EC Clinical and Medical Case Reports

Background: Typhoid fever is a serious public health concern in Nigeria, often presenting with febrile symptoms similar to other diseases, leading to potential misdiagnosis. Misdiagnosis of typhoid fever not only results in improper treatment but also compromises patient health outcomes. This study aimed to assess the impact of typhoid fever misdiagnosis on the hematological and microbiological profiles of febrile patients in Ogun State, Nigeria, focusing on the accuracy of diagnostic tools.

Materials and Methods: A cross-sectional predictive study was conducted among 100 febrile patients at the Federal Medical Center, Abeokuta, Ogun State, over a three-month period (September–November 2020). Blood samples were collected and analyzed for packed cell volume (PCV), hemoglobin (Hb), and differential white blood cell (WBC) count, including neutrophil-lymphocyte ratio (NLR) and monocyte-lymphocyte ratio (MLR). Blood cultures and Widal tests were performed to detect Salmonella typhi infection. Data were analyzed using SPSS version 22, with p-values <0.05 considered statistically significant.

Results: The study revealed significant differences in hematological parameters between typhoid-positive and negative patients. Infected subjects had lower PCV (36.28 ± 2.96%) and Hb levels (12.19 ± 0.88 g/dL) compared to non-infected subjects (PCV: 38.56 ± 4.46%, Hb: 13.02 ± 1.49 g/dL, p < 0.05). WBC counts were significantly lower in typhoid-infected patients (5.47 ± 1.75 × 10⁹/L) compared to non-infected individuals (7.0 ± 1.45 × 10⁹/L, p < 0.05), with increased neutrophil count and reduced lymphocyte and monocyte counts. Widal test sensitivity was 90.7%, but specificity was only 22.8%, indicating high false positives.

Conclusion: Typhoid fever misdiagnosis in febrile patients leads to significant alterations in hematological profiles and inappropriate treatments. The Widal test, though sensitive, lacks specificity, suggesting the need for improved diagnostic tools to avoid misdiagnosis and ensure accurate management of febrile illnesses.

 Keywords: Typhoid Fever; Misdiagnosis; Febrile Patients; Widal Test; Hematological Parameters; Blood Culture

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