Evaluation of PCR detection of S. typhi DNA in the diagnosis of clinically suspected Typhoid fever

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Diagnosis and SurveiLLance

1998

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Bvaluation of PCR detection of S. Aphi DNA
in the diagnosis of clinically suspected Tlphoid fever

155

D1-1

A.B. Deyt, Rama Chaudry2, Maya Gopinatht, D.S. Chandel2, B.V. Laxmi2

Abstrak
Demam tifo.id merupakan masalah penting bagi kesehatan masyarakat cli negara-negara berkembang. SuatL. kontrol yang efektif

memerlukan deteksi knsus, pengobatan definitif dan eliminasi surnber infeksi sertn perbaikan sistem kesehatan masyarakat. Inporan
karus yang mentadai sering tak dapat tlilakukan karena adanya pengobatan empiris tlengan antibiotika nrcnurunknn sensitifitas dari
hasil isolasi serta kurangnya spesifitas tlari pemeriksaan serologis di daerah erclemis. Kemampuan dari berbagai penteriksaan, tennasuk
biakan darah, tes Widal dan reaksi berantai polimerasa (PCR) untuk deteksi Salmonella typhi dalant usaln tlktgnosis demant tifoid tel.ah
tlievaluasi pada 60 penderita tersangkn dennrn enterik. EnampuLuh persen pentlerita telah mendapat pengobatan antibiotika secara
empirik sebelurn dilakukan pemeriksaan. Tujuhbelas penderila didiagnosis sebagai demam tifuid dan lùna lainnya sebagai demam paralifoid. Tigapuluh satu kttstts tak dapat didiagnosis dengan cara penteriksaan mikrobiologi, sedangkan tujuh penderin Ininnl,a msnderita berbagai penyakit menular yang lain. Diagnosis demam tifoirt ditegakkctn secara biakan tlarahs, tes Witlaltt dan pemeriksaan
PCRI . Lima dari tujuh pendeita dengan hasil PCR positif, n.egatif secara biaknn; sedangl40IU/dl)
(>80 tu/dl)
Raised

AST

(7o)

t5 (2s)
28 (46.7)
3
Vo)

(>40IU/dl)

(>80 ru/dr)

1

(5)

(

1.66)

52 (86.7)
28 (46.'t)
53 (88.3)
26 (43.3)

Vomiting

l0

Bradycardia

Splenomegaly
Hepatomegaly
Abdominal tenderness
Chest signs
Lymphadenopathy

43

Albuminuria (>++)

10

54

Urine sediments (RBC, WBC)
Abnormal chest x-ray
(miliary mottling)

T2

(16.7)
(20)

I

3.3)

Signs

( 71.7)
( e0)
2l ( 35)
19 ( 3r.7)
I

1

2

(

(

r8.3)
3.3)

(

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Diagnosis and Surveillance

1998

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positive blood culture for S. typhi
2. a titre of 2 1:160 for O and H agglutinins on first
test or four fold rise in O and H agglutinin titres
on paired samples
PCR ampli
-1. derironstratiorrof S. rypht DNA after
fication.

Escherichia coli in one, Klebsiella species in one and
Enterococcu.s in one. None of these cases had received pre-investigation antibiotic therapy. Plasmodiumviiax was detected in peripheral blood smear in

RESULTS

where as all the five cases with septicaemia had nondiagnostic rise in O and H agglutinins.

1.

Clinical manifestation

Detection of S. typhi DNA by PCR amplification

S. typhi DNA could be detected in blood samples of
None of the blood samples from controls
,"u-"n
"u."t.
were

blood
had a
them
nins on paired serology. All the cases with septicemic
illness other than typhoid were PCR negative'

manifestations of these patients are presented in Ta-

ble

1.

The diagnosis arrived after the investigations are presented in tubl" 3. It was observed that nine of the

Microbiological Profile
O and H agal test at the
out in 37 Pas of tYPhoid,
non-enteric
with
cases
7
and
paratyphoid
5 cases of
fever was
enteric
of
diagnosis
a
in
whom
illnesses)
for
treated

getting
while
week
one
after
considered
more
or
fold
four
a
showed
cases
two
Only
the same.
rise in titres of O and H agglutinins over their previous titres fulfilling the criteria for diagnosis for typhoid fever. Thus 13 cases in all had a positive Widal
iest. Results of Widal test in cases and controls are
presented in Table 2.

In l3

Table

3.

fever

Results of

widal

test in câses

Cases
H titre