How Useful is the Widal Test in Modern Clinical Practice in Developing Countries? A Review

Abstract

Background: It has been over a century since the Widal test was developed for diagnosing typhoid fever. Yet, the test remains the major means of diagnosing the disease in many of the developing countries where it remains endemic. This review appraises the Widal test in regard to its performance techniques, its various drawbacks and the available alternative diagnostics methods. Methods: The study was a non-systematic review. A literature search was conducted for relevant original and review articles primarily in MEDLINE database through PubMed. Relevant references in the articles at hand were searched manually with Google search engine. Related articles during the manual search were also reviewed. Inclusion criteria were the date of publication from 2,000 to 2017, original research conducted on human subjects and publication in the English Language. All articles that did not meet these criteria were excluded. Results: The Widal test is a relatively cheap and readily available test in developing countries where more sophisticated tests like culture and polymerase chain reaction are either not available or unaffordable where available. It is, however, difficult to interpret the result because of various reasons that may cause either a false positive or a false negative result. Although several alternative rapid diagnostic tests are now available, there is still no sufficiently reliable one that can replace the traditional diagnostic gold standard, which is culture isolation of the organism. Conclusion: The Widal test is grossly inadequate to be relied upon as a diagnostic tool for typhoid fever in an endemic area, culture isolation of the causative organism remains the gold standard for diagnosing the disease, and the quest to develop highly effective rapid diagnostic tests for the disease should continue.