Original Research Article 169 | Page Int J Med Res Prof.2016; 2(3); 169-73. www.ijmrp.com Determination of Significant Baseline Widal Titre amongst Health Personnel & General Population of Ajmer City Laxman Ram Mohanpuria 1 , Priyam Sharma 2 , Prateek Kamble 1 , Mohit Sharma 3* , Geeta Parihar 4 , Mahima Sharma 5 1 Senior Resident, 2 M.Sc. (Microbiology), 4 Professor and Head, Department of Microbiology, 3* Assistant Professor, Department of Cardio-Vascular and thoracic surgery, J.L.N. Medical College, Ajmer, Rajasthan, India. 5 Senior Demonstrator, Department of Physiology, R.U.H.S. Medical College, Jaipur, Rajasthan, India. ABSTRACT Background: Enteric Fever is the most infectious disease on global scale and endemic in all parts of India. In a developing country like India laboratory diagnosis of enteric fever relies heavily on serological tests such as widal test. Knowledge of prevalent endemic titre in a region needs to be periodically updated to interpret the significance of the titre as to patient is indeed suffering from enteric fever or not. The present study has been undertaken to evaluate the baseline antibody titre for O, H antigens of Salmonella Enterica, serovar Typhi and AH, BH antigen of Salmonella Enterica, serovar Paratyphi among health personnel and general adult population of Ajmer (Rajasthan). Aim and objectives: To evaluate the significant endemic baseline titre of Ajmer city using quantitative Widal test to suggest the cut off value for interpreting a positive widal test. To compare the endemic baseline titre amongst the Health care providers and General Population. Material and methods: A total number of 600 healthy volunteers and 200 medical personnel working in Jawahar Lal Nehru Medical College, Ajmer were screened during period of study from 1 st April 2014 to 31 st December 2015. Non repetitive samples were collected from healthy adults aged 18 year to 70 year. Results and conclusions: Out of 600 screened samples for healthy volunteers 61% were males and 39% were females. The frequency of positive results was 43.67%. The agglutinins to S. Typhi were the most prevalent among the sera of various dilutions (33.16% for 'O' antigen and 43.33% for 'H' antigen) which was tested. The levels of agglutinins for Salmonella paratyphi AH and paratyphi BH were low (only 1.16% for AH and 1.83% for BH antigen respectively).Out of 200 samples of health personnel screened 69% were males and 31% were females. The frequency of positive results was 45.5%. The agglutinins to S. Typhi were the most prevalent among the sera of various dilutions (33.16% for 'O' antigen and 44.5% for 'H' antigen) which were tested. The levels of agglutinins for Salmonella paratyphi AH and paratyphi BH were low (only 4.0% for AH and 1.5% for BH antigen respectively). Based on the above results, it has been recommended that cut-off titre of 1:80 for anti-O antibodies and of 1:120 for the anti-H antibodies may be considered as diagnostic for enteric fever in Ajmer region of Rajasthan, India. Keywords: Enteric fever, Salmonella, Widal titre. *Correspondence to: Dr. Mohit Sharma, Department of Cardio-Vascular and thoracic surgery, J.L.N. Medical College, Ajmer, Rajasthan, India. Email: aries.mohit@gmail.com Article History: Received: 21-04-2016, Revised: 27-04-2016, Accepted: 30-05-2016 Access this article online Website: www.ijmrp.com Quick Response code DOI: 10.21276/ijmrp.2016.2.3.037 INTRODUCTION Enteric Fever is one of the most infectious diseases on a global scale and endemic in all parts of India. Typhoid fever has important socio-economic impact because, most of the time, several months are necessary for a patient to recover and be able to work again. So accurate diagnosis of typhoid fever at an early stage is important not only for etiological diagnosis, but also to identify individuals that may serve as a potential carrier, who may be responsible for acute typhoid fever outbreaks. In India the disease is endemic with an incidence which ranges from 102 -2219 /100,000 population. 1 Hospital based studies and outbreak reports from India indicates that occurrence rate of enteric fever has risen sharply in recent years. 2 Enteric fever is endemic in developing countries like India and it continues to be one of the major public health problems. 3 Widal test is an alternative to the Microbial culture, which is commonly used for the diagnosis of enteric fever ever since its introduction 100 years back. 4 In the endemic areas, the healthy people may contain antibodies which are capable or reacting up to a variable titre in the Widal test, due to a past exposure, TAB vaccination and cross reacting antigens. Therefore it varies widely from place to place and is referred to as the baseline titre of that area. The isolation of the organism from blood, bone marrow or stool is required to confirm the diagnosis. 5-7 Although the isolation of Salmonella Typhi on blood culture remains the gold standard for diagnosis of typhoid fever, it is time consuming, requires elaborate laboratory equipment and a level of technical expertise which may not be present in resource-poor laboratories. Even under the best conditions, there may be failure to isolate the organism, especially after antimicrobial treatment has been started. Culture of bone marrow is more sensitive, but the procedure is invasive, stool cultures are positive in only 30% of patients with the acute illness. 7,8