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Interferon-alpha in viral and bacterial gastroenteritis: a comparison with C-reactive protein and interleukin-6
P Mangiarotti1, F Moulin, P Palmer
1Department of Pediatrics, Hopital Saint Vincent de Paul, Paris, France.
Insights
Serum markers like CRP and IL-6 are not reliable for distinguishing bacterial from viral acute diarrhea in children. Interferon-alpha shows promise but has a slow detection time, making it impractical for emergency cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Chemistry
Background:
- Acute diarrhea in children poses a diagnostic challenge, necessitating differentiation between bacterial and viral etiologies.
- Accurate etiological diagnosis is crucial for appropriate clinical management and antibiotic stewardship.
Purpose of the Study:
- To evaluate the utility of serum biomarkers, including C-reactive protein (CRP), interleukin-6 (IL-6), and interferon-alpha (INF-alpha), in differentiating bacterial from viral causes of acute diarrhea in hospitalized children.
Main Methods:
- Serum samples from 119 children hospitalized with acute diarrhea were analyzed for CRP, IL-6, and INF-alpha levels.
- Patients were categorized based on confirmed rotavirus (viral) or bacterial (Salmonella, Shigella, Campylobacter) infections.
Main Results:
- Elevated CRP (>10 mg/l) was observed in 48.3% of viral and 86.4% of bacterial cases. Elevated IL-6 (>100 pg/ml) was found in 11.7% of viral and 26.3% of bacterial cases.
- Interferon-alpha was detected in 79.1% of viral cases (sensitivity 79%) and 3.5% of bacterial cases (specificity 93%).
- The 48-hour turnaround time for INF-alpha testing limits its clinical utility, as stool pathogen identification is often faster.
Conclusions:
- Serum markers, including CRP, IL-6, and INF-alpha, demonstrate insufficient discriminatory power for rapid differentiation between bacterial and viral gastroenteritis in emergency pediatric settings.
- Current serum biomarkers are not adequate for definitive etiological diagnosis in acute pediatric diarrhea during initial clinical encounters.
Abstract:
The aim of the study was to identify serum markers able to differentiate bacterial and viral origin in acute diarrhoea. Interferon-alpha (INF-alpha), C-reactive protein (CRP) and interleukin-6 were determined on admission in the sera of 119 children aged between 1 mo and 14 y who were hospitalized for rotavirus (n = 60) or bacterial diarrhoea (Salmonella spp. 39 cases, Shigella spp. 15 cases, Campylobacter jejuni 5 cases). CRP concentration was >10 mg/l in 48.3% of children with viral gastroenteritis and 86.4% of children with bacterial gastroenteritis. IL6 concentration was >100 pg/ml in 11.7% and 26.3% of cases, respectively. INF-alpha was detected in 79.1% of children with rotavirus (sens 79%) and in 3.5% (spec 93%) with bacterial gastroenteritis. However the INF-alpha assay takes 48 h and pathogens are often identified from stools before interferon results are available. We found that serum markers are not discriminating enough to differentiate between viral and bacterial gastroenteritis in emergency cases.