Rapid diagnostic tests for typhoid and paratyphoid (enteric) fever

Lalith Wijedoru, Sue Mallett, Christopher M Parry, Lalith Wijedoru, Sue Mallett, Christopher M Parry

Abstract

Background: Differentiating both typhoid (Salmonella Typhi) and paratyphoid (Salmonella Paratyphi A) infection from other causes of fever in endemic areas is a diagnostic challenge. Although commercial point-of-care rapid diagnostic tests (RDTs) for enteric fever are available as alternatives to the current reference standard test of blood or bone marrow culture, or to the widely used Widal Test, their diagnostic accuracy is unclear. If accurate, they could potentially replace blood culture as the World Health Organization (WHO)-recommended main diagnostic test for enteric fever.

Objectives: To assess the diagnostic accuracy of commercially available rapid diagnostic tests (RDTs) and prototypes for detecting Salmonella Typhi or Paratyphi A infection in symptomatic persons living in endemic areas.

Search methods: We searched the Cochrane Infectious Diseases Group Specialized Register, MEDLINE, Embase, Science Citation Index, IndMED, African Index Medicus, LILACS, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) up to 4 March 2016. We manually searched WHO reports, and papers from international conferences on Salmonella infections. We also contacted test manufacturers to identify studies.

Selection criteria: We included diagnostic accuracy studies of enteric fever RDTs in patients with fever or with symptoms suggestive of enteric fever living in endemic areas. We classified the reference standard used as either Grade 1 (result from a blood culture and a bone marrow culture) or Grade 2 (result from blood culture and blood polymerase chain reaction, or from blood culture alone).

Data collection and analysis: Two review authors independently extracted the test result data. We used a modified QUADAS-2 extraction form to assess methodological quality. We performed a meta-analysis when there were sufficient studies for the test and heterogeneity was reasonable.

Main results: Thirty-seven studies met the inclusion criteria and included a total of 5080 participants (range 50 to 1732). Enteric fever prevalence rates in the study populations ranged from 1% to 75% (median prevalence 24%, interquartile range (IQR) 11% to 46%). The included studies evaluated 16 different RDTs, and 16 studies compared two or more different RDTs. Only three studies used the Grade 1 reference standard, and only 11 studies recruited unselected febrile patients. Most included studies were from Asia, with five studies from sub-Saharan Africa. All of the RDTs were designed to detect S.Typhi infection only.Most studies evaluated three RDTs and their variants: TUBEX in 14 studies; Typhidot (Typhidot, Typhidot-M, and TyphiRapid-Tr02) in 22 studies; and the Test-It Typhoid immunochromatographic lateral flow assay, and its earlier prototypes (dipstick, latex agglutination) developed by the Royal Tropical Institute, Amsterdam (KIT) in nine studies. Meta-analyses showed an average sensitivity of 78% (95% confidence interval (CI) 71% to 85%) and specificity of 87% (95% CI 82% to 91%) for TUBEX; and an average sensitivity of 69% (95% CI 59% to 78%) and specificity of 90% (95% CI 78% to 93%) for all Test-It Typhoid and prototype tests (KIT). Across all forms of the Typhidot test, the average sensitivity was 84% (95% CI 73% to 91%) and specificity was 79% (95% CI 70% to 87%). When we based the analysis on the 13 studies of the Typhidot test that either reported indeterminate test results or where the test format means there are no indeterminate results, the average sensitivity was 78% (95% CI 65% to 87%) and specificity was 77% (95% CI 66% to 86%). We did not identify any difference in either sensitivity or specificity between TUBEX, Typhidot, and Test-it Typhoid tests when based on comparison to the 13 Typhidot studies where indeterminate results are either reported or not applicable. If TUBEX and Test-it Typhoid are compared to all Typhidot studies, the sensitivity of Typhidot was higher than Test-it Typhoid (15% (95% CI 2% to 28%), but other comparisons did not show a difference at the 95% level of CIs.In a hypothetical cohort of 1000 patients presenting with fever where 30% (300 patients) have enteric fever, on average Typhidot tests reporting indeterminate results or where tests do not produce indeterminate results will miss the diagnosis in 66 patients with enteric fever, TUBEX will miss 66, and Test-It Typhoid and prototype (KIT) tests will miss 93. In the 700 people without enteric fever, the number of people incorrectly diagnosed with enteric fever would be 161 with Typhidot tests, 91 with TUBEX, and 70 with Test-It Typhoid and prototype (KIT) tests. The CIs around these estimates were wide, with no difference in false positive results shown between tests.The quality of the data for each study was evaluated using a standardized checklist called QUADAS-2. Overall, the certainty of the evidence in the studies that evaluated enteric fever RDTs was low.

Authors' conclusions: In 37 studies that evaluated the diagnostic accuracy of RDTs for enteric fever, few studies were at a low risk of bias. The three main RDT tests and variants had moderate diagnostic accuracy. There was no evidence of a difference between the average sensitivity and specificity of the three main RDT tests. More robust evaluations of alternative RDTs for enteric fever are needed.

Conflict of interest statement

LW and CMP are authors of Moore 2014 and Maude 2015. SM has no known conflicts of interest.

Figures

1
1
PRISMA flow diagram.
2
2
Summary receiver operating characteristic plot: Enterocheck WB, PanBio, SD Bioline, Mega Salmonella, Multi‐Test Dip‐S‐Tick.
3
3
Risk of bias and applicability concerns graph: review authors' judgements about each domain presented as percentages across included studies.
4
4
Risk of bias and applicability concerns summary: review authors' judgements about each domain for each included study.
5
5
Summary ROC Typhidot all test types.
6
6
Forest plots for Typhidot all test types.
7
7
Summary receiver operating characteristic plot of tests: Typhidot and Typhidot‐M by reference test. Abbreviations: BC: blood culture; BM: bone marrow; BC & PCR: blood culture and polymerase chain reaction.
8
8
Summary receiver operating characteristic plot of test: TUBEX. Reference test: Blood culture. One result per study.
9
9
Forest plot of TUBEX. Reference test blood culture.
10
10
Summary receiver operating characteristic plot: TUBEX by case control design. Abbreviation: BC: blood culture.
11
11
Summary receiver operating characteristic plot: TUBEX by reference test Abbreviations: BC: blood culture; BC & PCR: blood culture and polymerase chain reaction.
12
12
Summary receiver operating characteristic plot: KIT all test types. Threshold > 1+.
13
13
Forest plot of tests: KIT Threshold > 1+ by test type. Reference test: blood culture.
14
14
Summary receiver operating characteristic plot: KIT test by threshold > 1+ and > 2+.
15
15
Summary receiver operating characteristic plot: KIT ICT by reference test. Abbreviations: BC: blood culture; BC & PCR: blood culture and polymerase chain reaction.
16
16
Summary receiver operating characteristic plot: KIT by case control (All test types. Threshold >1+).
17
17
Summary receiver operating characteristic plot: Typhidot versus TUBEX. Paired studies only. One result per index test per study.
18
18
Summary receiver operating characteristic: TUBEX versus KIT. Paired results. One result per index per study.
19
19
Summary receiver operating characteristic plot: Typhidot versus TUBEX tests. One result per index test per study.
20
20
Summary receiver operating characteristic plot: TUBEX versus Test‐it Typhoid (KIT) tests. One result per index test per study.
21
21
Summary receiver operating characteristic: Typhidot versus KIT. No paired studies. One result per index per study.
22
22
Summary receiver operating characteristic plot: Typhidot tests by case control design.
1. Test
1. Test
Typhidot. Antibody: IgM or as reported. 1 result per study.
2. Test
2. Test
Typhidot. Antibody: IgM or as reported. Reference: BC.
3. Test
3. Test
Typhidot. Antibody: IgM or as reported. Reference: BC and BM.
4. Test
4. Test
Typhidot. Antibody: IgM or as reported. Reference: BC and PCR.
5. Test
5. Test
Typhidot. Antibody: IgM or as reported. Indeterminates reported.
6. Test
6. Test
Typhidot. Antibody: IgM or as reported. Indeterminates not reported.
7. Test
7. Test
Typhidot‐M. Antibody: IgM.
8. Test
8. Test
Typhi rapid Tr‐02. Reference: BC. Antibody: IgM.
9. Test
9. Test
Typhi rapid Tr‐02. Reference: BC & PCR. Antibody: IgM.
10. Test
10. Test
Typhidot all tests 1 result per study.
11. Test
11. Test
TUBEX. Reference:BC.
12. Test
12. Test
TUBEX. Reference: BC & PCR.
13. Test
13. Test
TUBEX 1 result per study.
14. Test
14. Test
KIT ICT. Reference:BC. Threshold > 1+.
15. Test
15. Test
KIT ICT. Reference: BC & PCR. Threshold > 1+.
16. Test
16. Test
KIT latex agglutination. Threshold > 1+.
17. Test
17. Test
KIT Dipstick. Threshold > 1+.
18. Test
18. Test
KIT ICT. Threshold > 1+.
19. Test
19. Test
KIT all tests. Threshold > 1+. One result per study..
20. Test
20. Test
KIT all tests. Threshold > 2+ studies only.
21. Test
21. Test
Enterocheck WB.
22. Test
22. Test
PanBio.
23. Test
23. Test
SD Bioline. Antibody: IgG.
24. Test
24. Test
SD Bioline. Antibody: IgM.
25. Test
25. Test
SD Bioline Antibody: IgM and IgG.
26. Test
26. Test
Mega Salmonella. Antibody: IgG.
27. Test
27. Test
Mega Salmonella. Antibody: IgM.
28. Test
28. Test
Multi‐Test Dip‐S‐Tick.
29. Test
29. Test
Enteroscreen.
30. Test
30. Test
Onsite Typhoid Combo CTK Biotech.

References

References to studies included in this review Abdoel 2007 {published data only}

    1. Abdoel TH, Pastoor R, Smits HL, Hatta M. Laboratory evaluation of a simple and rapid latex agglutination assay for the serodiagnosis of typhoid fever. Transactions of the Royal Society of Tropical Medicine and Hygiene 2007;101(10):1032‐8.
Anagha 2012 {published data only}
    1. Anagha K, Deepika B, Shahriar R, Sanjeev K. The easy and early diagnosis of typhoid fever. Journal of Clinical and Diagnostic Research 2012;6(2):198‐9.
Anusha 2011 {published data only}
    1. Anusha R, Ganesh R, Lalitha J. Comparison of a rapid commercial test, Enterocheck WB®, with automated blood culture for diagnosis of typhoid fever. Annals of Tropical Paediatrics 2011;31(3):231‐4.
Begum 2009 {published data only}
    1. Begum Z, Hossain MA, Musa AK, Shamsuzzaman AK, Mahmud MC, Ahsan MM, et al. Comparison between DOT EIA IgM and Widal Test as early diagnosis of typhoid fever. Mymensingh Medical Journal 2009;18(1):13‐7.
Beig 2010 {published data only}
    1. Beig FK, Ahmad F, Ekram M, Shukla I. Typhidot M and Diazo test vis‐à‐vis blood culture and Widal Test in the early diagnosis of typhoid fever in children in a resource poor setting. Brazilian Journal of Infectious Diseases 2010;14(6):589‐93.
Bhutta 1999 {published data only}
    1. Bhutta ZA, Mansurali N. Rapid serologic diagnosis of pediatric typhoid fever in an endemic area: a prospective comparative evaluation of two dot‐enzyme immunoassays and the Widal Test. American Journal of Tropical Medicine and Hygiene 1999;61(4):654‐7.
Dong 2007 {published data only}
    1. Dong B, Galindo CM, Shin E, Acosta CJ, Page AL, Wang M, et al. Optimizing typhoid fever case definitions by combining serological tests in a large population study in Hechi City, China. Epidemiology and Infection 2007;135(6):1014‐20.
Dutta 2006 {published data only}
    1. Dutta S, Sur D, Manna B, Sen B, Deb AK, Deen JL, et al. Evaluation of new‐generation serologic tests for the diagnosis of typhoid fever: data from a community‐based surveillance in Calcutta, India. Diagnostic Microbiology and Infectious Disease 2006;56(4):359‐65.
Fadeel 2011 {published data only}
    1. Fadeel MA, House BL, Wasfy MM, Klena JD, Habashy EE, Said MM, et al. Evaluation of a newly developed ELISA against Widal, TUBEX‐TF and Typhidot for typhoid fever surveillance. Journal of Infection in Developing Countries 2011;5(3):169‐75.
Gasem 2002 {published data only}
    1. Gasem MH, Smits HL, Goris MGA, Dolmans WMV. Evaluation of a simple and rapid dipstick assay for the diagnosis of typhoid fever in Indonesia. Journal of Medical Microbiology 2002;51(2):173‐7.
Gopalakrishnan 2002 {published data only}
    1. Gopalakrishnan V, Sekhar WY, Soo EH, Vinsent RA, Devi S. Typhoid fever in Kuala Lumpur and a comparative evaluation of two commercial diagnostic kits for the detection of antibodies to Salmonella Typhi. Singapore Medical Journal 2002;43(7):354‐8.
Hatta 2002a {published data only}
    1. Hatta M, Goris MGA, Heerkens E, Gooskens J, Smits HL. Simple dipstick assay for the detection of Salmonella Typhi‐specific IgM antibodies and the evolution of the immune response in patients with typhoid fever. American Journal of Tropical Medicine and Hygiene 2002;66(4):416‐21.
Hatta 2002b {published data only}
    1. Hatta M, Mubin H, Abdoel T, Smits HL. Antibody response in typhoid fever in endemic Indonesia and the relevance of serology and culture to diagnosis. South East Asian Journal of Tropical Medicine and Public Health 2002;33(4):742‐51.
Hosamani 2013 {published data only}
    1. Hosamani MA, Patil AB, Nadagir SD, Madhusudhan NS, Sambrani P. Diagnosis of enteric fever by Widal and two dot‐enzyme immunoassays: utility and difficulties. Journal of Pure and Applied Microbiology 2013;7(3):2378‐83.
House 2001 {published data only}
    1. House D, Wain J, Ho VA, Diep TS, Chinh NT, Bay PV, et al. Serology of typhoid fever in an area of endemicity and its relevance to diagnosis. Journal of Clinical Microbiology 2001;39(3):1002‐7.
Islam 2016 {published data only}
    1. Islam K, Sayeed MA, Hossen E, Khanam F, Charles RC, Andrews J, et al. Comparison of the performance of the TPTest, Tubex, Typhidot and Widal immunodiagnostic assays and blood cultures in detecting patients with typhoid fever in Bangladesh, including using a Bayesian latent class modeling approach. PLoS Neglected Tropical Diseases 2016;10(4):e0004558.
Ismail 2002 {published data only}
    1. Ismail TF, Smits H, Wasfy MO, Malone JL, Fadeel MA, Mahoney F. Evaluation of dipstick serologic tests for diagnosis of brucellosis and typhoid fever in Egypt. Journal of Clinical Microbiology 2002;40(9):3509‐11.
Jesudason 2002 {published data only}
    1. Jesudason M, Esther E, Mathai E. Typhidot test to detect IgG and IgM antibodies in typhoid fever. Indian Journal of Medical Research 2002;116:70‐2.
Jesudason 2006 {published data only}
    1. Jesudason MV, Sivakumar S. Prospective evaluation of a rapid diagnostic test Typhidot® for typhoid fever. Indian Journal of Medical Research 2006;123(4):513‐6.
Kawano 2007 {published data only}
    1. Kawano L, Leano SA, Agdamag DMA. Comparison of serological test kits for diagnosis of typhoid fever in the Philippines. Journal of Clinical Microbiology 2007;45(1):246‐7.
Keddy 2011 {published data only}
    1. Keddy KH, Sooka A, Letsoalo ME, Hoyland G, Chaignat CL, Morrissey AB, et al. Sensitivity and specificity of two typhoid fever rapid antibody tests for laboratory diagnosis at two sub‐Saharan African sites. Bulletin of the World Health Organization 2011;89(9):640‐7.
Khan 2002 {published data only}
    1. Khan E, Azam F, Ahmed S, Hassan R. Diagnosis of typhoid fever by Dot Enzyme Immunoassay in an endemic region. Journal of the Pakistan Medical Association 2002;52(9):415‐7.
Khanna 2015 {published data only}
    1. Khanna A, Khanna M, Gill KS. Comparative evaluation of Tubex TF (inhibition magnetic binding immunoassay) for typhoid fever in endemic area. Journal of Clinical and Diagnostic Research 2015;9(11):DC14‐7.
Khoharo 2011 {published data only}
    1. Khoharo HK. A comparative study of the typhidot (Dot‐EIA) and Widal tests in blood culture positive cases of typhoid fever. Tropical Doctor 2011;41(3):136‐8.
Ley 2011 {published data only}
    1. Ley B, Thriemer K, Ame SM, Mtove GM, Seidlein L, Amos B, et al. Assessment and comparative analysis of a rapid diagnostic test (TUBEX®) for the diagnosis of typhoid fever among hospitalized children in rural Tanzania. BMC Infectious Diseases 2011;11:147.
Limpitikul 2014 {published data only}
    1. Limpitikul W, Henpraserttae N, Saksawad R, Laoprasopwattana K. Typhoid outbreak in Songkhla, Thailand 2009–2011: clinical outcomes, susceptibility patterns, and reliability of serology tests. PLoS ONE 2014;9(11):e111768.
Maude 2015 {published data only}
    1. Maude RR, Jong HK, Wijedoru L, Fukushima M, Ghose A, Samad R, et al. The diagnostic accuracy of three rapid diagnostic tests for typhoid fever at Chittagong Medical College Hospital, Chittagong, Bangladesh. Tropical Medicine and International Health 2015;20(10):1376‐84.
Mehmood 2015 {published data only}
    1. Mehmood K, Sundus A, Naqvi IH, Ibrahim MF, Siddique O, Ibrahim NF. Typhidot: a blessing or a menace. Pakistan Journal of Medical Sciences 2015;31(2):439‐43. [DOI: 10.12669/pjms.312.5934]
Moore 2014 {published data only}
    1. Moore CE, Pan‐Ngum W, Wijedoru LPM, Sona S, Nga TVT, Duy PT, et al. Evaluation of the diagnostic accuracy of a typhoid IgM flow assay for the diagnosis of typhoid fever in Cambodian children using a Bayesian latent class model assuming an imperfect gold standard. American Journal of Tropical Medicine and Hygiene 2014;90(1):114‐20. [DOI: 10.4269/ajtmh.13-0384]
Naheed 2008 {published data only}
    1. Naheed A, Ram PK, Brooks WA, Mintz ED, Hossain MA, Parsons MM, et al. Clinical value of TUBEX™ and Typhidot® rapid diagnostic tests for typhoid fever in an urban community clinic in Bangladesh. Diagnostic Microbiology and Infectious Disease 2008;61(4):381‐6.
Olsen 2004 {published data only}
    1. Olsen SJ, Pruckler J, Bibb N, Nguyen TM, Tran MT, Nguyen TM, et al. Evaluation of rapid diagnostic tests for typhoid fever. Journal of Clinical Microbiology 2004;42(5):1885‐9.
Pastoor 2008 {published data only}
    1. Pastoor R, Hatta M, Abdoel TH, Smits HL. Simple, rapid, and affordable point‐of‐care test for the serodiagnosis of typhoid fever. Diagnostic Microbiology and Infectious Disease 2008;61(2):129‐34.
Prasad 2015 {published data only}
    1. Prasad KJ, Oberoi JK, Goel N, Wattal C. Comparative evaluation of two rapid Salmonella‑IgM tests and blood culture in the diagnosis of enteric fever. Indian Journal of Medical Microbiology 2015;33(2):237‐42.
Rahman 2007 {published data only}
    1. Rahman M, Siddique AK, Tam FCH, Sharmin S, Rashid H, Iqbal A, et al. Rapid detection of early typhoid fever in endemic community children by the TUBEX® O9‐antibody test. Diagnostic Microbiology and Infectious DIsease 2007;58(3):275‐81.
Sanjeev 2013 {published data only}
    1. Sanjeev H, Nayak S, Pai Asha KB, Rai R, Karnaker V, Ganesh HR. A systematic evaluation of a rapid DOT‐EIA, blood culture, and Widal Test in the diagnosis of typhoid fever. Nitte University Journal of Health Science 2013;3(1):21‐4.
Siba 2012 {published data only}
    1. Siba V, Horwood PF, Vanuga K, Wapling J, Sehuko R, Siba PM, et al. Evaluation of serological diagnostic tests for typhoid fever in Papua New Guinea using a composite reference standard. Clinical and Vaccine Immunology 2012;19(11):1833‐7.
Tarupiwa 2015 {published data only}
    1. Tarupiwa A, Tapera S, Mtapuri‐Zinyowera S, Gumbo P, Ruhanya V, Gudza‐Mugabe M, et al. Evaluation of TUBEX‐TF and OnSite Typhoid IgG/IgM Combo rapid tests to detect Salmonella enterica serovar Typhi infection during a typhoid outbreak in Harare, Zimbabwe. BioMed Research Notes 2015;8:50.
References to studies excluded from this review Alejandria 2012 {published data only}
    1. Alejandria M, Concepcion AO, Li RJ, Gutierrez J. The sensitivity and specificity of serologis tests in the diagnosis of typhoid fever in adults: a meta‐analysis. International Journal of Infectious Diseases 2012;16(Suppl 1):e393. [DOI: ]
Bakr 2011 {published data only}
    1. Bakr WMK, Aktar LA, Ashour MS, Toukhy AM. The dilemma of Widal Test ‐ which brand to use? A study of four different Widal brands: a cross sectional comparative study. Annals of Clinical Microbiology and Antimicrobials 2011;10:7. [10.1186/1476‐0711‐10‐7]
Banchuin 1987 {published data only}
    1. Banchuin N, Appassakij H, Sarasombath S, Manatsathit S, Rungpitarangsi B, Komolpit P, et al. Detection of Salmonella typhi protein antigen in serum and urine: a value for diagnosis of typhoid fever in an endemic area. Asian Pacific Journal of Allergy and Immunology 1987;5(2):155‐9.
Banerjee 1984 {published data only}
    1. Banerjee V, Mukherjee A. Comparative evaluation of microtitre and tube agglutination technique for serodiagnosis of enteric fever. Journal of Communicable Diseases 1984;16(1):82‐3.
Boomsma 1988 {published data only}
    1. Boomsma LJ. Clinical aspects of typhoid fever in two rural Nigerian hospitals: a prospective study. Tropical and Geographical Medicine 1988;40(2):97‐102.
Cardona‐Castro 2000 {published data only}
    1. Cardona‐Castro N, Gotuzzo E, Rodriguez M, Guerra H. Clinical application of a dot blot test for diagnosis of enteric fever due to Salmonella entrica serovar Typhi is patients with typhoid fever from Colombia and Peru. Clinical and Diagnostic Laboratory Immunology 2000;7(2):312‐3.
Castonguay‐Vanier 2013 {published data only}
    1. Castonguay‐Vanier J, Davong V, Bouthasavong L, Sengdetka D, Simmalavong M, Seupsavith A, et al. Evaluation of a simple blood culture amplification and antigen detection method for diagnosis of Salmonella enterica serovar Typhi bacteraemia. Journal of Clinical Microbiology 2013;51(1):142‐8.
Chaicumpa 1992 {published data only}
    1. Chaicumpa W, Ruangkunaporn Y, Burr D, Chongsa‐Nguan M, Echeverria P. Diagnosis of typhoid fever by detection of Salmonella Typhi antigen in urine. Journal of Clinical Microbiology 1992;30(9):2513‐5.
Chart 2007 {published data only}
    1. Chart H, Cheasty T, Pinna E, Siorvanes L, Wain J, Alam D, et al. Serodiagnosis of Salmonella enterica serovar Typhi and S. enterica serovars Paratyphi A, B and C human infections. Journal of Medical Microbiology 2007;56(Pt 9):1161‐6. [DOI: 10.1099/jmm.0.47197-0]
Chatterjee 1988 {published data only}
    1. Chatterjee PP, Mohan M, Talwar V, Rawat S. Evaluation of co‐agglutination test for diagnosis of typhoid fever in children. Indian Journal of Medical Research 1988;87:157‐60.
Choo 1994 {published data only}
    1. Choo KE, Oppenheimer SJ, Ismail AB, Ong KH. Rapid serodiagnosis of typhoid fever by dot enzyme immunoassay in an endemic area. Clinical Infectious Diseases 1994;19(1):172‐6.
Choo 1997 {published data only}
    1. Choo KE, Davis TME, Ismail A, Ong KH. Longevity of antibody responses to a Salmonella Typhi‐specific outer membrane protein: interpretation of a dot enzyme immunosorbent assay in an area of high typhoid fever endemicity. American Journal of Tropical Medicine and Hygiene 1997;57(6):656‐9.
Chua 2012 {published data only}
    1. Chua AL, Aziah I, Balaram P, Bhuvanendran S, Anthony AAA, Mohmad SN, et al. Identification of carriers among individuals recruited in the Typhoid Registry in Malaysia using stool culture, polymerase chain reaction, and dot enzyme immunoassay as detection tools. Asia Pacific Journal of Public Health 2012;27(2):NP2740‐8. [DOI: 10.1177/1010539512458521; PUBMED: 23000800]
Coovadia 1986 {published data only}
    1. Coovadia YM, Singh V, Bhana RH, Moodley N. Comparison of passive haemagglutination test with Widal agglutination test for serological diagnosis of typhoid fever in an endemic area. Journal of Clinical Pathology 1986;39(6):680‐3.
Das 2013 {published data only}
    1. Das S, Rajendran K, Dutta P, Taha SK, Dutta S. Validation of a new serology‐based dipstick test for rapid diagnosis of typhoid fever. Diagnostic Microbiology and Infectious Disease 2013;76(1):5‐9. [DOI: 10.1016/j.diagmicrobio.2013.01.012]
Dhanalakshmi 1986 {published data only}
    1. Dhanalakshmi D, Mallika M, Kumaravel K, Bhavani M, Lakshminarayana CS. Detection of Salmonella Typhi antigens by slide coagglutination in urine from patients with typhoid fever. Indian Journal of Pathology and Microbiology 1984;27(1):33‐5.
el‐Falaky 1970 {published data only}
    1. el‐Falaky IH, Hassan A, Wahab MF, el‐Kholy S. Diagnosis of Typhoid Fever by Haemagglutination. Journal of the Egyptian Public Health Association 1970;45(1):109‐18.
Fadeel 2004 {published data only}
    1. Fadeel MA, Crump JA, Mahoney FJ, Nakhla IA, Mansour AM, Reyad B, et al. Rapid diagnosis of typhoid fever by enzyme‐linked immunosorbent assay detection of Salmonella serovar Typhi antigens in urine. American Journal of Tropical Medicine and Hygiene 2004;70(3):323‐8.
Felezsko 2004 {published data only}
    1. Feleszko W, Maksymiuk J, Oracz G, Golicka D, Szajewska H. The TUBEX™ typhoid test detects current Salmonella infections. Journal of Immunological Methods 2004;285(1):137‐8. [DOI: 10.1016/j.jim.2003.10.020]
Gorelov 1988 {published data only}
    1. Gorelov AL, Levina GA, Kulyakina MN, Pavlova IP, Shakkanina KL, Prozorovsky SSV. Development and employment of an enzyme immuno‐assay test system for the detection of Salmonella typhi antigens in the blood typhoid fever patient. Laboratornoe Delo 1988;1:79‐83.
Handojo 2004 {published data only}
    1. Handojo I, Edijanto SP, Probohoesodo MY, Mahartini NN. Comparison of the diagnostic value of local Widal slide test with imported Widal slide test. South East Asian Journal of Tropical Medicine and Public Health 2004;35(2):366‐70.
Hoffman 1986 {published data only}
    1. Hoffman SL, Flanigan TP, Klaucke D, Leksana B, Rockhill RC, Punjabi NH, et al. The Widal slide agglutination test: a valuable rapid diagnostic test in typhoid fever patients at the Infectious Disease Hospital of Jakarta. American Journal of Epidemiology 1986;123(5):869‐75.
House 2005 {published data only}
    1. House D, Chinh NT, Diep TS, Parry CM, Wain J, Dougan G, et al. Use of paired serum samples for serodiagnosis of typhoid fever. Journal of Clinical Microbiology 2005;43(9):4889‐90. [DOI: 10.1128/JCM.43.9.4889-4890.2005]
Jackson 1995 {published data only}
    1. Jackson AA, Ismail A, Ibrahim TA, Kader ZS, Nawi NM. Retrospective review of dot enzyme immunoassay test for typhoid fever in an endemic area. South East Asian Journal of Public Health 1995;26(4):625‐30.
John 1984 {published data only}
    1. John TJ, Sivadasan K, Kurien B. Evaluation of passive bacterial agglutination for the diagnosis of typhoid fever. Journal of Clinical Microbiology 1984;20(4):751‐3.
Kalhan 1998 {published data only}
    1. Kalhan R, Kaur I, Singh RP, Gupta HC. Rapid diagnosis of typhoid fever. Indian Journal of Paediatrics 1998;65(4):561‐4.
Kalhan 1999 {published data only}
    1. Kalhan R, Kaur I, Singh RP, Gupta HC. Latext agglutination test (LAT) for the diagnosis of typhoid fever. Indian Journal of Paediatrics 1999;36(1):65‐8.
Kariuki 2004 {published data only}
    1. Kariuki S, Mwituria J, Munyalo A, Revathi G, Onsongo J. Typhoid is over‐reported in Embu and Nairobi, Kenya. African Journal of Health Science 2004;11(3‐4):103‐10.
Kaur 1988a {published data only}
    1. Kaur IR, Talwar V, Gupta HC, Rawat S. Comparative evaluation of latex agglutination (LAT) and coagglutination (COAG) tests for rapid diagnosis of typhoid fever. Journal of Communicable Diseases 1998;20(4):344‐8. [PUBMED: 3268601]
Kaur 1988b {published data only}
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Khanam 2013 {published data only}
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