Typhoid fever and malaria remain major public health concerns in tropical regions where both infections are endemic, largely due to overlapping clinical manifestations such as fever, headache, diarrhoea, vomiting, and chills, which complicate accurate diagnosis. The Widal test, although widely used in resource-limited settings, is limited by poor specificity and frequent cross-reactivity with non-salmonella conditions. This limitation can be attributed to non-specific polyclonal B-cell activation induced by Plasmodium spp. infection, which can result in false-positive Widal test outcomes in cases of co-infection with Salmonella spp., leading to misdiagnosis, inappropriate treatment, and the emergence of antimicrobial resistance. This study aimed to determine the prevalence of stool culture confirmed Salmonella spp. carriage, Plasmodium spp. infection and co-infection among Widal-positive patients, identify associated risk factors, and assess multidrug resistance (MDR) patterns of Salmonella isolates in Yaoundé. A cross-sectional study was conducted from September 2022 to April 2023 across five hospitals. Participants presenting with symptoms suggestive of typhoid fever and/or malaria who were tested positive to the Widal test were enrolled by convenience sampling. Sociodemographic and clinical data were collected using structured questionnaires. Malaria diagnosis was confirmed by microscopy of thick blood smears, while stool samples were cultured on Hektoen enteric agar for Salmonella isolation, followed by identification using the API 20E system and serotyping by slide agglutination. Antibiotic susceptibility testing was performed using the disk diffusion method (CASFM 2023 guidelines), and MDR indices were calculated. Among 277 Widal-positive participants, stool culture confirmed Salmonella spp. carriage was detected in 23 (8.4%), Plasmodium spp. in 113 (40.8%), and concurrent carriage of both in 12 (4.4%). Of the 23 Salmonella isolates, only 7 (30.4%) were typhoidal serovars (S. Paratyphi B); the remaining 16 (69.6%) were non-typhoidal serovars. Notably, S. Typhi was not recovered. A significant association was found between water source and Salmonella spp. carriage (p < 0.001). Among typhoidal isolates, resistance was observed to amoxicillin-clavulanic acid (100%) and piperacillin-tazobactam (71%), with no resistance to third-generation cephalosporins. Non-typhoidal isolates exhibited more complex resistance profiles, including carbapenem resistance.
References
[1]
WHO (2023) Typhoid Fact Sheet. https://www.who.int/news-room/fact-sheets/detail/typhoid
[2]
Brahimi, H. and Benchouk, S. (2020) épidémie de fièvre typho？de en 2019. MédecineetMaladiesInfectieuses, 50, S113. https://doi.org/10.1016/j.medmal.2020.06.232
[3]
Wam, E.C., Arrey, C.N., Sama, L.F., Agyingi, L.A. and Wam, A.N. (2019) Comparative Study on the Use of Widal Test to Stool Culture in the Laboratory Diagnosis of Typhoid Fever in Holy Family Hospital Akum, North West Region of Cameroon. TheOpenMicrobiologyJournal, 13, 73-80. https://doi.org/10.2174/1874285801913010073
[4]
Nkeza, A., Anna, N.L. and Jules Clement, A.N. (2019) Salmonella Carriage among Patients in Fako Division, Cameroon: A Cross-Sectional Study of Its Prevalence and Associated Risk Factors. JournalofAdvancesinMicrobiology, 16, 1-9. https://doi.org/10.9734/jamb/2019/v16i230121
[5]
Njoya, H.F., Awolu, M.M., Christopher, T.B., Duclerc, J.F., Ateudjieu, J., Wirsiy, F.S. and Atuhaire, C. (2021) Prevalence and Awareness of Mode of Transmission of Typhoid Fever in Patients Diagnosed with Salmonella Typhi and Paratyphi Infections at the Saint Elisabeth. Pan African Medical Journal, 40, Article 83.
[6]
Antonio-Nkondjio, C., Ndo, C., Njiokou, F., Bigoga, J.D., Awono-Ambene, P., Etang, J., et al. (2019) Review of Malaria Situation in Cameroon: Technical Viewpoint on Challenges and Prospects for Disease Elimination. Parasites&Vectors, 12, Article No. 501. https://doi.org/10.1186/s13071-019-3753-8
[7]
Ekesiobi, A., Igbodika, M. and Njoku, O. (2009) Co-Infection of Malaria and Typhoid Fever in a Tropical Community. AnimalResearchInternational, 5, 888-891. https://doi.org/10.4314/ari.v5i3.48754
[8]
Igbeneghu, C.A., Olisekodiaka, J. and Onuegbu, A.J. (2009) Malaria and Typhoid Fever among Adult Patients Presenting with Fever in Ibadan, Southwest Nigeria. International Journal of Tropical Medicine, 4, 112-115.
[9]
Rufai, T., Aninagyei, E., Akuffo, K.O., Ayin, C.T., Nortey, P., Quansah, R., et al. (2023) Malaria and Typhoid Fever among Patients Presenting with Febrile Illnesses in Ga West Municipality, Ghana. PLOSONE, 18, e0267528. https://doi.org/10.1371/journal.pone.0267528
[10]
Gopalakrishnan, V., Sekhar, W.Y., Soo, E.H., Vinsent, R.A. and Devi, S. (2002) Typhoid Fever in Kuala Lumpur and a Comparative Evaluation of Two Commercial Diagnostic Kits for the Detection of Antibodies to Salmonella Typhi. Singapore Medicine Journal, 43, 354-358.
[11]
Andualem, G., Abebe, T., Kebede, N., Gebre-Selassie, S., Mihret, A. and Alemayehu, H. (2014) A Comparative Study of Widal Test with Blood Culture in the Diagnosis of Typhoid Fever in Febrile Patients. BMCResearchNotes, 7, Article No. 653. https://doi.org/10.1186/1756-0500-7-653
[12]
Asif, N., Bashir, S. and Naeem, R. (2018) False Positivity of Widal Test in Malaria. Pakistan Journal of Medical & Health Sciences, 12, 437-439.
[13]
Samal, K.K. and Sahu, C.S. (1991) Malaria and Widal Reaction. The Journal of the Association of Physicians of India, 39, 745-747.
[14]
Jhaveri, K.N., Nandwani, S.K., Mehta, P.K., Surati, R.R. and Parmar, B.D. (1995) False Positive Modified Widal Test in Acute Malaria. The Journal of the Association of Physicians of India, 43, 754-755.
[15]
Anand, N. (2018) Incidence of Co-Infection of Malaria and Typhoid and Their Diagnostic Dilemmas. RecentAdvancesinPathology&LaboratoryMedicine, 4, 10-12. https://doi.org/10.24321/2454.8642.201815
[16]
Nchawa, Y.Y., Bassey, E.B., Inyang-etoh, P., Useh, M.F., Asuquo, A. and Angela, O. (2019) Antimicrobial Resistance Pattern in Salmonella enterica from Clinical and Poultry Sources in Calabar, Nigeria. JournalofMicrobiologyandAntimicrobials, 11, 5-10. https://doi.org/10.5897/jma2019.0413
[17]
Masumbe, P.N., MacDonald. B.E., Chedjou, J.P., Kamdem, S.D., Achon-duh-Atijegbe, O. and Mbacham, F.W. (2022) Malaria and Typhoid Fever Co-Infection amongst Febrile Patients in Yaoundé, Cameroon: Implication in the Genetic Diversity of Plasmodium falciparum. Biochemistry and Molecular Biology Journal, 7, 47-53.
[18]
WHO (World Health Organization) (2000) Bench Aids for the Diagnosis of Malaria Infections. https://iris.who.int/items/72498f01-d75e-450d-a368-dab643effcd0
[19]
WHO (2007) Antigenic Formulae of the Salmonella Serovars.
[20]
Khadka, P., Thapaliya, J. and Thapa, S. (2021) Susceptibility Pattern of Salmonella enterica against Commonly Prescribed Antibiotics, to Febrile-Pediatric Cases, in Low-Income Countries. BMCPediatrics, 21, Article No. 38. https://doi.org/10.1186/s12887-021-02497-3
[21]
CAS-FM (2023) Comité de l’antibiogramme de la Société Fran？aise de Microbiologie Recommandations 2023 V.1.0 Juin. https://www.sfm-microbiologie.org/wp-content/uploads/2023/06/CASFM2023_V1.0.pdf
[22]
Magiorakos, A.P., Srinivasan, A., Carey, R.B., Carmeli, Y., Falagas, M.E., Giske, C.G., et al. (2012) Multidrug-Resistant, Extensively Drug-Resistant and Pandrug-Resistant Bacteria: An International Expert Proposal for Interim Standard Definitions for Acquired Resistance. ClinicalMicrobiologyandInfection, 18, 268-281. https://doi.org/10.1111/j.1469-0691.2011.03570.x
[23]
Ndip, L., Egbe, F., Kimbi, H., Njom, H. and Ndip, R. (2015) Co-Infection of Malaria and Typhoid Fever in Feverish Patients in the Kumba Health District, Southwest Cameroon: Public Health Implications. InternationalJournalofTropicalDisease&Health, 9, 1-11. https://doi.org/10.9734/ijtdh/2015/18935
[24]
Netongo, P.M., Tchoutang, A.M., Eric, M.B., Tepa, A., Nzuno, M.C. and Kamdem, S.D. (2025) Malaria and Typhoid Fever Coinfection among Febrile Patients Attending a Health Facility in Yaoundé, Cameroon: A Cross‐Sectional Study. JournalofParasitologyResearch, 2025, Article ID: 9977704. https://doi.org/10.1155/japr/9977704
[25]
Ngai, R.Y., Marbou, W.J.T., Mbaveng, A.T. and Kuete, V. (2024) Haematological Profile and Antibiotic Resistance of Bacteria Responsible for Enteric Infections Isolated from Patients Suffering from Malaria and Enteric Infections on Consultation at the Dschang Regional Hospital. CanadianJournalofInfectiousDiseasesandMedicalMicrobiology, 2024, Article ID: 3383995. https://doi.org/10.1155/2024/3383995
[26]
Sohanang Nodem, F.S., Ymele, D., Fadimatou, M. and Fodouop, S.C. (2023) Malaria and Typhoid Fever Coinfection among Febrile Patients in Ngaoundéré (Adamawa, Cameroon): A Cross-Sectional Study. JournalofParasitologyResearch, 2023, Article ID: 5334813. https://doi.org/10.1155/2023/5334813
[27]
Achonduh-Atijegbe, O.A., Mfuh, K.O., Mbange, A.H.E., Chedjou, J.P., Taylor, D.W., Nerurkar, V.R., et al. (2016) Prevalence of Malaria, Typhoid, Toxoplasmosis and Rubella among Febrile Children in Cameroon. BMCInfectiousDiseases, 16, Article No. 658. https://doi.org/10.1186/s12879-016-1996-y
[28]
Browne, A.J., Kashef Hamadani, B.H., Kumaran, E.A.P., Rao, P., Longbottom, J., Harriss, E., et al. (2020) Drug-Resistant Enteric Fever Worldwide, 1990 to 2018: A Systematic Review and Meta-Analysis. BMCMedicine, 18, Article No. 1. https://doi.org/10.1186/s12916-019-1443-1
[29]
Yopa, D.S., Anya, P., Mendjime, P., Elouga, T., Nnanga-Nga, E. and Nguefack-Tsague, G. (2023) Evaluation of the Antimicrobial Resistance Surveillance System in Sentinel Sites in Cameroon. Cureus, 15, e40779. https://doi.org/10.7759/cureus.40779
[30]
Ndima Etouke, T.A., Ful Kuh, G., Djoumsie Gomseu, B.E., Nzesseu, V.L., Tamokou, J. and Dzoyem, J.P. (2024) Epidemiology of Multidrug-Resistant Salmonella Typhi and Paratyphi Isolated from Stool Culture. JournalofTropicalMedicine, 2024, Article ID: 3480080. https://doi.org/10.1155/jotm/3480080
[31]
Ohanu, M.E., Iroezindu, M.O., Maduakor, U., Onodugo, O.D. and Gugnani, H.C. (2019) Typhoid Fever among Febrile Nigerian Patients: Prevalence, Diagnostic Performance of the Widal Test and Antibiotic Multi-Drug Resistance. MalawiMedicalJournal, 31, 184-192. https://doi.org/10.4314/mmj.v31i3.4
[32]
Amsalu, T., Genet, C. and Adem Siraj, Y. (2021) Salmonella Typhi and Salmonella Paratyphi Prevalence, Antimicrobial Susceptibility Profile and Factors Associated with Enteric Fever Infection in Bahir Dar, Ethiopia. ScientificReports, 11, Article No. 7359. https://doi.org/10.1038/s41598-021-86743-9
[33]
Admassu, D., Egata, G. and Teklemariam, Z. (2019) Prevalence and Antimicrobial Susceptibility Pattern of Salmonella entericaserovar Typhi and Salmonella entericaserovar Paratyphi among Febrile Patients at Karamara Hospital, Jigjiga, Eastern Ethiopia. SAGEOpenMedicine, 7. https://doi.org/10.1177/2050312119837854
[34]
Ousenu, K., Ali, I.M., Sama, L.F., Ndam, M.N., Tchouangueu, T.F. and Tume, C.B. (2021) A Cross-Sectional Comparative Study of the Performance of the Widal Test and the Typhidot Immunoassay for Typhoid Fever Diagnosis in the West Region of Cameroon. CanadianJournalofInfectiousDiseasesandMedicalMicrobiology, 2021, Article ID: 8279122. https://doi.org/10.1155/2021/8279122
