Validation of ALT, Quantitative CRP and Eosinopenia as Surrogate Diagnostic Markers for Typhoid Fever

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Objective: To evaluate the diagnostic accuracy of alanine aminotransferase (ALT), quantitative C-reactive protein (CRP), and eosinopenia as surrogate markers for typhoid fever in patients admitted to Medical A Ward, Tertiary Care Hospital, Mardan. Methodology: A hospital based observational diagnostic study was conducted from October 2024 to April 2025. A total of 180 patients with suspected enteric fever were enrolled using consecutive sampling. Blood culture was used as the gold standard for confirmation of typhoid fever. Clinical and laboratory data including ALT, quantitative CRP, and eosinophil counts were analysed. Statistical analysis was performed using chi square test, descriptive statistics, and p value <0.05 was considered significant. Results: Out of 180 patients, 113(62.8%) were males and 67(37.2%) were females. Blood culture confirmed typhoid fever in 53(29.4%) patients. Mean age was 45.02±17.01 years, mean CRP was 49.41±23.05 mg/L, mean ALT was 55.02±31.16 U/L, and mean eosinophil count was 0.088±0.046×10⁹/L. Elevated CRP was found in 167(92.8%) patients, elevated ALT in 119(66.1%), and eosinopenia in 25(13.9%). No significant association was found between CRP elevation and typhoid fever (χ²=0.043, p=0.836), ALT elevation (χ²=0.035, p=0.852), or eosinopenia (χ²=0.166, p=0.684). Conclusion: ALT, quantitative CRP, and eosinopenia showed limited diagnostic value as standalone surrogate markers for typhoid fever in this cohort. These biomarkers should be used only as supportive tools alongside clinical judgement and microbiological confirmation in endemic settings.

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