Hubungan Antara Manifestasi Klinis dan Laboratorium dengan Skala Immunoglobulin M (IgM) Salmonella pada Pasien Demam Tifoid di Rumah Sakit Haji Adam Malik Tahun 2024

Abstract

Introduction: Typhoid fever is a systemic infectious disease requiring fast and accurate diagnosis due to potential serious complications. Bacterial culture, the gold standard, is often unavailable in primary healthcare, the IgM Salmonella serology test commonly used as an alternative. However, this serological test yields diverse and varied interpretations, potentially compromising diagnostic accuracy. Objective: This study evaluates the characteristics of patients' clinical manifestations and laboratory parameters that could support and predict IgM Salmonella serology test results as confirmation test. Methods: This retrospective study collected data from 364 medical records of patients suspected typhoid fever who had undergone IgM Salmonella testing between January and December 2024 at Adam Malik Hospital, Medan, Indonesia. Data were analyzed using correlation tests and multinomial logistic regression analysis to identify dominant factors influencing IgM Salmonella. Results and Discussion: Among the 364 patients studied, the most dominant clinical presentations and laboratory parameters were identified as fever, abdominal pain, malaise, nausea and elevated neutrofil. The IgM Salmonella scale distribution further demonstrated that 176 patients (48.4%) were in scale ≥6, followed by 127 (34.9%) in scale 3-5, and 61 (16.8%) in scale ≤2. Bivariate analysis indicated a significant correlation between clinical manifestations, fever (rs=0.145; p<0.01) and abdominal pain (rs=0.142; p<0.01) with increased IgM Salmonella scale. Furthermore, multinomial logistic regression analysis identified fever (OR=3.677; p<0.01) and abdominal pain (OR=2.915; p<0.01) as dominant predictors of elevated IgM Salmonella scale. Conclusion: There is a significant relationship between clinical manifestations and IgM Salmonella scale; more severe clinical presentations warrant greater caution and higher IgM Salmonella scale. This enables clinicians to confidently diagnose typhoid fever at an IgM Salmonella scale of 4, based on the correlation between the patients' clinical manifestations, laboratory parameters and IgM Salmonella scale.