ANTIBODY TITRE LEVELS TO FEBRILE ANTIGENS OF SALMONELLA SPECIES AMONG STUDENTS OF MICHAEL OKPARA UNIVERSITY OF AGRICULTURE, UMUDIKE

ABSTRACT

The prevalence of typhoid fever caused by Salmonella typhi and Salmonella paratyphi respectively have increasingly affected Nigerian students causing a shift in their healthy living, using students of Michael Okpara University of Agriculture, Umudike as a case study. This study is carried out to determine antibody titre levels to febrile antigens of Salmonella species among students of Michael Okpara University of Agriculture, Umudike at Umuahia, Abia state. The analysis was carried out with random blood samples of 50 students of Michael Okpara University in which the age and sex distribution of study respondents was determined with the help of questionnaire which contributed immensely for the information needed towards the success of this project. After the collection of data with the questionnaire from the same students that volunteered their blood for the success of the test(s), the age range of the respondents (i.e. Students) was between 20 to 28years of age, number of male students tested was 26 while total number of female students tested was 24. Then after proper laboratory investigations, using standard laboratory procedure; based on slide agglutination test, the total number of percentage of students with S.typhi was 20, and total number of students with S.paratyphi A, B, and C was 5.Based on tube agglutination test, the titre levels of agglutination of S.typhi and S.paratyphi A, B, and C under the somatic (O) and flagella (H) antigen(s) which was less than 1:80, equal to 1:80 and greater than 1:80 was 25 and 30 respectively. Then based on Widal agglutination test, the blood samples from the female students recorded higher titre values compared to that of the males’ which is as a result of poor personal and general hygiene practices by the females in their hostels and consumption of food and water contaminated with the pathogen via fecal to oral contact.

TABLE OF CONTENTS

Title Page    i

Certification ii

Dedication iii

Acknowledgement iv

Table of Contents v

List of Tables vii

Abstract viii

CHAPTER ONE

1.0 INTRODUCTION

1.1 Background Information                                                                                 1

1.2 Problem Statement                                                                                             4

1.3 Aims and objectives                                                                                            5

CHAPTER TWO

2.0 LITERATURE REVIEW                                                                                        6

2.1 Typhoid Fever                                                                                                    8

2.1.1 Pathology                                                                                                          9

2.2 Epidemiology of Typhoid Fever                                                                           9

2.3 Clinical Presentation of Typhoid Fever                                                            11

2.4 Transmission and Risk Factors                                                                       12

2.5 Immune Response to Salmonella                                                                      13

2.5.1 Innate immune response                                                                                 14

2.5.2 Acquired immune response                                                                             15

2.5.2.1 Role of T cells during the immune response                                                    16

2.5.2.2 Role of antibodies in immunity against Salmonella                                           16

2.6 Virulence factors of Salmonella                                                                         16

2.7 Prevention of Typhoid Fever

2.7.1 Safe water and food                                                                                           17

2.7.2 Proper sanitation                                                                                              17

2.7.3 Health education                                                                                               18

2.7.4 Typhoid fever vaccines                                                                                   18

2.8 Diagnosis of typhoid fever                                                                                     19

2.8.1 Widal agglutination test                                                                                    19

2.8.2 Tube Agglutination Test                                                                                     20

2.9 Treatment of Typhoid Fever                                                                              21

2.9.1 General management                                                                                          21

2.9.2 Treatment for complicated typhoid fever                                                           21

2.10 Resistance of S. Typhi to Antibiotics                                                                  22

CHAPTER THREE

3.0 MATERIALS AND METHODS

3.1 Study Area                                                                                                      23

3.2 Source Population                                                                                           23

3.3 Collection of Specimens                                                                                      23

3.4 Widal Test                                                                                                        23

3.5 Slide Test Procedure                                                                                           24

3.6 Standard Tube Test Method                                                                             24

CHAPTER FOUR

4.0      RESULT                                                                                                             25

CHAPTER FIVE

5.0   DISCUSSION AND CONCLUSION                                                                          33                                                                                         

5.1   Conclusion                                                                                                            34

5.2   Recommendation                                                                                                   35

        References                                                                                                             36

LIST OF TABLES

Tables                                                                Title                                                          pages     

1. Age and sex distribution of study respondents                                               26

2. Showing the number of students infected with S.typhi and S.paratyphi              27

          A, B, C based on slide agglutination test                                                        28

3. Antibody titre levels to febrile antigens of S.typhi in the study population          29          

4. Showing titre levels of agglutination of S.paratyphi A in tube agglutination test  30

      5. Showing titre level of agglutination of S.paratyphi B in tube agglutination test      31

      6. Showing titre level of agglutination of S.paratyphi C in the tube agglutination test 32

CHAPTER ONE

1.0 INTRODUCTION

The bacterium, Salmonella typhi, is known to cause typhoid fever, a life threatening illness (Abera et al., 2010). Annually, typhoid fever is known to record cases estimated to be between 13-16 million, which result in 216,000 deaths. The most affected are children and young adults between the ages of 5 and 19 years. As of 2010, these cases caused about 190,000 deaths, a rise from 137,000 recorded in 1990. This study tends to identify and quantitate antibodies in human sera which were achieved with three different brands of Widal test kits (plasmatec, biotec and Chronolab to be précised) as the selected febrile antigens for the laboratory investigation. Salmonella typhi (such as Typhoid fever) infections pose a serious health effect in developing countries. A reliable data base on blood positive cultures is essential for prompt interventions. A data was retrieved from a previous study in seen facilities in Abuja and three (3) hospitals in Kano from 2008 to 2017 and 2013 to 2017, respectively. A declining trend in percentage positivity of S typhi was observed in Abuja with more erratic trends in Lagos and Kano. Another data obtained from daily trust from different hospitals across the country showed a wide disparity between the number of people diagnosed with typhoid fever with Widal tests and those diagnosed from other confirmatory tests such as blood and stool culture tests. At Aminu Kano Teaching Hospital, Kano (AKTH), statistics showed that 569 suspected cases of typhoid fever were recorded between January and June, 2018. The acting Head of Microbiology Department, Dr.Edwin Chinagozi who disclosed this to daily trust said 199 cases tested positive through Widal tested method while 9 patients were isolated through blood and stool culture, respectively. Contaminated water and poor sanitation are the most common causes of typhoid fever in developing nations (Bhanu et al., 2011). Though one can be treated with antibiotics, a few who recover are known to still harbor the bacteria for years in their gall bladder or intestinal tracts. These chronic carriers as they are referred to may infect others through shedding the bacteria in their feces though they might not have signs or symptoms (Breiman et al., 2012). The problem however, is the fact that in developing nations, the equipment, supplies and trained laboratory personnel required especially in primary health-care can rarely be found. However, most health-care facilities use only one of these methods without confirmation of results with a second test method. This at times leads to unnecessary and inappropriate antimicrobial treatment of patients without the typhoid fever due to misdiagnosis.

A very similar but often less severe disease is caused by Salmonella enterica subspecies I serotype Paratyphi A and B or in short form Salmonella Paratyphi A and B (Reddy et al., 2010).

Crowded and impoverished populations with inadequate sanitation that are exposed to unsafe water and food with high probability of contamination with feces are at risk of developing the infection. Humans are the natural reservoirs for the Salmonella typhi. Studies show that Salmonella bacteria can survive for days in groundwater or seawater and for months in contaminated eggs and the infectious dose may vary between 103-106 organisms. Besides the above mentioned risk factors, climatic variables such as, rainfall, vapor pressure and temperature have been shown to have important effects on the transmission/distribution of typhoid infections in human populations (Nandagopal et al., 2010).

 Increased bilirubin and pneumonia has been reported in some complicated infections. Some survivors become asymptomatic S typhi carriers and have the potential to transmit the bacteria for a long time (Lozano et al., 2012).

1.1       AIM :

The aim of the study is to detect the titre value of antibodies present in test serum due to the contagions of Salmonella genus causing enteric or typhoid fever by using direct widal slide and tube agglutination test(s), respectively.

OBJECTIVES :

1. To investigate diagnostic performance of slide agglutination results of three commercially available Widal test kits denoted as Kit 1, Kit 2 and Kit 3.

2. To compare the results of slide agglutination and tube titration.

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