Clinical and Laboratory Findings Including the Diagnostic Value of the Widal Test in Pediatric Cases of Typhoid Fever in Tehran

Background and Objective: The diagnosis of typhoid fever in children is a challenge due to the non-specific clinical picture. The current role of the Widal test for diagnosis in developing countries has not been clear. Materials and Methods: Charts were reviewed on all children ? 15 years of age discharged from 5 pediatric teaching hospitals in Tehran from 1991 to 2004 with a diagnosis of typhoid fever. The Widal test was performed on 58 children with confirmed and 40 children with probable typhoid fever and as control groups, 40 febrile children admitted with infections other than typhoid fever, and 40 afebrile children admitted for elective surgery. Results: For the confirmed cases of typhoid fever, 33 (57%) were male and the mean age was 7.5 ± 3.5 years. Fever was present in 56 cases (97%) and the mean duration of fever before admission was 14 ± 8 days. Other symptoms included tachycardia (60%), anorexia (60%), vomiting (60%), diarrhea (57%), abdominal pain (48%), and headache (34%). Hepatomegaly was present in 55% of cases, splenomegaly in 44%, and Rose spots in 14% of them. Positive cultures were from blood (45/58), stool (18/58), and bone marrow (12/17) with 4 cases having only positive bone marrow cultures. Positive titers of at least 1:40 for anti “O” and/or anti “H” agglutinins were found in 78% of confirmed cases, 65% of possible cases, 12.5% of febrile controls, and no afebrile controls. Conclusion: The Widal test remains a useful test for diagnosis of typhoid fever in developing countries where blood cultures may not be available or may be negative because of prior antibiotic therapy. A titer of at least 1:40 for anti “O” and/or anti “H” agglutinin should be considered a positive titer in Iranian children.