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Background  Serodiagnosis of typhoid fever by Widal test based on demonstrating the presence of agglutinins (antibodies) in the serum of an infected patient, against the H (flagellar) and O (somatic) antigens of  Salmonella enterica  serotype Typhi has been associated with many debates. This is why the aim of this study was to: (i) Compare the diagnostic accuracy of four different commercial kits used to perform Widal test (Remel, BioSystems, Dialab and Biotec). (ii) Compare the sensitivity and specificity of both anti-O and anti-H antibodies. (iii) Compare the validity of single versus paired serum samples with a rising titer for the diagnosis of typhoid fever.    Methods  Duplicate serum samples were obtained from150 patients clinically diagnosed as typhoid fever patients. Moreover, single serum samples were obtained from 25 patients with febrile diseases other than typhoid fever. All samples were tested using the four different Widal brands and  Salmonella  Typhi IgM anti-LPS ELISA    Results   - The results of Widal tests differed markedly using the four Widal brands in terms of sensitivity and specificity at three cut-off values of 1/80, 1/160 and 1/320. Remel brand gave the highest sensitivities and the lowest specificities and Dialab brand gave the highest specificities and the lowest sensitivities for both anti-O and anti-H antibodies at the three cut-off values.   - Four fold rise in the antibodies titer was not demonstrable among clinically diagnosed typhoid fever patients  -H agglutinins were less sensitive and less specific than O agglutinins    Conclusions  -Widal test results showed marked discrepancies using different Widal brands. None of the serum samples of the typhoid fever patients showed four fold rise in the antibody titers. Raised O agglutinins were of slightly greater diagnostic value than raised H agglutinins.    Significance and impact of study  Widal test done sequentially using two brands could be of value in typhoid fever diagnosis. Single serum sample could be used for typhoid fever diagnosis relying on anti O titer.

The dilemma of widal test - which brand to use? a study of four different widal brands: a cross sectional comparative study