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Serum C-reactive protein concentrations in Malaysian children with enteric fever
K E Choo1, T M Davis, R L Henry
1Department of Pediatrics, Hospital Universiti Sains Malaysia, Kelantan.
Insights
Serum C-reactive protein (CRP) is highest in children with confirmed typhoid fever. While elevated CRP reflects the immune response, it has limited diagnostic accuracy for typhoid fever in children.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Chemistry
- Diagnostic Microbiology
Background:
- Typhoid fever diagnosis in children can be challenging, especially in resource-limited settings.
- Serum C-reactive protein (CRP) is a marker of inflammation, but its utility in diagnosing typhoid fever requires further investigation.
Purpose of the Study:
- To evaluate the role of serum C-reactive protein (CRP) in diagnosing typhoid fever among febrile Malaysian children.
- To assess the diagnostic performance of serum CRP compared to culture and clinical diagnosis.
Main Methods:
- A study involving 227 febrile children, categorized into culture-positive Salmonella typhi, culture-negative typhoid, and non-typhoidal illness groups.
- Serum CRP levels were measured and analyzed using regression and receiver-operator characteristic (ROC) analyses.
- Comparison of CRP levels across groups and assessment of sensitivity, specificity, and area under the curve (AUC).
Main Results:
- Children with culture-positive typhoid fever exhibited significantly higher serum CRP levels compared to other groups.
- Serum CRP showed a positive association with Widal agglutinin titres in culture-positive patients.
- Serum CRP demonstrated low sensitivity (68%) and specificity (58%) for diagnosing typhoid fever, with an AUC of 0.65.
Conclusions:
- Elevated serum CRP is indicative of enteric fever and reflects the immune response in culture-positive children.
- Serum CRP has limited value as a standalone diagnostic test for typhoid fever due to low sensitivity and specificity.
- Raised serum CRP may serve as an adjunctive marker in assessing febrile children in typhoid-endemic areas.
Abstract:
To investigate the role of serum C-reactive protein (CRP) in the diagnosis of typhoid fever, we studied 227 febrile Malaysian children hospitalized during a 12-month period. The children were: culture-positive for Salmonella typhi (Group 1; n = 108); culture-negative but with typical clinical features of typhoid fever (Group 2; n = 60); or had non-typhoidal illness (Group 3; n = 59). Group 1 children had the highest serum CRP concentrations (geometric mean [SD range]; 43 [12-150] mg/l vs. 26 [8-85] mg/l in Group 2 and 21 [4-110] mg/l in Group 3; p < 0.001). In regression analysis, age, patient group and fever duration were independently associated with serum CRP (p < 0.05) but gender was not. In Group 1 patients, there was a significant positive association between serum CRP and Widal O and H agglutinin titres. In receiver-operator characteristic (ROC) analysis of serum CRP for Groups 1 and 2 combined, compared with Group 3, the area under the curve (AUC) was 0.65. These data show that the serum CRP is highest in culture-positive children with enteric fever and reflects the immune response to the infection in this group. Nevertheless, serum CRP had relatively low sensitivity and specificity for confirmed or clinically diagnosed typhoid fever (68 and 58 per cent, respectively at 'cut-off' concentration 30.0 mg/l), and an AUC value only moderately above that associated with no predictive power (0.5). Although of limited use as a primary diagnostic test, a raised serum CRP may still have a place as one of a range of features that facilitate assessment of a febrile child in a typhoid-endemic area.