Preventive medicine reports · 2025
Diagnostic accuracy of three tests for Salmonella Typhi infection in adult patients presenting to health facilities in an informal urban settlement in Nairobi, Kenya.
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Nganga Anthony K, Mweu Marshal M
Аннотация
OBJECTIVE: Accurate and timely diagnosis of typhoid fever is undermined by the absence of reliable reference test(s). The objective here was to estimate the sensitivity (Se), specificity (Sp), negative and positive predictive values (NPV and PPV) of the Widal, Salmonella Typhi (S. typhi) rapid antigen (AccurateR Salmonella Antigen Test kit (SAT)) and antibody (OnSite Typhoid IgM/IgG Combo Rapid Test (Rapid Ab)) tests for the diagnosis of acute S. typhi infection in Kenya.
METHODS: This cross-sectional study enrolled patients symptomatic of typhoid fever at three health facilities situated within an informal urban settlement in Nairobi County, Kenya. Using the patients' diagnostic data, a Bayesian latent class model was used to infer the tests' diagnostic accuracy.
RESULTS: The Rapid Ab test recorded the highest Se (94.9% [95% PCI 76.1, 99.8]) compared to Widal (59.5% [95% PCI 48.6, 77.9]) and SAT (54.2% [95% PCI 43.5, 64.8]). The assay's Sp (95.9% [95% PCI 85.0, 99.8]) was statistically similar to Widal (85.9% [95% PCI 80.8, 91.7] but superior to SAT (67.1% [95% PCI 60.7, 73.0]). PPVs for the Rapid Ab and Widal tests were comparable but distinct from SAT. NPV for the Rapid Ab test was the highest.
CONCLUSION: The Rapid Ab assay lends itself as a suitable standalone diagnostic to guide surveillance, diagnosis and treatment of acute typhoid fever in high-burden, resource-limited settings.
METHODS: This cross-sectional study enrolled patients symptomatic of typhoid fever at three health facilities situated within an informal urban settlement in Nairobi County, Kenya. Using the patients' diagnostic data, a Bayesian latent class model was used to infer the tests' diagnostic accuracy.
RESULTS: The Rapid Ab test recorded the highest Se (94.9% [95% PCI 76.1, 99.8]) compared to Widal (59.5% [95% PCI 48.6, 77.9]) and SAT (54.2% [95% PCI 43.5, 64.8]). The assay's Sp (95.9% [95% PCI 85.0, 99.8]) was statistically similar to Widal (85.9% [95% PCI 80.8, 91.7] but superior to SAT (67.1% [95% PCI 60.7, 73.0]). PPVs for the Rapid Ab and Widal tests were comparable but distinct from SAT. NPV for the Rapid Ab test was the highest.
CONCLUSION: The Rapid Ab assay lends itself as a suitable standalone diagnostic to guide surveillance, diagnosis and treatment of acute typhoid fever in high-burden, resource-limited settings.