Role of Serology in Confirming Enteric Fever: A Study at Specialist Hospital Gusau, North West Nigeria

Serological testing for enteric fever remains a common but diagnostically imprecise practice in Nigerian clinical settings, reflecting the limited availability of blood culture infrastructure. This study evaluated the role of serological testing in the confirmation of enteric fever among febrile patients at Specialist Hospital Gusau, Zamfara State, North West Nigeria. A cross-sectional comparative study was conducted among 240 febrile patients with clinical suspicion of enteric fever. Widal tube agglutination test, Typhidot IgM ELISA, and blood culture were performed simultaneously on all participants. Diagnostic accuracy measures of sensitivity, specificity, and likelihood ratios were calculated with blood culture as the reference standard. Blood culture confirmed Salmonella Typhi in 17.5% of patients. Widal test at titre 1:160 showed sensitivity of 73.8% and specificity of 52.4%. Typhidot IgM demonstrated higher sensitivity at 81.0% and specificity of 74.6%. Combination of Typhidot and blood culture improved overall diagnostic yield. Prior antibiotic use significantly reduced blood culture sensitivity. False-positive Widal rates were highest in patients from areas with prior malaria and brucellosis exposure, suggesting non-specific cross-reactivity. The study confirms the limited diagnostic reliability of the Widal test and recommends phased introduction of Typhidot IgM ELISA as a more reliable adjunct to blood culture, alongside capacity building for blood culture infrastructure at specialist hospitals in North West Nigeria. Keywords: enteric fever, Widal test, Typhidot, blood culture, serological diagnosis