Skip to main content

Counts and cards – a novel way to detect typhoid infections in the ED


The diagnosis of typhoid fever is made by growth of the causative microorganism from culture of bone marrow aspirate or blood which is time dependent. In a busy ED like ours, typhoid fever is a frequent presentation. There is need for a rapid and reliable test made available at the bed side, to detect typhoid infections. The sensitivity and specificity of Enterocheck WB, a card test that detects IgM antibodies to salmonella typhi and low eosinophil counts were compared individually and together, with the gold standard of blood culture using BacT/Alert.


Setting - Multi specialty community based teaching hospital in Chennai with about 1500 ED visits per month

Number of subjects – 95.

Study design - Retrospective study done from January 2012 for a period of 1 year.


For 4 or lesser days of fever, typhoid IgM had sensitivity of 66.67%, specificity of 40%. For 5 or greater days of fever, sensitivity was 75.61%, specificity 50%.

Eosinophil count was persistently low (0.09%) in all typhoid cases irrespective of day of presentation of fever.

Sensitivity of a low eosinophil count was 100%, specificity being 14.8%.

In all culture positive cases, sensitivity of IgM and low eosinophil counts together was 100%. For all culture negative cases, specificity was 92.3%. So both IgM and eosinophil count together have a high specificity as well as sensitivity.


This was a retrospective study. Prospective study is awaited to reconfirm the results.


The typhoid IgM test can be performed at the bedside in the ED. Eosinophil count can be easily obtained from a CBC. In conjunction, they can accurately detect salmonella infections for early initiation of appropriate treatment in the ED itself, thereby saving time, money and precious hospital beds.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Parivalavan Rajavelu.

Rights and permissions

Open Access  This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.

The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

To view a copy of this licence, visit

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Mallick, P., Maddali, A., Thangalvadi, T. et al. Counts and cards – a novel way to detect typhoid infections in the ED. Int J Emerg Med 7, P1 (2014).

Download citation

  • Published:

  • DOI:


  • Typhoid Fever
  • Eosinophil Count
  • Bone Marrow Aspirate
  • Frequent Presentation
  • Causative Microorganism