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C reactive protein in the evaluation of febrile illness
Insights
Serum C-reactive protein (CRP) levels help diagnose infections in children. A CRP level above 40 mg/L effectively identifies bacterial infections in children ill for over 12 hours.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Chemistry
Background:
- Febrile illnesses in children require accurate diagnosis.
- Differentiating viral from bacterial infections is crucial for appropriate treatment.
- Serum C-reactive protein (CRP) is a biomarker used in infection assessment.
Purpose of the Study:
- To evaluate the diagnostic utility of quantitative serum C-reactive protein (CRP) concentrations in febrile children.
- To determine the threshold of CRP for distinguishing bacterial from viral infections.
Main Methods:
- Prospective study of 154 febrile children (excluding specific conditions and age groups).
- Comparison with 75 children with confirmed bacterial infections.
- Analysis of CRP levels in relation to infection type and symptom duration.
Main Results:
- A CRP level greater than or equal to 40 mg/L detected 79% of bacterial infections with 90% specificity.
- In children ill for over 12 hours, CRP < 20 mg/L indicated viral infection.
- Septic infections with CRP ≤ 20 mg/L occurred only when symptoms were < 12 hours.
Conclusions:
- Serum CRP concentration is a valuable tool for evaluating febrile children, especially those ill for more than 12 hours.
- CRP levels, combined with symptom duration, aid in differentiating bacterial from viral infections.
- A CRP threshold of ≥ 40 mg/L shows high sensitivity and specificity for bacterial infections in this population.
Abstract:
We studied prospectively 154 febrile children to determine the diagnostic value of the quantitative serum C reactive protein concentrations (CRP). Children with acute otitis media, acute tonsillitis, or treated with antibiotics during the two previous weeks and infants less than 2 months of age were excluded. Ninety seven children were from private paediatric practice and 57 were patients who had been admitted to hospital. The comparison group consisted of 75 children with confirmed bacterial infections whose CRP values were recorded retrospectively. In the study group 35 (23%) children had a confirmed viral infection, 92 (59%) had a probable viral infection as judged from the clinical picture and outcome of the illness, and 27 (18%) had a bacterial or probable bacterial infection. When the duration of the disease was more than 12 hours and the CRP value less than 20 mg/l, all children had a confirmed or probable viral infection. Nine children (one from the study group and eight from the comparison group) were found to have a septic infection and a CRP value of 20 mg/l or less. In all these cases, however, the duration of the symptoms was less than 12 hours. In addition CRP less than or equal to 20 mg/l was found in five (14%) children with urinary tract infection in the comparison group. CRP values of 20-40 mg/l were recorded in children with both viral and bacterial infections. A CRP value greater than or equal to 40 mg/l detected 79% of bacterial infections with 90% specificity. Our data show that determination of serum CRP concentrations is a valuable tool in evaluating children who have been ill for more than 12 hours.