In 1896 and named after its inventor, Georges-Fernand Widal, is an indirect agglutination test for enteric fever or undulant fever whereby bacteria causing typhoid fever is mixed with a serum containing specific antibodies obtained from an infected individual. In cases of Salmonella infection, it is a demonstration of the presence of O-soma false-positive result. Test results need to be interpreted carefully to account for any history of enteric fever, typhoid vaccination, and the general level of antibodies in the populations in endemic areas of the world. Typhidot is the other test used to ascertain the diagnosis of typhoid fever. As with all serological tests, the rise in antibodylevels needed to perform the diagnosis takes 7-14 days, which limits its applicability in early diagnosis. Other means of diagnosing Salmonella typhi include cultures of blood, urine and faeces. These organisms produce H2S from thiosulfate and can be identified easily on differential media such as bismuth sulfite agar. 2-mercaptoethanol is often added to the Widal test. This agent more easily denatures the IgMclass of antibodies, so if a decrease in the titer is seen after using this agent, it means that the contribution of IgM has been removed leaving the IgG component. This differentiation of antibody classes is important as it allows for the distinction of a recent from an old infection. The Widal test is positive if TO antigen titer is more than 1:160 in an active infection, or if TH antigen titer is more than 1:160 in past infection or in immunized persons. A single Widal test is of little clinical relevance due to the high number of cross-reacting infections, including malaria. If no other tests are available, a fourfold increase in the titer in the course of the infection, or a conversion from an IgM reaction to an IgG reaction of at least the same titer, would be consistent with a typhoid infection. A new serological test called the Tubex test is neither superior nor better performing than the Widal test. Therefore, Tubex test is not recommended for diagnosis of typhoid fever.
