Diagnosis of typhoid fever in Nigeria: misuse of the Widal test

Abstract
In the last 2 years, there has been public panic across Nigeria about an epidemic of a ‘killer’ febrile disease, purportedly typhoid fever. The evidence for this epidemic is reviewed in the light of appropriate diagnosis of typhoid fever. All the patients were diagnosed as typhoid fever, primarily based on Widal test results. Investigations in the hospital of 15 patients confirmed malaria in 70% who, though failing to respond to chloroquine, promptly responded to treatment with Fansidar® (sulfadoxine + pyrimethamine). Fever in the remaining 30%, without evidence of malaria and who failed to respond to chloroquine, Fansidar® and antibacterials including chloramphenicol, remitted spontaneously. The merits and limitations of the Widal test are discussed. It is concluded dial diagnosis of typhoid fever by the Widal test alone is prone to error, and that any claims of a typhoid fever epidemic in Nigeria remain mere conjecture. Misuse of the Widal test and, subsequently, misuse of the antibiotic chloramphenicol, should be very strongly condemned.

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