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Value of serum C-reactive protein concentrations in febrile children without apparent focus
1Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Serum C-reactive protein (CRP) effectively differentiates bacterial infections from non-bacterial illnesses in febrile children. A falling CRP level indicates recovery, often before temperature normalizes.
Area of Science:
- Pediatrics
- Infectious Diseases
- Biochemistry
Background:
- Febrile children without a clear infection source pose diagnostic challenges.
- Differentiating bacterial from non-bacterial illnesses is crucial for appropriate treatment.
- Serum C-reactive protein (CRP) is a potential biomarker for infection severity.
Purpose of the Study:
- To evaluate serum CRP's utility in distinguishing bacterial infections (including bacteremia) from non-bacterial illnesses (NBI) in young febrile children.
- To assess serum CRP as an indicator of treatment response, recovery, or complications.
- To determine the diagnostic accuracy of serum CRP levels for bacteremia.
Main Methods:
- Prospective study of 100 febrile children (age ≤ 3 years) without an apparent focus of infection.
- Serum CRP levels measured on days 1, 3, and 5.
- Correlation of CRP levels with final diagnosis (bacteremia, meningitis, UTI, otitis media, NBI) and clinical outcome.
Main Results:
- Serum CRP ≥ 40 mg/l was present in 95% of bacteremia cases and 7 of 8 meningitis cases.
- 84% of non-bacterial illness (NBI) cases had CRP < 40 mg/l (mean 22 mg/l).
- CRP levels for urinary tract infections and otitis media were similar to NBI cases.
- Sensitivity for bacteremia was 95% with a 67% positive predictive value.
- A declining CRP trend indicated recovery and therapeutic response earlier than temperature changes.
Conclusions:
- Serum CRP is a valuable tool for differentiating bacterial infections from NBI in febrile children.
- Elevated CRP levels strongly suggest bacteremia or serious bacterial infections.
- Serial CRP monitoring is a sensitive indicator of treatment efficacy and patient recovery.
Abstract:
We examined the value of serum C-reactive protein (CRP) in febrile children without an apparent focus of infection, (i) as a tool to differentiate bacteraemia and bacterial infection from a non-bacterial illness (NBI), and (ii) as an indicator of recovery or complications. Included in the study were 100 children up to the age of 3 years with a temperature of > or = 38.5 degrees C, without an apparent focus. The serum CRP concentration was measured on days 1, 3 and 5 of evaluation and correlated with the final diagnosis and outcome. The serum CRP was 40 mg/l and above in 95% of patients (18/19) with bacteraemia and also in seven of the eight with purulent meningitis, while it was < 40 mg/l in 84% of patients (52/62) with NBI (mean (SD) 22 (28.6) mg/l). The mean serum CRP concentration among six children with a culture-positive urinary tract infection (16.3 (8.3) mg/l) and five with otitis media (9 (5.7) mg/l) was similar to those with NBI. The sensitivity of serum CRP > or = 40 mg/l for diagnosis of bacteraemia was 95% and the positive predictive value 67%. On serial monitoring, a fall in the CRP concentration was a sensitive indicator of recovery from infection and provided the earliest clue to therapeutic response long before a fall in temperature.