Comparative evaluation of various tests for diagnosis of concurrent malaria and typhoid Fever in a tertiary care hospital of northern India.

[typhoid]

Malaria and Typhoid are two major infectious diseases , still prevalent in most of the tropical countries including India . Millions of individuals residing in these endemic cases contact these diseases either concurrently or as acute infection superimposed on a chronic one .Diagnosis and comparative evaluation of various tests for diagnosis of Typhoid - Malaria co -infection in patients suffering from febrile illness .Around 800 patients of both Out Patient Department (OPD ) and In Patient Department (IPD ) were referred to microbiology lab for Widal test / Typhi dot IgG /IgM and Malaria card test between July 2012 - September 2012 . Patients found to be suffering from co -infection were further confirmed for typhoid by blood culture . Those patients who were found sterile on blood culture were further confirmed by stool culture . Patients positive by Malaria card test (either antibody or antigen or both ) were confirmed by peripheral blood smear examination for malaria parasite by both thick and thin smear examination .68 (8 .5 %) patients were found to be suffering from co - infection by the above tests . Blood culture revealed 15 (22 %) bacterial pathogens in the widal positive patients out of which 6 (8 .8 %) were Salmonella Typhi and 3 (4 .41 %) were Salmonella Paratyphi A . Stool culture revealed 8 (11 .7 %) S .Typhi and 5 (7 .35 %) S . Paratyphi A cases . Out of 68 patients positive by Malaria card test , only 36 (52 .94 %) showed Malaria parasite in peripheral blood smear also . Thus the no . of confirmed cases of co -infection was found to be only 1 .6 %.The interpretation of Widal test and Malaria card test , when diagnosing concurrent malaria and typhoid fever , must therefore be done with a lot of caution . Negative or positive Widal agglutination test is neither definitive nor completely informative . Similarly erroneous interpretation of Malaria card test (especially Antibody detection card test ) result may lead to prolonged treatment and economic burden on patient .