Global estimate of Typhoid fever is 21 million cases annually, resulting in an estimated 216,000 - 600,000 deaths per year, predominantly in children of school age or younger, the majority of which is in Asia [1]. It is one of the most common infectious diseases prevalent in India. In 2014 the reported data showed 1.7 million cases and 429 deaths. Maximum cases were reported from Bihar (273,0007 cases with four deaths). Many cases were reported from Andhra Pradesh (186,446 cases and five deaths)[1]. Children are disproportionately affected by Typhoid fever, with a peak incidence between 5 to 15 years of age [2]. It is a life-threatening systemic infection caused by salmonella typhi usually transmitted through the feaco-oral route. Similar but often less severe disease,paratyphoid fever,is caused by Paratyphi A,BorC[2].

Early and prompt diagnosis of Typhoid is mandatory among children. With the increasing use of antibiotics, the clinical presentation is nonspecific and difficult to diagnose clinically. Since the clinical scenarios of common infections like Malaria, Typhoid, Leptospirosis and Scrub are very similar, it is very difficult for treating physicians to recognise Typhoid fever based on clinical features. Hence it is mandatory to have a valid diagnostic test with good sensitivity and specificity for early detection of enteric fever in children [3]. Although blood culture is the gold standard investigation, it is cumbersome and requires elaborate laboratory equipment. Sensitivity is also affected by the amount of blood obtained for culture. It is further reduced with the starting of antimicrobial therapy before confirmation of the diagnosis [4]. Recent advances in immunology have led to the discovery of rapid, reliable, easy perform the serological test with higher sensitivity and specificity. Typhidot is one such serological test available for rapid diagnosis[5]. A simple bedside test like Diazo which has served in epidemic situations in the past should also be re-evaluated for patients in rural or remote health settings. Diazo test becomes positive from day 5 of fever and remains positive till day 31 of fever. The average duration of test positivity was 6 to 16 days of fever [6]. We would like to compare the sensitivity and specificity of the Typhidot M and Diazo test with the blood culture as the gold standard in the early diagnosis of Typhoid fever.

Though typhoid fever is a common infection in children, it is difficult to diagnose because of its nonspecific symptoms and signs. However, it is necessary to diagnose early to initiate appropriate antibiotic therapy because a delay in starting antibiotic treatment may lead to several morbidities and even death. The gold standard for diagnosing typhoid fever has always been the blood culture method. Still, it is time-consuming, requires elaborate laboratory equipment and a level of technical expertise which may not be present in resource-poor laboratories. This delay may result in complications of typhoid fever.

The majority of the patients (50%) were in the age group of 6-10 years which is similar to the study done by Devaranavadagi RA et al. [7]. Where the most common age group was 5-10 years, in our study majority of children (46%) belonged to the lower class. This is in conjunction with the observation made by Rasaily R et al. [8], where most cases came from lower socio-economic classes with poor personal hygiene.

In our study, 26% of the cases were positive by blood culture, which is more or less comparable to the observations made by Retnosari S et al. [9] and Yadav et al. [10], who has reported 24% positivity and 28.5% positivity respectively for blood culture. The comparatively lower sensitivity of blood culture may be because of the ridiculous use of antimicrobial agents and difficulty drawing the required quantity of blood for cultures in children. It has been observed in the current study that 33% of the cases were positive by Typhidot M test, which is found to be consistent with 32.4% reported by Mehmoodet al [11]. and 50.4% reported by Udayakumar et al [12].