Application of Real-Time PCR in Rapid Diagnosis of Typhoid Fever in Primary Healthcare Settings in Kogi State

Typhoid fever caused by Salmonella Typhi remains a major public health problem in resource-limited settings across Nigeria, where blood culture, the gold standard diagnostic method, is unavailable in most primary healthcare centers (PHCs). This study evaluated the application of real-time PCR as a rapid diagnostic tool for typhoid fever in PHC settings in Kogi State, North Central Nigeria. Blood samples were collected from 200 febrile patients presenting to three PHCs with clinical features consistent with enteric fever. Salmonella Typhi was detected using a real-time PCR targeting the flagellin (fliC) gene, with concurrent blood culture performed for comparative evaluation. Sensitivity, specificity, positive and negative predictive values were calculated. Real-time PCR demonstrated superior sensitivity (92.3%) compared to blood culture (61.5%) in confirmed typhoid cases. A statistically significant reduction in diagnosis time was achieved with PCR (4 hours) versus culture (5-7 days). Antimicrobial resistance profiling of culture-confirmed isolates revealed 48% resistance to nalidixic acid, indicative of reduced fluoroquinolone susceptibility. The study establishes that real-time PCR platforms can be feasibly deployed at PHC level in North Central Nigeria given appropriate cold chain and power infrastructure investment. Keywords: typhoid fever, real-time PCR, Salmonella Typhi, primary healthcare, Kogi State.