Ohanu M E, Mbah A U, Okonkwo P O, Nwagbo F S
Department of Medical Microbiology, University of Nigeria Teaching Hospital, Enugu.
West Afr J Med. 2003 Sep;22(3):250-2. doi: 10.4314/wajm.v22i3.27961.
A total of 270 febrile patients (130 males and 140 females) aged between 15 and 59 were screened using thick and thin blood film stains for malaria, bacteriologic culture and Widal test for enteric fevers. Sixty (22%) were positive for malaria while 38 (14%) were positive for enteric fevers out of which 16 (26.6%) concomitantly had malaria parasite. Cases without malaria parasite (MP) or enteric fever organism were 172 (63.7%) and classified as pyrexia of unknown origin (PUO). Forty-four were strictly malaria cases out of which 36 (82%) were due to Plasmodium falciparum, and all had antibody Widal titres > or = 160 to 0 antigen while 4 (9%) were due to Plasmodium malariae, 3 (6.8%) were due to P. ovale and 1 (2.3%) was due to P. vivax. Twenty (52.6%) of the 38 patients with enteric fever had typhoid, all had Widal titres > or = 160 to 0 antigen. In all, antibody reaction Widal titres to H antigen were < 20. There was no statistical significant difference [chi2 = 327.2, P > 0.05] between Widal titres of malaria and typhoid cases. Hence using Widal test alone, one cannot differentiate typhoid fever from malaria. In another 250 healthy adults, of equal sex distribution, used as controls 12 (4.8%) had malaria parasite and 4 (1.6%) had enteric fever organisms. While only 4 (1.6%) gave Widal titre of 80 to 0 antigen the rest had antibody titres of < 20 to O antigen. Malaria could interfere with serological diagnosis of typhoid and hence lead to over diagnosis of typhoid in Nigeria.
对270名年龄在15至59岁之间的发热患者（130名男性和140名女性）进行了筛查，采用厚血膜和薄血膜染色法检测疟疾，采用细菌培养和肥达试验检测肠热病。60人（22%）疟疾检测呈阳性，38人（14%）肠热病检测呈阳性，其中16人（26.6%）同时感染疟原虫。未感染疟原虫（MP）或肠热病病原体的病例有172例（63.7%），被归类为不明原因发热（PUO）。44例为单纯疟疾病例，其中36例（82%）由恶性疟原虫引起，所有患者对0抗原的肥达抗体效价≥160，4例（9%）由三日疟原虫引起，3例（6.8%）由卵形疟原虫引起，1例（2.3%）由间日疟原虫引起。38例肠热病患者中有20例（52.6%）患伤寒，所有患者对0抗原的肥达抗体效价≥160。总体而言，对H抗原的肥达抗体反应效价<20。疟疾和伤寒病例的肥达抗体效价之间无统计学显著差异[χ2 = 327.2，P>0.05]。因此，仅使用肥达试验无法区分伤寒热和疟疾。在另外250名健康成年人（性别分布均等）作为对照中，12人（4.8%）感染疟原虫，4人（1.6%）感染肠热病病原体。只有4人（1.6%）对0抗原的肥达抗体效价为80，其余患者对O抗原的抗体效价<20。疟疾可能会干扰伤寒的血清学诊断，从而导致尼日利亚伤寒的过度诊断。
