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Blastomyces dermatitidis is a fungus typically found in the soil of endemic regions such as the Midwest, concentrating in areas like Ohio, Mississippi, and the Great Lakes area. The systemic infection caused by inhaling Blastomyces dermatitidis is known as blastomycosis. The frequency of blastomycosis in non-endemic regions is increasing for a variety of speculated reasons, such as higher rates of immunosuppressed individuals and possible climate. Due to clinician unfamiliarity, misdiagnosis of blastomycosis is common, which potentiates worsening systemic infections. This study shows the clinical course of a patient with blastomycosis in a non-endemic region, highlighting the need for education for clinicians in non-endemic areas. A 72-year-old female with a history of chronic obstructive pulmonary disease (COPD), coronary artery disease, a 47-year smoking history, and hypertension presented for outpatient management of COPD. CT three months prior to presentation showed nodular opacities in the lungs. A bronchoscopy was performed and revealed negative findings for malignancy or infection; the patient developed worsening symptoms leading to hospitalization. Subsequent testing revealed Blastomyces dermatitidis. She was promptly treated with a six to 12-month course of itraconazole with close follow-up. The study highlights the need not to rule out causes of infection based on location. Blastomycosis can resemble community-acquired pneumonia. Making the correct diagnosis is paramount, as delays can result in morbidity. Fungal cultures may be the gold standard, but due to the long culture time, there need to be other diagnostic tests like urine antigen testing. This study highlights the need to increase awareness of clinicians who experience blastomycosis patients in a non-endemic region.

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Human toxocariasis (HT) is a widespread zoonotic infection globally, notably prevalent in tropical areas. Enhancing our understanding of toxocariasis can lead to increased attention towards the socioeconomic impact and control of this neglected zoonosis. We conducted a comprehensive review of all available articles and official documents on toxocariasis in Iran to identify research gaps and critical needs for its control. This review highlights that despite numerous studies exploring various aspects of toxocariasis in definitive and paratenic hosts, as well as humans and environmental contamination, significant data deficiencies and gaps persist across different regions in the country. These gaps involve investigating the worm burden and reinfection rates in definitive hosts, developing more sensitive methods to detect and differentiate of Toxocara species, and understanding the behavior of definitive host animals. Additionally, identifying potential paratenic hosts for HT and exploring the organ-specific affinity and survival duration of Toxocara larvae within these hosts are essential areas for exploration. It's also imperative to comprehend the sylvatic and domestic cycles of the parasite in paratenic hosts. Furthermore, assessing egg density in the environment, exploring potential new sources such as water, and identifying regions with optimal climatic conditions for the survival and development of Toxocara eggs are crucial for the formulation of effective prevention and control strategies. Identifying at-risk groups, developing early diagnosis techniques, employing imaging methods, and identifying long-term complications in humans are also crucial. Community health organizations should prioritize health education for the public and professionals. Furthermore, accurately estimating definitive host populations, monitoring and preventing their movements in public places, implementing regular deworming practices for pets and stray hosts, and recognizing the infection's significance as a health priority are critical. This comprehensive understanding advocates for a holistic "one health" approach to control of HT.

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Typhoid fever has the highest disease burden in countries in low- and middle-income countries, primarily located in Asia and Sub-Saharan Africa. Previous typhoid vaccines such as the live attenuated typhoid (Ty21a) vaccine and Vi (virulence) capsular polysaccharide vaccine had the limitation that they could not be administered with other standard childhood immunizations and were ineffective in children under two years of age. To address these shortcomings of the previous vaccines, typhoid conjugate vaccines (TCVs) were developed and prequalified by the World Health Organization. Cross-reacting material and tetanus toxoid are widely used as carrier proteins in TCVs. According to various studies, TCV has higher efficacy, has a more extended protection period, and is safe and immunogenic in infants as young as six months. This review article aims to comprehensively appraise the data available on TCVs' efficacy, duration of protection, safety, and immunogenicity in endemic regions.

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Tuberculosis remains a global health threat, notably with a considerable burden of extrapulmonary cases. Prostate tuberculosis stands out as a rare and challenging diagnosis, often resulting in substantial management delays. In this report, we present the case of a 55-year-old man in whom initial suspicion of prostate cancer resulted in the diagnosis of prostate tuberculosis. The diagnostic methods, progressive features, and therapeutic tools of this rare condition are discussed.

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INTRODUCTION:  Burkholderia infection commonly presents as bacteraemic pulmonary disease; however, it is notorious for its wide variety of presentations in chronic cases, including musculoskeletal manifestations. It is common in patients living in endemic areas with comorbidities such as diabetes and who have chronic alcoholism. It was previously under-reported due to a low index of suspicion. Now, there is an increasing trend of diagnosis of these infections in non-endemic areas because of various factors, such as MALDI-TOF, molecular tests, and PCR. MATERIALS AND METHODS: This is a single tertiary centre study of 10 patients, diagnosed with Burkholderia infection and treated at our institution between 2021 and 2023 and followed up for a minimum of six months. Information was collected from outpatient and inpatient records. RESULTS: In this study, the mean age of the patients was 45 years, with eight males and two females. Out of 10, seven patients had comorbidities. However, only one patient has a history of travelling to an endemic area. All our patients were treated operatively, and the course of intervention and the planning of the surgical procedure were decided according to clinico-radiological findings. Six out of 10 patients suffering from Burkholderia species infections have a history of prolonged ICU stay, four of them tested positive for Burkholderia pseudomallei and the remaining two tested positive for Burkholderia cepacia, with a mean average time of 24.6 days. Diabetes was the most common comorbidity in 70% of the patients. The knee was the most commonly affected joint, showing involvement in 60% of patients. We have done surgical intervention in all patients. In our study, we have given IV antibiotics for a minimum of six weeks to all patients, followed by oral antibiotic therapy for three to six months on the basis of regular follow-up of clinico-haematologic parameters. CONCLUSION: Infections caused by Burkholderia species should be considered a potential causative agent of musculoskeletal infections in non-endemic areas without prior history of travelling to endemic areas. It may present with a chronic, mild course; a high index of suspicion is required, and it is important that due suspicion translates to prompt diagnosis and appropriate treatment to mitigate the course of the disease and associated morbidities in patients.

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Coccidioidomycosis is a potentially fatal fungal disease of humans and animals that follows inhalation of Coccidioides spp. arthroconidia in the environment. The disease in dogs resembles that in people, and because dogs may be at increased risk of exposure due to their proximity to the ground and digging behavior, they are valuable models for the disease in humans. Dogs have been sentinels for identification of new regions of endemicity in Washington and Texas. Canine serosurveillance has also been used to predict variables associated with environmental presence of Coccidioides spp. Expansion of the endemic region of coccidioidomycosis with climate change-along with predicted population increases and increased development in the southwest United States-may result in 45.4 million additional people at risk of infection by 2090. Here we provide an overview of the value of dogs as sentinels for the disease and encourage the routine reporting of coccidioidomycosis cases in dogs to public health agencies. We also highlight the value of dogs as naturally occurring models for studying novel treatment options and preventatives, such as a novel live avirulent coccidioidomycosis vaccine.

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Mycetoma is a chronic discharging infection involving the skin, subcutaneous tissue, fascia, and bone, which is endemic in tropical and subtropical countries. We report a rare case of mycetoma localized on the foot of a patient living in a country with a temperate climate. A 32-year-old male patient presented with painless swelling in the right foot. He had undergone surgery 3 years ago with the same complaints. Magnetic resonance imaging revealed a 90 × 65 × 37 mm cystic soft tissue lesion in the posterior of the right ankle. Histological analysis identified the fungus. Extensive resection was performed. Mycetoma is characterized by chronic granulomatous inflammatory response, often associated with sinus tract formations due to fungal (eumycetoma) or bacterial (actinomycetoma) organisms. Here we provide a literature review and highlight the importance of increasing awareness toward mycetoma, particularly in non-endemic regions.

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Neurocysticercosis is endemic in many parts of the underdeveloped and developing countries, with continuous presence in developed countries due to the influx of migrants from regions where the diseases are endemic. Neuroimaging, anatomic pathological techniques, immunodiagnostic tests, clinical examination and epidemiologic considerations will easily provide the diagnosis. However, physicians in developed countries are perhaps progressively missing the diagnosis, and need to re-acquaint themselves with the condition and acquire a high suspicion index. The authors present a medicolegal case where the forensic team made a conclusion of neurocysticercosis (among other diagnoses), following post mortem examination of a largely skeletonized and mummified human remains. Characteristic changes were observed in the calvarium of the decedent at autopsy. Review of the antemortem medical records revealed that Computed Tomography (CT) scan had 12 years earlier, suggested diagnostic features in a Hispanic migrant, but the attending surgeons failed to consider the possibility of the condition. Physicians should pay attention to suggestive clinical findings especially when attending to individuals coming from endemic parts of the world. Cysticercosis remains endemic and a misdiagnosis can potentially attract medical malpractice suits. Forensic pathologists should also consider the possibility of uncommon clinical disorders, even in skeletonized remains. Perhaps an earlier diagnosis might have altered the outcome in the decedent.

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Resumen Introducción: La distribución espacial y temporal de la infección por SARS-CoV-2 sobrepasa las áreas endémicas de enfermedades transmitidas por vector (ETV), cuya vigilancia en México ha cambiado sustancialmente a partir del primer caso confirmado de COVID-19. Objetivos: Estimar y comparar las tasas de incidencia de las ETV antes y después de la introducción del SARS-CoV-2 en México. Métodos: Estudio retrospectivo de casos de ETV de 2014 a 2021. Las tasas de incidencia de cada ETV en el periodo previo (2014-2019) y posterior (2020-2021) a la introducción del SARS-CoV-2 en México fueron calculadas y comparadas. Resultados: Antes de la introducción del SARS-CoV-2, las tasas de incidencia de las ETV fueron altas y posterior a la introducción del coronavirus hubo un descenso en los índices epidemiológicos; sin embargo, solo se identificó diferencia estadística significativa en la tasa de incidencia de la malaria (p ≤ 0.05) y otras rickettsias (p ≤ 0.05). Conclusiones: Algunas medidas para reducir los casos de COVID-19, como el distanciamiento social, el confinamiento domiciliario, la reducción en el aforo en el transporte público y el trabajo en casa, probablemente contribuyeron a disminuir temporalmente el número de casos de las ETV; sin embargo, puede haber rebrote de las ETV en el futuro cercano.

Abstract Introduction: SARS-CoV-2 infection spatial and temporal distribution overlaps with endemic areas of vector-borne diseases (VBD), whose surveillance in Mexico has substantially changed since the first COVID-19 confirmed case. Objectives: To estimate and compare the incidence rates of VBDs before and after the introduction of SARS-CoV-2 in Mexico. Methods: Retrospective study of VBD cases from 2014 to 2021. The incidence rates of each VBD in the period before (2014-2019) and after (2020-2021) the introduction of SARS-CoV-2 in Mexico were calculated and compared. Results: Before the introduction of SARS-CoV-2, the incidence rates of VBDs were high and after the introduction of coronavirus there was a decrease in epidemiological indices; however, there was only statistically significant difference in the incidence rate of malaria (p ≤ 0.05) and other rickettsiae (p ≤ 0.05). Conclusions: Some measures to reduce COVID-19 cases, such as social distancing, home confinement, reductions in public transport and working at home (home office), probably temporarily decreased the number of VBD cases; however, there may be a resurgence of VBDs in the near future.

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BACKGROUND: Dengue has become one of the major vector-borne diseases, which has been an important public health concern. We aimed to estimate the disease burden of dengue in major endemic regions from 1990 to 2019, and explore the impact pattern of the socioeconomic factors on the burden of dengue based on the global burden of diseases, injuries, and risk factors study 2019 (GBD 2019). METHODS: Using the analytical strategies and data from the GBD 2019, we described the incidence and disability-adjusted life years (DALYs) of dengue in major endemic regions from 1990 to 2019. Furthermore, we estimated the correlation between dengue burden and socioeconomic factors, and then established an autoregressive integrated moving average (ARIMA) model to predict the epidemic trends of dengue in endemic regions. All estimates were proposed as numbers and age-standardized rates (ASR) per 100,000 population, with uncertainty intervals (UIs). The ASRs of dengue incidence were compared geographically and five regions were stratified by a sociodemographic index (SDI). RESULTS: A significant rise was observed on a global scale between 1990 and 2019, with the overall age-standardized rate (ASR) increasing from 557.15 (95% UI 243.32-1212.53) per 100,000 in 1990 to 740.4 (95% UI 478.2-1323.1) per 100,000 in 2019. In 2019, the Oceania region had the highest age-standardized incidence rates per 100,000 population (3173.48 (95% UI 762.33-6161.18)), followed by the South Asia region (1740.79 (95% UI 660.93-4287.12)), and then the Southeast Asia region (1153.57 (95% UI 1049.49-1281.59)). In Oceania, South Asia, and Southeast Asia, increase trends were found in the burden of dengue fever measured by ASRs of DALY which were consistent with ASRs of dengue incidence at the national level. Most of the countries with the heaviest burden of dengue fever occurred in areas with low and medium SDI regions. However, the burden in high-middle and high-SDI countries is relatively low, especially the Solomon Islands and Tonga in Oceania, the Maldives in South Asia and Indonesia in Southeast Asia. The age distribution results of the incidence rate and disease burden of dengue fever of major endemic regions showed that the higher risk and disease burden are mainly concentrated in people under 14 or over 70 years old. The prediction by ARIMA showed that the risk of dengue fever in South and Southeast Asia is on the rise, and further prevention and control is warranted. CONCLUSIONS: In view of the rapid population growth and urbanization in many dengue-endemic countries, our research results are of great significance for presenting the future trend in dengue fever. It is recommended to policy makers that specific attention needs to be paid to the negative impact of urbanization on dengue incidence and allocate more resources to the low-SDI areas and people under 14 or over 70 years old to reduce the burden of dengue fever.

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Since the first case report in 1942, the peste-des-petits-ruminants virus (PPRV) has been causing infection in a wide range of susceptible hosts, particularly in disease-endemic regions. In the last 40 years, various reports highlighted the evidence of disease and viral genome in around 46 animal species from nine diverse families, including Bovidae, Cervidae, Camelidae, Suidae, Canidae, Felidae, Muridae, and Elephantidae. This evidence of clinical and/ or subclinical infection and the presence of the virus in an extended range of susceptible hosts emphasizes the cross-species transmission that remains a significant obstacle to effective control, particularly in disease-endemic regions. Therefore, a better understanding of virus transmission, host susceptibility, and epidemiological investigation of the disease is crucial to achieving the goals of efficient disease control and eradication programs initiated by OIE and FAO in various diseases-endemic regions. Nevertheless, the propensity of PPRV to inter- and intra-transmission may be a possible constraint in disease control strategies in terms of the new outbreak with the involvement of unusual or novel hosts. Considering this aspect, we tried to summarize the scattered data on PPR in available information about the susceptibility of a wide range of wildlife species, large ruminants, camels, and unusual hosts.

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INTRODUCTION: SARS-CoV-2 infection spatial and temporal distribution overlaps with endemic areas of vector-borne diseases (VBD), whose surveillance in Mexico has substantially changed since the first COVID-19 confirmed case. OBJECTIVES: To estimate and compare the incidence rates of VBDs before and after the introduction of SARS-CoV-2 in Mexico. METHODS: Retrospective study of VBD cases from 2014 to 2021. The incidence rates of each VBD in the period before (2014-2019) and after (2020-2021) the introduction of SARS-CoV-2 in Mexico were calculated and compared. RESULTS: Before the introduction of SARS-CoV-2, the incidence rates of VBDs were high and after the introduction of coronavirus there was a decrease in epidemiological indices; however, there was only statistically significant difference in the incidence rate of malaria (p ≤ 0.05) and other rickettsiae (p ≤ 0.05). CONCLUSIONS: Some measures to reduce COVID-19 cases, such as social distancing, home confinement, reductions in public transport and working at home (home office), probably temporarily decreased the number of VBD cases; however, there may be a resurgence of VBDs in the near future.

INTRODUCCIÓN: La distribución espacial y temporal de la infección por SARS-CoV-2 sobrepasa las áreas endémicas de enfermedades transmitidas por vector (ETV), cuya vigilancia en México ha cambiado sustancialmente a partir del primer caso confirmado de COVID-19. OBJETIVOS: Estimar y comparar las tasas de incidencia de las ETV antes y después de la introducción del SARS-CoV-2 en México. MÉTODOS: Estudio retrospectivo de casos de ETV de 2014 a 2021. Las tasas de incidencia de cada ETV en el periodo previo (2014-2019) y posterior (2020-2021) a la introducción del SARS-CoV-2 en México fueron calculadas y comparadas. RESULTADOS: Antes de la introducción del SARS-CoV-2, las tasas de incidencia de las ETV fueron altas y posterior a la introducción del coronavirus hubo un descenso en los índices epidemiológicos; sin embargo, solo se identificó diferencia estadística significativa en la tasa de incidencia de la malaria (p ≤ 0.05) y otras rickettsias (p ≤ 0.05). CONCLUSIONES: Algunas medidas para reducir los casos de COVID-19, como el distanciamiento social, el confinamiento domiciliario, la reducción en el aforo en el transporte público y el trabajo en casa, probablemente contribuyeron a disminuir temporalmente el número de casos de las ETV; sin embargo, puede haber rebrote de las ETV en el futuro cercano.

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Intestinal amoebiasis and sequelae such as amoebic liver abscess are rarely reported in the era of modern medicine. Atypical presentation of amoebic liver abscess with high false-positive results on serology in endemic regions poses major diagnostic issues in the developing nations of the world. We report a case of amoebic liver abscess and describe the imaging appearances in a 59-year-old female. A detailed medical history was elicited to determine the etiology of amoebic liver abscess. Furthermore, the diagnosis was confirmed based on serological tests. Percutaneous aspiration of the amoebic liver abscess was performed, and treatment was initiated with intravenous metronidazole followed by diloxanide furoate. The patient has been on follow-up since three months with a negative stool examination and with no complaints of recurrence.

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BACKGROUND: Behçet's disease (BD), a chronic systemic vasculitis, has distinct geographical and ethnic variation. Data regarding the epidemiology of patients with BD in the U.S. are limited; therefore, we sought to describe BD patient characteristics and medication use in the U.S., and compared them with data from patients from endemic regions. METHODS: We conducted a cross-sectional study using data from the RISE registry (2014-2018). Patients aged ≥ 18 years with BD were included. Sociodemographic and treatment information was extracted. We compared patients from the RISE registry to data from other published studies of patients with BD from endemic areas. RESULTS: One thousand three hundred twenty-three subjects with BD from the RISE registry were included. Mean age was 48.7 ± 16.3 years, female to male ratio was 3.8:1, and 66.7% were White. The most frequently used medications included glucocorticoids (67.6%) and colchicine (55.0%). Infliximab and adalimumab were the most used biologics (14.5% and 14.1%, respectively); 3.2% of patients used apremilast. The RISE registry had more women (79.3%), and patients were older compared to previously published BD studies from endemic areas. Methotrexate and TNFi were more commonly reported in RISE (21.8% and 29.4%) compared to studies from Egypt and Turkey. Colchicine, cyclosporine, and cyclophosphamide were more commonly used in cohorts from Egypt, Turkey, and Iran. CONCLUSIONS: Findings from the largest BD dataset in the U.S. suggest that BD patients are predominantly female. Further research is needed to explore the reasons for the higher prevalence of BD among women in the U.S. and its possible impact on disease severity and management.

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OBJECTIVE: To evaluate the long-term outcome and prognostic factors of patients with nasopharyngeal carcinoma (NPC) from low-endemic regions of China who received definitive intensity-modulated radiation therapy (IMRT). METHODS: The clinical data from 608 patients with newly-diagnosed non-metastatic NPC who have received initial treatment at our cancer center from January, 2008 to December, 2013 were retrospectively reviewed. All patients received definitive IMRT, and 87.7% received platinum-based chemotherapy. RESULTS: The median follow-up duration was 51 months (follow-up rate, 98.5%; range, 10-106 months) for the entire cohort. The 5-year overall survival rate was 79.7%. The 5-year local relapse-free survival rate, regional relapse-free survival rate, distant metastasis-free survival rate and progression-free survival rate were 92.4%, 93.3%, 79.2% and 74.3%, respectively. A total of 153 patients had experienced treatment failure, with distant metastasis as the primary cause in 77.1% (118/153). Patients with T4 or N3 diseases had a significantly poorer prognosis than other subcategories. Stage T4 and N3 were closely associated with distant metastasis, with the metastatic rate of 29.3% and 45.5%, respectively. CONCLUSION: IMRT provides patients with non-metastatic NPC with satisfactory long-term survival. Both T stage and N stage are important prognostic factors for NPC patients. Patients with T4 or N3 diseases have significantly increased distant metastatic rates and poor survival time.

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COVID 19 has hardly left any part of the world untouched. Two hundred thirteen countries have been affected by this disease, with 17,208,324 cases and 670,626 deaths as of July 30, 2020. If we look at the death toll caused by Malaria, this year, it is closely nearing COVID 19 deaths, 5, 68,700 deaths. Malaria mostly occurs in poor, tropical, and subtropical regions across the globe. In 2018, Malaria was most rampant in Africa, followed by Southeast Asian Regions (SEAR). SEAR is at the greatest risk of both COVID 19 and malaria. Strategies for essential commodities and antimalarial activities are affected by COVID 19 when the rainy season registers the maximum malaria load. We searched the literature to explore the evidence regarding efficacious antimalarial activities and the gap created by the COVID 19 pandemic, responsible barriers, and challenges, with the possible approaches towards accomplishing a target for malaria control.

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BACKGROUND & OBJECTIVES: Anthrax is a zoonotic disease of public health concern in India. One of the key predisposing factors is linked to the behaviour of the community. This study was nested within a baseline survey to understand the risk perception, attitude, socio-cultural and behavioural practices among different communities in an anthrax endemic tribal district of Odisha, India. It was aimed to explore the systemic gaps from the officials of different departments while addressing the animal and human anthrax cases and the knowledge, attitude, and behavioural practices among the tribal communities with regards to both animal and human anthrax signs, symptoms, and transmission from animal to human. METHODS: A qualitative exploratory study was carried out in the district of Koraput, Odisha. Insights from eight focus group discussions (FGDs) and 42 in-depth-interviews (IDIs) with the stakeholders from health, veterinary, forest, general administrative departments and community were collected and analyzed thematically. RESULTS: Major themes that emerged were inter-departmental coordination, livestock vaccination, surveillance network, laboratory facilities, prevention and control strategies with regards to the animal and human anthrax cases. The study also emphasized setting up the surveillance system as per the standard guidelines, and strengthening the diagnostic facilities for timely detection of confirmed cases. It also highlighted the current needs and the gaps among inter-sectoral coordination, collaboration, and sensitization among Health, Veterinary, Forest, Education, Nutrition, and Tribal Welfare Departments at various levels to reduce the prevalence and control the outbreaks of anthrax in the district and State. INTERPRETATION & CONCLUSIONS: The coordination gaps, financial burden, insufficient relevant knowledge and information among the concerned stakeholders were the issues found in this study in addition to non-availability of proper diagnostic facility. The coordination among different departments adapting One Health approach may be one of the best possible ways for the elimination of anthrax cases in an endemic region.

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Non-tuberculous mycobacteria (NTM) are ubiquitous dwellers of environmental niches and are an established cause of natural and nosocomial infections. The incidence of NTM infections is rising owing to a growing population of immunocompromised and vulnerable individuals, complex medical and surgical procedures, as well as increased awareness and diagnostic capabilities. The prevalence of different NTM varies between continents, regions, and countries. The true global burden of pulmonary and extrapulmonary disease is unknown and estimates are subject to under and/or over-estimation. Diagnosis requires confirmation by isolation of NTM along with clinical and radiological criteria, which may be suboptimal at all levels. Susceptibility testing is complex and clinical breakpoints are not available for many of the drugs. Frequently, NTM infections are not considered until late in the course of disease. Improved and rapid detection of tuberculosis cases in high-burden countries has, however, also brought NTM infections into the limelight, and has identified a need for research efforts towards rapid diagnostic tests and the identification of biomarkers to monitor the treatment response in patients with NTM infections.

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BACKGROUND: Widal test is the most widely used laboratory investigation for diagnosis of typhoid. However, the test interpretation remains controversial in the context of endemic regions such as Bangladesh, as agglutination occurs at varied titrations among a large percentage of healthy population. Paired Widal tests are often not feasible; hence single unpaired test has to be used for screening, diagnosis and treatment. OBJECTIVE: We aimed to assess the normal range of baseline titre for Anti TO, TH, AO, AH, BO agglutinins among healthy population in an endemic country with a view to guide the researchers and the clinicians, facilitating further investigation on updating cut off points of single Widal test for screening and diagnosis of typhoid fever in the context of Bangladesh. METHODS: A cross-sectional study was carried out in Mymensingh Medical College, Bangladesh on 2925 male immigration applicants. A single blood sample was collected for Widal test and interpreted using standard guidelines. RESULTS: The highest baseline titer for Anti TO, TH, AO, AH, BO agglutinins among 95% of the healthy participants was found to be 1:80 for each respectively. A titre of 1: 40 was observed for BH antigen. CONCLUSION: In case of singular Widal test, baseline values for the normal range was found to be 1:20 - 1:80 for all the antigens (TO, TH, AO, AH, BO, BH), except BH, for which it was 1:20-1:40. Further studies, inclusive of other sociodemographic groups and positive controls are required to determine the updated cut off values.

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