Review of Rapid Diagnostic Tests vs. Culture Method for Detection of Salmonella Typhi among Febrile Patients in Urban Health Centers

Abstract

Typhoid fever remains a major public health problem in many low- and middle-income countries, particularly in urban communities where poor sanitation, overcrowding, and inadequate access to safe drinking water promote the transmission of Salmonella Typhi. Accurate and timely diagnosis is essential for effective patient management, appropriate antimicrobial therapy, and the control of antimicrobial resistance. Although blood culture is widely recognized as the reference standard for laboratory confirmation of typhoid fever, its routine application is constrained by prolonged turnaround time, specialized laboratory requirements, and reduced sensitivity following prior antibiotic use. Consequently, several rapid diagnostic tests (RDTs), including the Widal test, Typhidot, TUBEX TF, and other immunochromatographic assays, have been developed to facilitate early diagnosis, particularly in resource-limited healthcare settings. This review critically evaluates published studies comparing the diagnostic performance of rapid diagnostic tests with blood culture among febrile patients in urban health centers. Evidence from systematic reviews, meta-analyses, and comparative clinical studies indicates that while RDTs offer significant advantages in terms of speed, simplicity, and accessibility, their diagnostic accuracy varies considerably across different populations and endemic settings. Typhidot generally demonstrates higher sensitivity, whereas TUBEX TF provides comparatively better specificity. However, neither test consistently achieves sufficient diagnostic performance to replace blood culture as the definitive confirmatory method. The review further highlights the limitations associated with the Widal test, including poor specificity and cross-reactivity in endemic regions. Overall, the available evidence supports the use of rapid diagnostic tests as valuable screening tools while emphasizing the continued importance of blood culture for definitive diagnosis and antimicrobial susceptibility testing. The review also identifies important research gaps regarding the evaluation of RDT performance in urban primary healthcare facilities in Nigeria and other sub-Saharan African countries, where locally generated evidence remains limited. Future studies are recommended to establish context-specific diagnostic algorithms that combine rapid testing with confirmatory culture to improve clinical decision-making and patient outcomes.