healthy people have rheumatoid factor in their blood, but it's

not clear why.

RHEUMATOID FACTOR (RF)
PRINCIPLE OF RF SLIDE TEST
BASIC CONCEPTS
 Latex agglutination
 Rheumatoid factor test measures the amount of rheumatoid  reagent is IgG – coated latex particles
factor in your blood.  Combine patient serum with latex reagent
 Rheumatoid factors are proteins produced by your immune  Observe for agglutination
system that can attack healthy tissue in your body.  RF (IgM) will cause agglutination
 They can attack healthy joints, glands or other normal cells by
mistake
 High levels of Rheumatoid factor in the blood are most often
associated with autoimmune diseases, such as Rheumatoid
arthritis and Sjorgen’s syndrome. But rheumatoid factor may
be detected in some healthy people, and people with
autoimmune diseases sometimes have normal levels of
rheumatoid factor.

OTHER TESTS FOR RHEUMATOID ARTHRITIS

 A rheumatoid factor test is one of the group of blood tests RESULTS

primarily used to help pinpoint a diagnosis of Rheumatoid
arthritis. Other tests may include:  Agglutination is a positive (+) result
a) Anti – nuclear antibody test (ANA)
b) Anti – cyclic citrullinated peptide (anti – CCP)
antibody test
c) C- reactive protein test (CRP)
d) Erythrocyte sedimentation rate (ESR)
 The amount of rheumatoid factor in your blood helps the
physician choose the treatment approach that will work best
for the situation.

RHEUMATOID FACTOR (RF)

 Rheumatoid arthritis is a type of autoimmune disorder that

causes pain, swelling, and stiffness of the joints.
 RF is used to help diagnose Rheumatoid arthritis or other
autoimmune disorders.
 Rheumatoid factors (RF) are:
a) IgM directed against IgG
b) Detected using rapid tests
c) 75% to 85% or patients with Rheumatoid arthritis
have elevated serum RF
d) RF can be present in other conditions
RHEUMATOID FACTOR IN OTHER CONDITIONS
 Lupus
 Sjorgen’s syndrome
 Juvenile arthritis
 Scleroderma
 Mononucleosis
 Tuberculosis
 Certain cancers, such as leukemia or multiple myeloma
 About 20 percent of people with rheumatoid arthritis have
little or no rheumatoid factor in their blood. So even if your
results were normal, your health care provider may order
more tests to confirm or rule out a diagnosis.
 If your results were not normal, it doesn't necessarily mean
you have a medical condition needing treatment. Some
RESULTS
 Conditions other than Rheumatoid arthritis can cause positive
results
 15% - 25% of RA patients can be negative for RF
 RF test is not specific for RA
 Negative test does not rule out RA
 Other conditions can have increase RF
 Other tests can be used to follow disease course
RHEUMATOID FACTOR (RF)
 An RF test is not used to diagnose osteoarthritis. Although
rheumatoid arthritis and osteoarthritis both affect the joints,
they are very different diseases.
 Rheumatoid arthritis is an autoimmune disease that affects
people at any age, but usually occurs between the ages of 40
and 60. It affects more women than men. Symptoms may
come and go and vary in severity.
 Osteoarthritis is not an autoimmune disease. It is caused by
the wear and tear of joints over time and usually affects adults
over the age of 65.
WIDAL TEST
BASIC CONCEPTS
 Widal test is a serological method to diagnose enteric or
typhoid fever that is cause by the infection with pathogenic
microorganisms like Salmonella typhi, Salmonella paratyphi
a, b and c
 The method of diagnostic test is based upon agglutination
(clumps) reaction between antibodies of patient serum and
antigens specifically prepared from Salmonella species.
 Salmonella possess the following (3) three antigens:
a. Flagellar antigen or H antigen – composed of
proteins, heat labile and sensitive, antibody
formation are rapid and sustained, highly
immunogenic, antibody level persists for a longer
period.
b. Somatic antigen or O antigen – composed of
polysaccharide, heat stable and alcohol resistant,
antibody formation are rapid but only on a early
phase, less immunogenic, antibody level falls off
quickly.
c. Surface antigen or Vi antigen – surface
polysaccharide envelope covering the O antigen.
This antigen is expressed only on few serotypes and
renders the bacilli inagglutinable with O antiserum.
The name is believed that Vi is related to virulence.
 Widal test measures agglutination antibodies directed against
a Salmonella O somatic surface antigen and/or a Salmonella
H flagella antigen of the suspected organism.
 The Widal test detects antibodies against O and H antigens.
 Uses direct agglutination
 First discovered by Fernand Widal in 1896
CLINICAL MANIFESTATION
 Chest congestion
 Constipation
 Diarrhea
 Gastroenteritis
 Headache
 Body malaise
 High temperature
 Loss of appetite
 Stomach pains
MODES OF TRANSMISSION
 Ingestion of contaminated food or water
 Rarely, from person to person
 Fecal – oral route
 Most of the time carriers come from food handlers
SERODIAGNOSIS OF TYPHOID
 Widal test by Rapid Slide (Screening) test -1 min
 Widal test by Tube Agglutination test -2 – 4 hours
 Typhidot test (IgG/IgM rapid test) -15 minutes
 ELISA -45 min – 2 hours
 Electrochemiluminiscent immunoassays -45 min – 2 hours
 PCR (Polymerase chain reaction) -7– 10 days
PRINCIPLE OF WIDAL TEST
• Antibody in the serum produced in response to Salmonella
organism, the kit contains antigen suspensions that are killed
bacteria and they were stained to enhance the reading of
agglutination tests.
• The blue stained organisms are specific to the somatic
antigens (O antigen), while the red stained antigens are
specific to the flagella antigens (H antigen).
WIDAL KIT INCLUSIONS
 Antigen suspension specifically prepared from Salmonella
species
 Positive control vial
 Negative control vial
 Package insert
 White glass slide
 Stirring sticks
WIDAL CONTROLS
 Widal negative control (-)
-contains no antibodies against the specific bacteria
 Widal positive control (+)
-The widal positive control contains ready to use standardized
goat antiserum with polyspecific antibodies having specific
reactivity towards S. typhi O and H antigens and is useful in
the validation of the performance of Widal reagents.
 A positive and negative control should be run with each test.
 If the reagent falls to agglutinate with the positive control, or
dose agglutinate with the negative control, it should be
 discarded or review the procedure and repeat the test with a
new test kit.

LIMITATONS OF WIDAL TEST

 The Widal test has a very low specificity, less sensitive,

confusing and difficult to interpret for the diagnosis of typhoid
fever because cross – agglutinating antibodies remaining
from the past infections with related salmonella serotypes
give false positive results.
 Furthermore, in areas where fever due to infections is a
common occurrence. So false positive reactions may occur as
a result of non-typhoid.

CAUSES OF FALSE-POSITIVE WIDAL AGGLUTINATION TEST

 Previous immunization with Salmonella antigen

 Cross – reaction with non-typhoid salmonella
 Variability and poorly standardized commercial antigen
preparation kit.
 Infection with malaria
 Other Enterobacteriaceae sharing the same
Endotoxins/lipopolysaccharides.

WHY WIDAL TEST IS STILL USED

 Although Widal test is an old serologic assay and no longer

performed in many developed countries, it is still used in
some because of its low cost and limited resources which
releases results in a short period of time.
 It is concluded that even today, the Widal test is one of the
best, easily accessible, cheap and simple method for the
diagnosis of typhoid fever.

PROPHYLAXIS

 Simple hand hygiene and washing can reduce several cases of

typhoid
 All milk and dairy products should be pasteurized
 Avoid drinking untreated water
 Avoid raw fruits and vegetables
 Screening of food handlers for S. typhi
 Vaccines