title: False-positive widal in melioidosis.
abstract: Enteric fever is endemic in this part of the world, and Widal test is one of the time-honored laboratory tests that are being used for years to diagnose the disease. On the other hand, melioidosis is a newly emerging disease from this region, which is most often misdiagnosed or underdiagnosed by clinicians. It is well accepted that false-positive Widal reactions following certain non-typhoid Salmonella infections may occur commonly. Three cases of high titers of Widal test are described, where melioidosis was the actual diagnosis in every occasion and was never suspected until diagnosed microbiologically. All the patients had shown a partial response to ceftriaxone. Blood and pus cultures grew Burkholderia pseudomallei, whereas Salmonella typhi was not isolated from blood in any patient. With appropriate antibiotics, the patients showed clinical and microbiological improvement with lowering of Widal titers. These 3 cases show that high Widal titer in any patient may mislead the diagnosis of melioidosis, and further laboratory workup should always be done to rule out melioidosis, especially in cases with nonresponsiveness to treatment.
authors.affiliation: Department of Medicine, Kasturba Medical College, Manipal, India. drrohithv@gmail.com
authors.forename: Rohith
authors.initials: R
authors.lastname: Valsalan
authors.forename: S
authors.initials: S
authors.lastname: Shubha
authors.forename: C
authors.initials: C
authors.lastname: Mukhopadhyay
authors.forename: K
authors.initials: K
authors.lastname: Saravu
authors.forename: M
authors.initials: M
authors.lastname: Maneesh
authors.forename: B A
authors.initials: BA
authors.lastname: Shastry
authors.forename: N R
authors.initials: NR
authors.lastname: Rau
authors.forename: V R
authors.initials: VR
authors.lastname: Pandit
authors.forename: Hazel
authors.initials: H
authors.lastname: Gonsalves
mesh_terms: D000328:Adult; D000368:Aged; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D016957:Burkholderia pseudomallei; D002443:Ceftriaxone / Q000627:therapeutic use; D004318:Doxycycline / Q000627:therapeutic use; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use; D008297:Male; D008554:Melioidosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D000077731:Meropenem; D008875:Middle Aged; D013845:Thienamycins / Q000627:therapeutic use; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D013845:Thienamycins; D015378:Imipenem; D019980:Amoxicillin-Potassium Clavulanate Combination; D002443:Ceftriaxone; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D000077731:Meropenem; D004318:Doxycycline