Rapid diagnosis of typhoid fever by co-agglutination in an Indian hospital

Detection of Salmonella typhi infection by a co-agglutination assay for specific O, H and Vi antigens and by blood culture were compared for 110 patients with suspected typhoid fever. Blood cultures were positive for S. typhi in 25.5% of patients. Co-agglutination tests with patients’ serum and with blood culture supernates gave positive results in 70.9% and 67.3% of cases respectively. S. typhi antigens Hd and O9 were detected in patients’ serum by co-agglutination in 96.4% of blood culture-positive, and 62.2% of blood culture-negative patients. Co-agglutination results were uniformly negative with serum samples from a control group of 50 healthy individuals, 20 patients with febrile non-typhoid infectious disease and 20 patients with non-infectious febrile disease. Of the 25 patients with suspected typhoid fever who had not received prior antibiotic treatment, 88% yielded positive blood cultures and 96% gave positive results in serum co-agglutination tests. By contrast, of the 85 patients who had received prior antibiotics, only 7% yielded positive blood cultures, but 63.5% gave positive results in serum co-agglutination tests. Co-agglutination tests with serum offer a simple, rapid, sensitive, specific and economical method for the early diagnosis of typhoid fever.