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Counts and cards – a novel way to detect typhoid infections in the ED
International Journal of Emergency Medicine volume 7, Article number: P1 (2014)
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.
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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). https://doi.org/10.1186/1865-1380-7-S1-P1
- Typhoid Fever
- Eosinophil Count
- Bone Marrow Aspirate
- Frequent Presentation
- Causative Microorganism