Clinical characteristics of enteric fever and performance of TUBEX TF IgM test in Indonesian hospitals.

Autor: Nurmawati S; Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia.; Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia., Alam A; Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia.; Pediatric Department, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin Hospital, Bandung, Indonesia., Djauhari H; Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia.; Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia., Merati TP; Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia.; Faculty of Medicine, Udayana University, Denpasar, Indonesia., Sudarmono P; Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia.; Faculty of Medicine, Universitas Indonesia, Central Jakarta, Indonesia., Setiawaty V; Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia.; Prof. Dr. Sulianti Saroso Infectious Disease Hospital, North Jakarta, Indonesia., Arlinda D; Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia.; Health Policy Agency, Ministry of Heath, Central Jakarta, Indonesia., Sugiyono RI; Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia.; Health Policy Agency, Ministry of Heath, Central Jakarta, Indonesia., Arief M; Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia.; Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia., Hadi U; Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia.; Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Academic Hospital, Surabaya, Indonesia., Aman AT; Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia.; Dr. Sardjito General Hospital/Faculty of Medicine, Universitas Gadjah Mada, Sleman, Indonesia., Lokida D; Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia.; Tangerang General Hospital, Tangerang, Indonesia., Gasem MH; Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia.; Dr. Kariadi General Hospital/Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia., Tjitra E; Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia.; Health Policy Agency, Ministry of Heath, Central Jakarta, Indonesia., Liang CJ; Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia.; National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland, United States of America., Neal A; Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia.; National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland, United States of America., Kosasih H; Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia., Karyana M; Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia.; Health Policy Agency, Ministry of Heath, Central Jakarta, Indonesia., Lau CY; Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia.; National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland, United States of America., Alisjahbana B; Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia.; Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia.; Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin Hospital, Bandung, Indonesia.
Jazyk: angličtina
Zdroj: PLoS neglected tropical diseases [PLoS Negl Trop Dis] 2024 Jul 25; Vol. 18 (7), pp. e0011848. Date of Electronic Publication: 2024 Jul 25 (Print Publication: 2024).
DOI: 10.1371/journal.pntd.0011848
Abstrakt: Background: Accurate diagnosis of enteric fever is challenging, particularly in low- and middle-income countries, due to the overlap of clinical and laboratory features with other pathogens. To better understand the difficulties in enteric fever diagnosis, we evaluated the characteristics of patients clinically diagnosed with enteric fever and the real-world performance of TUBEX TF, one of the most used tests in Indonesia.
Methodology/principal Findings: Patients were recruited through the AFIRE (Etiology of Acute Febrile Illness Requiring Hospitalization) study at eight Indonesian hospitals. Blood culture was performed for all patients, and TUBEX TF was performed for suspected enteric cases. Salmonella PCR and ELISA tests were performed at a reference lab. Sensitivity and specificity of TUBEX TF and IgM and IgG anti-S. Typhi ELISA were determined. Of 301 patients clinically diagnosed with enteric fever, 50 (16.6%) were confirmed by blood culture and/or PCR. Confirmed cases were mostly school-aged children presenting with fever, anorexia, dizziness and/or abdominal pain with normal leukocyte count or leukopenia. TUBEX TF demonstrated a sensitivity of 97.6% to 70.7% and specificity of 38.3% to 67.2% at cutoffs of 4 and 6, respectively. Acute IgG demonstrated the best sensitivity and specificity, at 90.7% and 82.7%, respectively, and the best ROC characteristics.
Conclusions/significance: A substantial proportion of enteric fever was misdiagnosed at all study hospitals, likely due to the overlap of clinical characteristics and lab parameters with those of other common pathogens. The TUBEX TF rapid serological assay demonstrated suboptimal performance in our setting and tended to over-diagnose enteric fever. The role of IgG from acute specimens for identification of enteric fever cases merits additional consideration.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)
Databáze: MEDLINE
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