Weil Felix Test: Principle, Procedure and limitation

Weil-Felix is a nonspecific agglutination test which detects anti-rickettsial antibodies in patient’s serum. Weil-Felix test is based on cross-reactions which occur between antibodies produced in acute rickettsial infections with antigens of OX (OX  19, OX 2, and OXK) strains of Proteus species.  Dilution of patient’s serum are tested against suspensions of the different Proteus strains.

Several rickettsiae, such as Rickettsia prowazekii, Rickettsia tsutsugamushi, and R. rickettsii, posses antigens that cross-react with antigens of OX strains of Proteus vulgaris.

Proteus OXK strain agglutinins are produced in scrub typhus and OX 2 and OX 19 agglutinins in other rickettsial diseases, see the table below

Organism Weil-Felix Reaction
OX 19 OX 2 OXK
R. prowazekii (Epidemic typhus) + + + +/-
R. typhi (Murine typhus) + + + +/-
R. tsutsugamushi (Scrub typhus) + + +
R. rickettsii (Rocky Mountain Spotted fever) +/ + + + +/ + + +


Limitation of Weil Felix test:

Both Sensitivity and specificity of weil-felix test is low, but its predictive value can be increased by testing both acute and convalescent phase samples and observing rise in antibody titre.

Weil-felix test has low sensitivity, i.e. its gives high percentage of false negative results. This is common in case of Scrub Typhus.

It also shows low specificity, i.e. false positive results are obtained in other diseases such as leptospirosis, and relapsing fever (diseases which require differentiating from rickettsial infections), in Proteus infections, brucellosis and acute febrile illness.