretation

Enteric fever – Part 2 – Typhoid / Enteric fever Diagnosis, Widal test, Its Procedure and Interpretation
February 14, 2021Lab TestsMicrobiology

Sample

  1. It is done on the serum of the patient for the widal test.
    1. A random sample can be taken.
  2. For blood, culture collects the blood in sterile test tubes or the specialized culture tubes.
  3. For urine culture, clean the area and then collect the mid-stream sample.
  4. Stool culture samples may be collected in sterile containers.
  5. Bone marrow, if needed, will be done with all precautions and in a sterile manner.

Purpose of the test (Indication)

  • This test is done to diagnose enteric fever (Typhoid and paratyphoid fever).

Pathophysiology

  1. Diseases caused by salmonella are divided into two groups:
    1. Typhoidal infection by the S.typhi and S.paratyphi.
      1. Humans are the only host of these pathogens, and spread is person-to-person or via contaminated foodstuffs and water.
    2. Non-typhoidal infection from all other organisms.
      1. The most common non-typhoidal organisms in the USA are S.typhimurium, S.enteriditis.
      2. These infections 95% are food born.
  2. History of widal test:
    1. In 1896 widal test was discovered by George-Fernand Widal for the diagnosis of enteric fever.
  3. Enteric fever includes typhoid and paratyphoid fever.
    1. Paratyphoid fever is milder than typhoid fever.
    2. Enteric fever is also called typhoid fever.
  4. Typhoid fever is caused by the bacterium Salmonella Typhi.
    1. Salmonella typhi has an incubation period of 14 to 21 days. Sometimes may even longer.
    2. 30% of the cases become chronic carriers due to persistent infection of the gallbladder.
  5. This has flagellar antigen H antigen, and Lipopolysaccharides antigen is somatic or O antigen.
    Typhoid bacilli structure

    Typhoid bacilli structure

  1. The incubation period is 5 to 21 days.
  2. Typhoid fever is common in the developing world, where it affects about 21.5 million persons each year.
  3. Salmonella Typhi lives in humans and is also found in chickens and eggs.
  4. It is present in the blood and intestinal tract.
  5. The carrier can harbor bacilli in the gallbladder.
  6. Both patients and carriers shed Salmonella Typhi in their feces (stool).

Mode of spread

  1. Man is the only natural host for the S. Typhi, transmitted in contaminated drinks and foods.
  2. Food: In the case of contaminated foods and drinks.
  3. Spread from the carrier, who is shedding Salmonella Typhi in their feces.
  4. Contaminated drinking water: If sewage water is contaminated with Salmonella Typhi.
  5. Typhoid fever is more common in areas of the world where handwashing is less frequent.
  6. Once Salmonella Typhi bacteria are eaten or drunk, they multiply and spread into the bloodstream.
  7. After the bacteria’s ingestion, invade the small intestine and its Peyer’s patches and spread to regional lymph nodes.
    1. From it goes into the blood circulation and gives rise to bacteremia.

Microbiology of salmonella:

Salmonella Typhi

  1. Salmonella infection facts are:
    1. 105 to 109 organisms are needed to cause infection.
    2. The above number is lower in:
      1. Infants.
      2. Patients with pernicious anemia.
      3. Patients taking antacids or H2 receptor blockers.
    3. The other factors (more prone) for infections are:
      1. Old age.
      2. Patients treated with antimicrobial therapy.
      3. HIV infection.
      4. Therapeutic immunosuppressive treatment.
      5. Patients with malarial infection.
      6. Sickle cell anemia.
      7. Patient with splenectomy.
      8. Patients with diabetes mellitus.
      9. Patients with malignant tumors.
      10. Autoimmune diseases like SLE
  2. This can grow well on ordinary media.
  3. From the feces, MacConkey agar and Desoxycholate agar culture will show pale, non-lactose fermenter colonies.
    1. Xylose lysine desoxycholate agar shows red colonies with a black center.
    2. Wilson and Blair’s bismuth sulfite agar shows black metallic colonies due to H2S production.
  4. Non-lactose fermenter.
  5. These are motile.
  6. These bacteria produce acid and gas H2S from the carbohydrate, except for S.typhi, which does not produce gas.
  7. Salmonella serotypes, clinically divided, are:
    1. Salmonella typhi.
    2. Salmonella cholerae-suis.
    3. Samonella eneteritidis.
  8. Vi antigen is a polysaccharide capsule that surrounds the O antigen.
    1. This will protect the bacteria from the antibody attack on the O antigen.
    2. This antigen is also called Vi for virulence.
      Pathogenesis of enteric fever

      Pathogenesis of enteric fever

Signs and symptoms

  1. Salmonella can cause following diseases in the human:
    1. Typhoid fever.
    2. A carrier state.
    3. Sepsis.
    4. Gastroenteritis (Diarrhea).
  2. The onset is insidious, and there are nonspecific symptoms with intermittent fever and headache.
    1. Initially, there is diarrhea followed by fever, and later on, develops anorexia, headaches, malaise, myalgia, arthralgia, cough, and sore throat.
    2. After one week later, there is nausea, vomiting, and chest pain. Systemic toxemia, neuropsychiatric manifestations, cough, coryza, sore throat, and chest pain.
    3. There may be abdominal pain.
    4. These symptoms resolve in 2 to 4 weeks.
  3. The patient has a fever, and the pattern of the fever is typical.
    1. Fever is persistent and does not touch the normal level. This may be as high as 103 to 104 F.
      Enteric fever signs symptoms and the course of the disease

      Enteric fever signs, symptoms, and the course of the disease in detail

  4. The patient may feel weak.
  5. May have stomach pains, abdominal pain, headaches, or loss of appetite.
  6. In some cases, patients have a rash of flat type and rose-colored spots.
    Enteric fever rose spot rashes

    The enteric fever rose spot rashes.

     

  7. You may see abdominal tenderness, hepatosplenomegaly, lymphadenopathy, and a maculopapular rash called rose spots in the early stages.
  8. After the recovery, 5 to 10% of the cases will continue to excrete organisms for several months; these are called convalescent carriers.
  9. 1 to 4% of the cases will carry the bacteria for more than one year and are called chronic carriers.
    1. The common site of the organisms is the gall bladder. These carriers may have gall stones.
  10. In 50% of the cases, there is splenomegaly and hepatomegaly.
  11. In 30% of the cases, rose spot rashes are seen.
    1. These are 2 to 4 mm, slightly raised, discrete, irregular in shape, and blanching pink macules.
    2. These rose spots are seen on the anterior chest in crops of 5 to 15 in number.
    3. These spots last for 3 to 4 days and fade away without any scar formation.
      Salmonella typhi infection and its course of the disease in the patient

      Salmonella typhi infection and its course of the disease in the patient

 

Pathology of the Enteric fever

Pathology of the Enteric fever

The complications of enteric fever:

  1. Without treatment or even after the treatment, severe complications may occur.
  2. These complications are usually seen in the third week (2 to 4 weeks) of the illness. These includes:
    1. Intestinal perforation was seen in 1% to 2% of the cases.
    2. Intestinal hemorrhage was seen in 3% to 20% of the cases.
    3. Meningitis.
    4. Lobar pneumonia is seen in 5% of the cases.
    5. Osteomyelitis.
    6. Acute cholecystitis was sen in 2% of the cases.
    7. Acute myocarditis was seen in 1% to 2% of the cases.
    8. Secondary suppurative lesions may be seen like pneumonia, parotitis, and furunculosis.
    9. Rarely seen complications are:
      1. Pericarditis.
      2. Endocarditis.
      3. Splenic or liver abscess.
      4. Orchitis.
  3. The fourth week of illness is characterized by improvement.
  4. The Carrier state:
    1. The carrier state is defined as when the organisms are found in the stool for more than one year.
    2. 3% of the S.typhi patients become a carrier.
    3. The site of the chronic infection is the biliary tree.
    4. The presence of the stones or chronic scarring makes it difficult to eradicate the infection.
  5. In developing countries, the mortality is around 30%.
    1. 10% of untreated cases will have a relapse.
  6. The mortality in the USA is 1 to 2%.

Diagnosis of Typhoid fever:

  1. WBCs are decreased and maybe in the range of 4000 to 6000/cmm during the first two weeks.
    1. 3000 to 5000/cmm during the next 2 weeks.
    2. WBCs count around 10,000/cmm or more may suggest perforation of the intestine or suppuration.
  2. The peripheral blood smear shows normocytic anemia.
    1. In case of bleeding, anemia may become hypochromic and microcytic.
  3. Blood culture is positive during the first 10 days of fever in 90% of the cases.
    1. <30% positive after the third week of illness.
  4. Stool cultures are positive after the 10th day of illness, increasing frequency up to 4th or 5 the week.
    1. Stool culture-positive after the 4 months indicates carrier state.
  5. Urine culture is positive during the second to the third week in 25% of the cases, even if the blood culture is negative.
  6. Widal test is positive after 7 to 10 days of infection. O and H antigens are found.
    1. There are an increase and the peak in the third to the fifth week of infection.
    2. After that, the titer starts to fall for several weeks.
    3. O antigen appears before the appearance of H antigen.
    4. The rising titer of O antigen is very important for the diagnosis.
    5. During the convalescent stage, the H antigen is higher than the O antigen.
    6. Positive widal test may be seen in:
      1. Typhoid fever.
      2. After the vaccination.
      3. In the case of a previous infection.
    7. The early treatment of the infection will not raise the titer, or it main remains negative or low.
    8. H antigen has little value in the diagnosis of typhoid fever.

The procedure of the Widal test:

  1. Serial dilution of the patient serum is taken 1:40 to 1:320
  2. Now add an equal volume of Salmonella antigen.
  3. This can be done as a Slide method or as a Tube method.
  4. When running in the tube, then incubate tubes for 12 hours or overnight.
  5. Prepare the serial dilution, as shown in the diagram.
    Serial dilution in the widal test

    Serial dilution in the widal test

Widal test reading:

It is done as follows and can read the result where there is the start of the agglutination, as shown in the following diagram.

The procedure of the widal test and interpretation

The procedure of the widal test and interpretation

Drawback: This test will be positive after 7 to 10 days of Enteric fever.

  1. Serologically salmonella has 5 serogroups: A, B, C, D, and E, based on O somatic antigen.
    1. Based on H-antigen are 1200 serotypes.
      1. 7 to 10 days antibody to D-somatic antigen appears.
        1. These antibodies against O antigens reach their peak by 3 to 5 weeks.
      2. H-flagellar antibodies appear later on.
    2. Widal test will be positive after 7 to 10 days of infection.
    3. The titer of O-antibodies 1:80 is suspicious in unvaccinated patients.
    4. The titer of 1:160 is strongly suggestive of infection in unvaccinated individuals.
    5. The titer of 1:40 for Antibody to flagellar-antigen (H) are suspicious in unvaccinated individual.
      1. While 1:160 is strongly suggestive.
    6. Titers are much higher in the vaccinated individual.
    7. Vi antigen for S.typhi is used to screen the carrier. antibodies to Vi-antigen are positive in

Interpretation of the widal the test:

  1. The highest dilution of the serum is noted where there is agglutination.
  2. If it ends at 1:320, then that is the titer.
  3. The Widal test is positive
    1. if “O” antigen titer is    >1:160 = active infection.
    2. If the “H” antigen titer is     >1:160, it indicates past infection or in immunized persons.
    3. A fourfold increase in the titer (e.g., from 1:40 to 1:160) is diagnostic.

O antigen

  1. In the acute stage, Antigen O will be positive, and titer will be more than 1:160.
  2. O antigen appears early and also disappear early.

H antigen

  1. H antigen rises late and disappears late.
  2. This will be positive in the recovery stage.

Vi antigen

  1. This is an indicator of the carrier stage.

The false-positive test may be seen due to cross-reacting infections, including malaria.

Other diagnostic tests for the diagnosis of Typhoid (Enteric) fever are:

  1. Blood culture, which will be positive in the first week when the Widal test is negative.
  2. Stool culture.
    1. 60 to 70% of cases are negative during the first week, and more patients positive in the third week of infection.
    2. Stool 90% of the cases are cleared of the bacteria by the 8th week of infection.
  3. Urine culture.
  4. Bone marrow culture. This is a very sensitive test.
    1. Bone marrow 90% of the cases are positive despite antibiotic therapy if these are ≤5 days.
  5. Another serological test is Typhidot.
    1. In this test, the serum of the patient is taken.
    2. This kit claims that enteric fever may be diagnosed in the first week of fever.

      Interpretation of the Typhidot test in enteric fever

      Interpretation of the Typhidot test in enteric fever

    3. The gold standard is the blood culture, where 90% of cases are positive in the first week.
      1. 50% of cases are positive by the third week.
      2. For better yield, centrifuge the blood and take a buffy coat for culture.
  6. Other samples are stool, urine, Rose spot, bone marrow, and gastric or intestinal secretions.
  7. When culture is done simultaneously on blood, bone marrow, and intestinal secretions, positivity is >90%.
  8. A small % become the carrier, and their stool culture remains positive for at least one year.
    Enteric fever diagnosis summary

    Enteric fever diagnosis summary

Summary of the Culture in Enteric fever patients from  a different site:

Time period Clinical S/S Presence of Rose spot Blood Stool Urine Bone marrow
  1. During I.P
  2. 0 to 1 week
  1. Diarrhea (10% to 20%)
  2. Or constipation
Negative negative

±

(Transiently positive)

Negative Negative
  1. 1 to 2 weeks
  2. Invasion of the intestine
  3. Invasion of the lymphoid tissue
  1. Anorexia
  2. Fever
  3. Headache
  4. Myalgia
  5. Malaise
  6. Cough
  7. Sore throat
Negative Positive in 80 to 90% of the cases Negative Negative Negative
  1. 2 to 4 weeks
  2. Enteric fever confirmed
  1. Systemic toxemia
  2. Nausea, vomiting
  3. Abdominal pain
  4. Neuropsychiatric manifestation
  5. Coryza and cough
  6. Sore throat
  7. Chest pain
Positive in 60% of the cases Positive in 80 to 90% of the cases Positive in 80% of the cases Positive in 25% of the cases Positive in 90% of the cases
  1. 4 to 5 weeks
  2. Convalescent stage

The patient is in recovering stage

 

Positive cases start decreasing.
  1. Negative in ongoing disease
  2. Negative in relapse
Positive in 50% of the cases Positive in 10% of the cases Positive cases start decreasing
  1. >5 weeks
  2. Late complications
  1. Cholecystitis
  2. Osteomyelitis
  3. Soft tissue abscess formation
Negative
  1. Negative in ongoing disease
  2. Negative in relapse
Decreasingly positive Decreasingly positive Negative

Treatment

  1. The drug of choice is chloramphenicol, but it has many side-effects.
  2. Ciprofloxacin is now a drug of choice.
  3. Ampicillin, amoxicillin, 3rd generation cephalosporins, and fluoroquinolones can be used.
  4. C0-trimoxazole is better than chloramphenicol with fewer side-effect.

Vaccination for the Enteric fever.

There are various types of vaccines, oral as well as I/M are available. The best one is the oral vaccine.

Type of the available vaccine The dose of the vaccine The success rate for protection Relative information
Ty21a (Vivotif Berna)
  1. One capsule one hour before the meal for 4 days
  2. One capsule every day for 4 days
  3. Give booster dose every 5 years.
  1. Efficacy is 43% to 96%
  2. Don’t give antibiotics.
  3. Don’t give with antimalarial drugs.
  1. This is a live attenuated vaccine.
  2. Not recommended in children under the age of 6 years
  3. Don’t give in immunosuppressed patients.
  1. S.typhi (whole organism)
  2. This is a heat-killed vaccine.
  1. 0.5 mL I/M for 2 doses
  2. Give the second dose after >4 weeks apart
  3. Booster dose 0.1 mL, every 3 years
  4. The dose for the children 6 months to 10 years of age is 0.25 mL
  1. Efficacy is 51% to 77%
The side-effects are:

  1. Severe headache in 10% of the cases
  2. Fever is seen in 17% to 29% of the cases
  3. Pain at the site of injection is seen in 35% to 60% of the cases
  4. Rarely severe  reaction is seen
  1. Vi capsular polysaccharide [ViCP] OR
  2. Typhim Vi
  1. 0.5 mLI/M in 2 doses
  2. Give the second dose after >4 weeks apart
  3. Booster dose every 2 years
  4. Not recommended for children younger than 2 years
  1. Efficacy is 55%
The side-effects are:

  1. local erythema or induration in 7%
  2. Headache in 1.5% to 3%
  3. Fever in 1%

Carriers:

    1. It is difficult to treat carriers because of gall bladder involvement.
    2. Ampicillin is the most useful drug, but it is to be given in larger doses and for an extended period of time.
    3. Chloramphenicol is less effective than ampicillin.
    4. Ciprofloxacin can also be tried.
    5. The ultimate end is cholecystectomy.

For Nonmedical (non-specialists) person explanation of Widal test (Enteric fever):

  1. Please advise the Widal test if the fever persists for more than 5 days and is constant. It does not touch the normal level.
  2. The titer of O antigen 1:40 is considered negative.
  3. Just see the O antigen titer if it is 1:160, indicate Enteric fever.
  4. If the O antigen is 1:80, repeat the test after 5 to 7 days, and now if the titer is 1:160, the rising titer again indicates acute infection.
  5. While H antigen does not indicate acute infection or acute enteric fever.
Possible References Used
Go Back to Lab Tests

Comments

Afroz jahan Reply
August 2, 2020

Good write up.
Thanks

Dr. Riaz Reply
August 2, 2020

Thanks a lot.

Afroz jahan Reply
August 2, 2020

Widal test is explained in a very simple way.

Dr. Riaz Reply
August 2, 2020

Thanks.

Abdulai Joseph Gbla Reply
September 28, 2020

What does it mean if someone has a 1:160

Dr. Riaz Reply
September 29, 2020

If it is O 1:160 means positive and you can repeat after 3 to 7 days, and you will find a rising titer.

Pankaj Reply
November 11, 2020

Hello sir ..my widal test s typho o 1:320 and fever comes in my inside body 2 month normal fever ..
Dear
Your widal is positive. You need to take a course on antibiots.
Prof.Riaz

Dr. Riaz
November 11, 2020

Dear
Your widal is positive. You need to take a course on antibiotics.
Prof.Riaz

Hakima Reply
February 13, 2021

What is it means if reaction shows 1:40 both H and O

Dr. Riaz
February 14, 2021

I will say negative and advise you to repeat the widal test after 5 to 7 days. If there is an increase in the value, then I will say it is positive. If again the same value comes, then it is definitely negative.

Mayuri Makode Reply
August 23, 2020

Very well explainaton… Very useful

Dr. Riaz Reply
August 23, 2020

Thanks.

Pankaj Reply
November 11, 2020

Thanks a lot

Asha Reply
October 7, 2020

Sir, i have 1:320 in thypoid result
And i took injection course for 3 days morning and evening …. 10 days pills paracetamol and antibiotic… Still i am having severe headache sir…

Dr. Riaz Reply
October 7, 2020

1:320 if it is O antigen, then definitely it is enteric fever. These antibodies will disappear after a minimum of one year. First O antigen will disappear and later on H antigen.

Vishal Choudhary Reply
September 9, 2020

Very well explained…

Dr. Riaz Reply
September 20, 2020

Thanks.

Ujehcee Franca Reply
September 25, 2020

I appreciate your write-up, as it’s has ease enlightened me on my test results.
T

Dr. Riaz Reply
September 28, 2020

thanks

Dr A G Mulla Reply
September 30, 2020

Widal test done on 9/09/20 give S typhi titre 1:180 after 20 days repeat test shows O titer negative (Nil)
How fast O titre disappears.
Please explain

Dr. Riaz Reply
September 30, 2020

O antigen titer negative means no typhoid fever. But titer of 1:180 was indicative typhoid fever but when there is no rising titer then typhoid fever possibility is out.
Please let me know about the H antigen titer. Your results are Confusing because O antigen toter can not become 0 in just 20 days.

Dr A G Mulla Reply
September 30, 2020

Please reply earliest possible.

Dr. Riaz Reply
September 30, 2020

Replied to your question.

Dhananjay Reply
October 9, 2020

If widal- O 1:160 and H 1:80
And after around 15 days of treatment; Typhidot says IgM is negative & IgG is also negative.
So whether typhoid has resolved or person had no typhoid earlier (at time of widal)….
My doubt is simply that if IgG indicate remote infection then, should it not be positive in typhidot??…..or if it is negative then, there was no typhoid????
Please reply as soon as possible.

Dr. Riaz Reply
October 9, 2020

IgM Typhidot negative means the acute phase of the enteric fever is over.

Mian aftab ahmad Reply
October 10, 2020

Sir i have widal test with report of Typ O 1:20+ 1:40+ 1:80+ 1:160- 1:320- 1:640-
sir kindly explain that would i have typh fever? plz explain
i was completed 6 injection of shexon 1gm
and now i am getting ciprofloxacin tablet 500mg

Dr. Riaz Reply
October 10, 2020

Replied.

Mian aftab ahmad Reply
October 10, 2020

Sir i have widal test with report of Typ O 1:20+ 1:40+ 1:80+ 1:160- 1:320- 1:640-
sir kindly explain that would i have typh fever? plz explain
i was completed 6 injection of shexon 1gm
and now i am getting ciprofloxacin tablet 500mg

Dr. Riaz Reply
October 10, 2020

Your titer is 1:80, this is borderline, you should repeat widal after 5 to 7 days. If now it is 1:160, then it favors enteric fever. If it is the same at 1:80, then less likely of enteric fever.

Khaled Reply
October 10, 2020

Good Evening sir
My widal report is
S typhi o 1:320
S typhi H 1:80
S Para Typhi AH 1:20
S Para Typhi BH 1:20

But I don’t have fever, had slight back pain Body pain and cold

Kindly suggest

Dr. Riaz Reply
October 10, 2020

These values favor the diagnosis of enteric fever.

Rivaz Reply
October 14, 2020

Good Evening sir
My widal report is
S typhi o 1:160
S typhi H 1:80
S Para Typhi AH 1:40
S Para Typhi BH 1:40

I have a low grade fever of 99-99.2 and body pain. Have done the antibiotics course using ceftas for 15 days but there is no improvement in fever. I have fever from almost a month now.

Kindly suggest

Inderjit Singh Reply
October 15, 2020

Please explain sir.. My father had gone trough Typhoid IGM TEST and it was negative and after 5 days we have done widal test and report is like
Salmonella typhi O (TO) Reactive upto Titre
1:160
Salmonella typhi H (TH) Reactive upto Titre
1:160
Salmonella paratyphi A, H (AH) Reactive upto Titre
1:80
Salmonella paratyphi B, H (BH) Reactive upto Titre
1:80
Note: 1. Titres 1:80 and above of “O” antigen & 1:160 and above
please explain us

Dr. Riaz Reply
October 15, 2020

Please let me know what ahppend after 5 days?

Ayesha Reply
October 15, 2020

Sir
I hve typhoid in rage of typhi O 1:320
Typhi H 1:160
Paratyphi 1:80
Paratyphi 1:40
I’m taking Azifile I dnt hve fever but I got redpatches on my left ankle
Is that very critical Sir

Dr. Riaz Reply
October 16, 2020

O 1:320 is positive for typhoid fever. Ankle rashes may be due to drugs.

Ayesha Reply
October 16, 2020

Sir Plz replay as soon as possible

Dr. Riaz Reply
October 16, 2020

replied.

Hanan Reply
October 17, 2020

Sir ,pls I need your help
S typhi(0) less than 80
Typhi 160 H
Paratyphi less than 80
S.Paratyphi less than 80
Bruccella app less than 80

Dr. Riaz Reply
October 17, 2020

1:80 test report is borderline, can take it as negative. Repeat the test after 5 to 7 days. If there is an increase in the value, then the test will be positive.

seem Reply
October 21, 2020

Good Evening sir
My widal report is
S typhi o 1:160
S typhi H 1:80
S Para Typhi AH 1:40
S Para Typhi BH 1:40
I have a low grade fever of 99-99.2 and body pain. Have done the antibiotics course using ceftas for 15 days but there is no improvement in fever. I have fever from almost a month now.
Kindly suggest

Dr. Riaz Reply
October 21, 2020

Your widal test shows a positive result. You should consult some good physicians to change the antibiotics or find the cause of fever,

Sreedhar Reply
October 23, 2020

Good Evening sir
My widal report is
S typhi O Antigen Negative 1:20 Dil
S typhi H Antigen Positive 1:40 Dil
S Para Typhi AH Antigen Negative 1:20 Dil
S Para Typhi BH Antigen Negative 1:20 Dil
I have a low grade fever of 98-98.4 and body pain. Have done the antibiotics course using for 5 days there is improvement in fever. Cough is persistent
Kindly suggest

Dr. Riaz Reply
October 23, 2020

You should check your blood CBC and have an Xray chest,

kanchi sagar Reply
October 23, 2020

Hi sir 6 days back my result is
Salmonella typhi O antigen 1:80
Salmonella typhi H antigen 1:160
And now
O antigen 1:80
H antigen 1:40
But from two days my fever got 103 degrees and 101 I am using monochef 1 mg daily morning and evening from two days
Is it going to be cured? Please suggest the answer asap

Dr. Riaz Reply
October 23, 2020

Now your widal test doesn’t favor typhoid fever.
Please consult a physician for a fever.

kanchi sagar Reply
October 23, 2020

Are you suggesting that the fever was not because of typhoid?

Sherwin G Reply
October 23, 2020

Hi sir, for example, the result of the widal test if the is like this:
Dilution: 1:20
Reaction: +++

Dilution: 1:40
Reaction: ++

Dilution: 1:80
Reaction: ++

Dilution: 1:160
Reaction: +

Dilution: 1:320
Reaction: +/-

Dilution: 1:640
Reaction: –

What is my approximate antibody titer? Does the +/- can be considered since it is the highest dilution where agglutination occurs, hence, <25% of agglutination is seen?

Dr. Riaz Reply
October 23, 2020

1:80 O antigen-positive is borderline. Needs repeat the test after 5 to 7 days. If it is 1:160, then it is positive. If it is again 1:80, then it is negative.

kanchi sagar Reply
October 23, 2020

Thank you so much sir it helps me a lot

Sherwin G Reply
October 24, 2020

Thanks a lot sir if you’ll happen to address my concern ❤️

Dr. Riaz Reply
October 24, 2020

please can you let me know the issue?

Saranya Reply
October 24, 2020

Good morning sir,
My widal report is
S typhi o 1:320
S typhi H 1:160
S Para Typhi AH 1:20
S Para Typhi BH 1:20

CRP : 0.6 mg/dl is there any viral infection? Please suggest me

Dr. Riaz Reply
October 25, 2020

Your widal test is positive. I don’t think you have a viral disease.

Junaid Reply
October 26, 2020

Hi sir..
Widal report..
S. Typhi O 1:80
S. Typhi H 1:80
Para AH 1:80
Para BH 1:80
Kindly guide..

Dr. Riaz Reply
October 26, 2020

These numbers are borderline. Please repeat the test after 5 to 7 days. If titer (number) increases, then the widal test is positive, if remains the same, then is negative.

Saranay Reply
October 27, 2020

Thank you soo much for your response sir. please clarify me one thing sir, CRP level 0.6 mg/dl is normal level or infected. Widal test is positive then CRP is very high?

Dr. Riaz Reply
October 28, 2020

CRP level is normal. You have not given the widal test report.

Timothy Abavana Reply
October 28, 2020

Please Doctor My widal test reads
Salmonella typhi O: 1:20
Salmonella typhi H: 1:20. Please Doctor is this test negative or positive. From Ghana, Navrongo.

Dr. Riaz Reply
October 28, 2020

Widal test is negative.

Amit Reply
October 30, 2020

Good Evening sir
My widal report is
S typhi o 1:320
S typhi H 1:160
S Para Typhi AH –
S Para Typhi BH –

But I have fever, had some cold.

Before 1 month report was same .
I take medicine and before 1 week
It is
S typhi o 1:160
S typhi H 1:160
S Para Typhi AH -1:40
Kindly suggest 1:40
Now it’s increase widal report is
S typhi o 1:320
S typhi H 1:160
S Para Typhi AH –
S Para Typhi BH –
Pls suggest what shows it and what I do for this .

Dr. Riaz Reply
October 30, 2020

Your widal test is positive. You need a good physician who should advise you the right antibiotics.

Amit Reply
October 30, 2020

Sir I suffer from typhoid since 1 month
s typhi o 1:320
S typhi h 1:320
Before a month

Then 1 week it’s
S typhi o 1:160
S typhi h 1:160

And today it’s increase
S typhi o 1:320
S typhi h 1:160

Sir Please suggest me what should I do.

Dr. Riaz Reply
October 30, 2020

I think you need to consult a good physician who should give you the right antibiotics.

Ramee Reply
October 31, 2020

My sis having S. T. O 1:80dil
S. T. H 1:80 is thz typhoid positive or high

Ramee Reply
October 31, 2020

Pllzzz sir tell me

Dr. Riaz Reply
October 31, 2020

Please let me know your question?

Dr. Riaz Reply
October 31, 2020

These numbers are borderline, please repeat widal after 5 to 7 days. If the number increases then it is typhoid fever. If the number is the same or decreased, then not typhoid fever.

Dr. Riaz Reply
October 31, 2020

Replied to your question.

Josan Reply
November 1, 2020

My cousin widal report is
T’H – positive upto 1:80
T’O – positive upto 1:160
What does this indicate?

Dr. Riaz Reply
November 1, 2020

It favors typhoid fever. O titer 1:160 comes in a positive range.

Ramee Reply
November 1, 2020

Tnku so much sir

Manish Reply
November 6, 2020

Sir, I am experiencing mild fever and weakness from past 10days.
My widal test report says-
S.typhi O – 1.80
S.typhi H- 1.80
What does this means?

Dr. Riaz Reply
November 7, 2020

These figures are borderline. Please repeat the widal after 5 to 7 days. If this is 1:160, then definitely it is typhoid fever.

amal Reply
November 8, 2020

In immunological practical examination, two students were given a same patient serum to test for the presence of Salmonella antibodies. One of the students made dilutions to the given serum up to 1:620 and got a positive result, while the other made the dilutions till 1:160, and he got a negative result.

can you answer this question please

Dr. Riaz Reply
November 8, 2020

The answer is very simple. When the antibody titer is very high then this will be negative in early dilution. You have to make more dilution to see the positive result.

Dr. Riaz Reply
November 8, 2020

This is called the prozone phenomenon.

Igiriva Reply
November 13, 2020

In February,salmonella typhi ‘O’- dilution-1:160

Igiriva Reply
November 13, 2020

Salmonella typhi ‘H’-dilution 1:160

Dr. Riaz Reply
November 13, 2020

H titer 1:160 indicates past infection. What was your O antigen titer?

Dr. Riaz Reply
November 13, 2020

Indicate borderline result if there is rising titer then definitely Typhoid fever.

Ali Reply
November 17, 2020

Sir my widal test for all components come to 1.80, im having fever since last 30 days, back pain, headache & once had blood clots from stool & throat. Im having antibiotics since last 2 days named cebosh cefixime 200mg. Plz suggest something as feeling very week internally.

Dr. Riaz Reply
November 17, 2020

Your Widal test does not favor Typhoid fever. Please repeat your widal and have an X-Ray chest. If your ESR is very high, then you must consult a good physician.

Annu chouhan Reply
November 17, 2020

My S titer ‘O’Brien is 1:40 and ‘ H’ is 1:80 and Ah and Bhai are negative but one month before this tst my report was O and H both titer are 0:80..and between this period still now my fingers, wrist snd ankle were swollen and hv lot of pain in moving them what to do is it positive or not

Dr. Riaz Reply
November 17, 2020

Please see your email.

Arun kumar Reply
November 24, 2020

Sir my result was s typhi O 1:40 positive and s typhi H 1:40 positive . Do i have typhoid fever?

Dr. Riaz Reply
November 24, 2020

This widal test is negative for typhoid fever.

Arun kumar Reply
November 24, 2020

Thanks doctor but why they mentioned positive in my report . Can you explain me this ?

Edwin Esonwune Reply
December 2, 2020

Thanks Dr. You are doing a great job.I have learnt a lot.

Best regards
Edwin from. Nigeria

Dr. Riaz Reply
December 2, 2020

Thanks. I need encouraging remarks like yours.

Dr. Riaz Reply
December 2, 2020

Thanks, I need encouraging remarks like yours.

Naseem Sultana syeda Reply
December 2, 2020

Thank you doctor .. you are clearing many doubts .. May Allah reward you immensely for this help..

Dr. Riaz Reply
December 2, 2020

Thanks, You are welcome.

Deepika Sharma Reply
December 3, 2020

Hi Doctor,

My Father who is 65 years old, is also diabetic. He is having a fever for the last 7 days.

O is 1.8
H is 1.8
AH non-reactive
BH non-reactive

What does this mean? Can you please help?

Dr. Riaz Reply
December 3, 2020

If this is 1:80, then this is borderline for typhoid fever. You need to repeat after 5 to 7 days. If it is the same, then there is no typhoid fever; if it is increased to 1:160, then positive for enteric fever.

jyoti Reply
December 4, 2020

sir my mother is ill from months her widal is 320 after medicines ger fever went to 100 and today again her fever rises to 103 what should i do?

Dr. Riaz Reply
December 4, 2020

I think the widal test may be repeated, and she needs to have a workup for PUO (pyrexia due to unknown reason). She needs consultation by a good physician and the lab workup.

Thanga Reply
December 7, 2020

S. Typhi O = 1/40
S. Typhi H =1/40
Does this values confirm Typhoid?

Thanga Reply
December 7, 2020

S. Typhi O = 1/40 ( < 160 repeat after 1 week . Two fold increase )
S. Typhi H =1/40 ( in titre confirms the Salmonella infection )
S. Paratyphi AH Negative ( Single Widal estimation is of little )
S. Paratyphi BH Negative
Does this values confirm Typhoid?

Dr. Riaz Reply
December 8, 2020

No, With these figures, the widal test is negative.

baljit Reply
December 10, 2020

sir i have s typhi o 1:320
s typhi h 1:160
along with covid what should i do please advice.. i have headache low fever weakness white tongue for about 28 days..

Dr. Riaz Reply
December 10, 2020

I think you need treatment by some good physician. Your widal test is positive. You have to keep an eye on your body’s oxygen level. Oximeters are available, and these are not costly. Keep an eye that your body oxygen level should not go below 90% (normal level is 95% to 100%). Now recommendations are giving steroids and antiviral therapy.
Again I will suggest consulting a physician.

Barb Carrig Reply
December 19, 2020

Hello Sir,
From the Widal test I showed antibodies to Salmonella typhi (O type Vi) and Salmonella paratyphi (H type b). I was very sick while on vacation in South America one year ago. My doctor doesn’t seem to know how to treat this. Am I a carrier and what antibiotics do you recommend? Thank you so much.

Dr. Riaz Reply
December 19, 2020

Please, what are the values of the widal test? If these are around 1:40, then widal is negative. I am sure your physicians must be the better judge.

tc chan Reply
December 26, 2020

In the picture under “Widal test procedure:”. Why are 1:20, 40, 80 are negative?

Dr. Riaz Reply
December 26, 2020

Because of the concentration and the ratio of antigen and antibody, only then will you see agglutination when the ratio is adequate.

tc chan Reply
December 26, 2020

In the picture under “Widal test procedure:”. Why are 1:20, 40, 80 are negative?

Raksh Reply
January 8, 2021

Report for 4 year kid
Complaining pain near navel area
From.around 15 days with some time feeling like vomit .

Widal test
Salmonella typhi O. Reactive upto titre 1:80
Salmonella typhiH. Reactive upto titre 1:80

USG report
Liver normal in size portal vein and radical shows bright echogenic walls

Multiple enlarged mesenteric lymph nodes are seen largest at the root measuring 19*18

CBC.
PCV 40.30%
RBC count. 5.31mill/mm3

SGOT. 54UL
SGOT. 54

Please give your opinion as it is very hard to get blood test again done for kid.

Dr. Riaz Reply
January 8, 2021

Widal test O 1:80 is borderline. You have not written TLC and differential. Pain near the naval area needs to rule out appendicitis/ parasitic infestation. If the child has a problem for 14 days, then appendicitis is out. This child most likely may have a parasitic infestation. Please consult a good pediatrician.

Raksh Reply
January 9, 2021

Thank very much in replying very soon .I am very thankful to you ..your speedy reply on this post means a lot to me.I pary for your well being and progress in every aspect of your life .
Tlc 5 21
Lymphocytes 2.77
Eosinophils 0.04
Rest parameters in differtaial are ok

Child specialist has being consulted just received online report and was worried .

Raksh Reply
January 9, 2021

Thank very much in replying very soon .I am very thankful to you ..your speedy reply on this post means a lot to me.I pary for your well being and progress in every aspect of your life .
Tlc 5 21
Lymphocytes 2.77
Eosinophils 0.04
Rest parameters in differtaial are ok

Urine routine /culture… normal

If I plz tell what is Multiple enlarged mesenteric lymph nodes are seen largest at the root measuring 19*18.
hild specialist has being consulted just received online report and was worried .

Dr. Riaz Reply
January 9, 2021

TLC and DLC look normal. Rest mesenteric lymph nodes may be enlarged unless there is some history of fever and raised ESR. I will suggest you consult a good pediatrician for the possibility of parasitic infestation.

Raksh Reply
January 9, 2021

Thanks very much

Vijay Reply
January 19, 2021

Sir but my widal test o 1:40 and H 1:40. I have completed my course of 1 month and stopped taking medicine before 1 month now i chek my blood then results is 1:40 o, and 1:40 h what will I do plz sir ? Tell mr

Dr. Riaz Reply
January 19, 2021

This is the normal range. No need to worry.

Pardeep Kumar Reply
January 21, 2021

Hi sir please reply
My Widal test
TO: 1/160
TH: 1/160
AH: 1/80
BH: 1/40

And in CBC everything normal sir what I do ?

Dr. Riaz Reply
January 21, 2021

Your widal O antigen 1:160 indicates acute infection. To confirm the diagnosis, repeat widal test after 5 to 7 days; if the O antigen is 1:320, that will confirm the enteric fever.

Jyoti Reply
January 25, 2021

I had fever post that I took widal test which reads as
WIDAL Test (Slide Method)
SALMONELLA TYPHI `O` Negative In 1:20 Dilution
SALMONELLA TYPHI `H` Positive In 1:80 Dilution
S.PARATYPHI A `H` Negative In 1:20 Dilution
S.PARATYPHI B `H` Negative In 1:20 Dilution
Is this an indication of typhoid?

Dr. Riaz Reply
January 25, 2021

To me, this widal test is negative for an enteric fever—no need to worry about 1:20 titer and even antigen H.

MD Reply
February 1, 2021

Sir I have been feeling tired and lethargic for a week now. Did widal test and CBC today, below are observations, kindly share your expertise.

S Typhi O – 1:80
S Typhi H – 1:80

Platelet Count – 1.25 lakh/cmm
MCH – 33.56 PG
MCHC – 39.43 gm/dl

Rest all parameters in the reports suggest OK.

I must mention that you are doing a great service to the society. We need more great souls like you.

Regards,

Manoj Reply
February 1, 2021

Sir I have been feeling tired and lethargic for a week now. Did widal test and CBC today, below are observations, kindly share your expertise.

S Typhi O – 1:80
S Typhi H – 1:80

Platelet Count – 1.25 lakh/cmm
MCH – 33.56 PG
MCHC – 39.43 gm/dl

Rest all parameters in the reports suggest OK.

I must mention that you are doing a great service to the society. We need more great souls like you.

Regards,

Dr. Riaz Reply
February 3, 2021

Please, how much were your ESR and TLC ?. 1:80 titer is borderline; please repeat Widal after 5 to 7 days. If the titer is high, then it indicates typhoid fever.

Olafimihan opeyemi Reply
February 23, 2021

I have used malaria drugs twice and Cipro now table for typhoid after that I went for test and the widal test show S.Typhi O 1/40, H 1/160. S paratyphi A: O 1/20 H 1/20. S paratyphi B , O 1/40 H 1/160 . S paratyphi c , O 1/20, H 1/20 please explain it to me

Dr. Riaz Reply
February 23, 2021

H antigen titer indicates past infection or vaccination. In comparison, other antigens which indicate acute infection are in the normal range.

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