National Institute for Biomedical Research, Kinshasa, the Democratic Republic of the Congo.
Trans R Soc Trop Med Hyg. 2012 Jun;106(6):348-55. doi: 10.1016/j.trstmh.2012.03.006. Epub 2012 May 1.
The diagnosis of typhoid fever (TF) in Kinshasa (DR Congo) was assessed by on-site surveys, external quality assessment (EQA) of the Widal test and a microbiological blood culture surveillance study. In 331/536 (61.8%) health facilities, clinicians diagnosed TF by clinical picture and the Widal test. An EQA on the Widal test consisting of three samples revealed correct scores by respectively 27.1%, 65.6% and 3.1% of 125 participating laboratories. Most (80.9% of 152 laboratories) performed <100 Widal tests per month, with a median sample positivity rate of 32.6% (range 0-90.7%). The Widal test was mostly performed on a single sample and by slide agglutination (89.5% and 97.0% respectively); errors in cold chain and procedures were recorded (not making serial dilutions, estimating titres by the intensity of agglutination). Among 293 prescribers, 52.2% and 40.8% requested the Widal test for treatment follow-up and detection of chronic carriers respectively. Salmonella Typhi was recovered from the blood in 2.4% of 3820 patients suspected as having TF, with non-typhoid Salmonellae and other Enterobacteriaceae accounting for the majority of organisms. In conclusion, clinicians rely highly on the Widal test for the diagnosis of TF and the Widal test is poorly performed and interpreted.
在金沙萨（刚果民主共和国）进行了现场调查、外源性质量评估（EQA）的伤寒血清学检测和微生物血培养监测研究，以评估伤寒（TF）的诊断。在 536 家卫生机构中的 331 家（61.8%），临床医生根据临床症状和伤寒血清学检测诊断 TF。伤寒血清学检测的 EQA 由三个样本组成，125 家参与实验室的正确率分别为 27.1%、65.6%和 3.1%。大多数实验室（152 家实验室中的 80.9%）每月进行的伤寒血清学检测<100 次，中位数样本阳性率为 32.6%（范围 0-90.7%）。伤寒血清学检测主要进行单次样本和玻片凝集检测（分别为 89.5%和 97.0%）；冷链和操作程序中存在错误（未进行连续稀释，通过凝集强度估计效价）。在 293 名开处方者中，52.2%和 40.8%分别为了治疗随访和慢性携带者的检测要求进行伤寒血清学检测。在怀疑患有 TF 的 3820 名患者中，仅 2.4%从血液中分离到伤寒沙门氏菌，而非伤寒沙门氏菌和其他肠杆菌科细菌占大多数。总之，临床医生高度依赖伤寒血清学检测来诊断 TF，且伤寒血清学检测的表现和解释都较差。
