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LETTER TO EDITOR  
Year : 2013  |  Volume : 5  |  Issue : 1  |  Page : 34
Utility of c-reactive protein in febrile children with clinically undetectable serious infection


University College of Medical Sciencses and Guru Tegh Bahadur Hospital, Delhi, India

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Date of Web Publication14-Feb-2013
 

How to cite this article:
Grover A, Mittal H, Faridi M M, Sikka M, Singh NP. Utility of c-reactive protein in febrile children with clinically undetectable serious infection. J Global Infect Dis 2013;5:34

How to cite this URL:
Grover A, Mittal H, Faridi M M, Sikka M, Singh NP. Utility of c-reactive protein in febrile children with clinically undetectable serious infection. J Global Infect Dis [serial online] 2013 [cited 2020 Aug 10];5:34. Available from: http://www.jgid.org/text.asp?2013/5/1/34/107174


Sir,

We aimed to study the utility of C-Reactive Protein (CRP) in detecting serious bacterial infection (SBI) in children with fever as there is sparse data available, especially in India. [1],[2],[3],[4] One hundred and nine children (1-36 months of age) with fever (≥ 39΀C; < 7 days) without any focus of infection were enrolled in this prospective cohort study. Those with recent vaccination, immunodeficiency and antibiotic use were excluded. Investigations included Total Leukocyte Count (TLC) and Absolute Neutrophil Count (ANC) (Coulter MS 93 and Micros 60), Band count, CRP (Teco Diagnostics , USA), urinalysis and blood culture. Twenty-one children had SBI (Occult Bacteremia (OB)-10, Urinary Tract Infection (UTI)-6, pneumonia-3, meningitis-1 and enteric fever-1). Higher incidence of SBI suggests higher infection rate. [5] Main organisms found on cultures were Staphylococcus aureus(5), Staphylococcus epidermidis(3), Enterobacter faecalis(1) and Klebsiella species(1) for OB; Escherichia coli(5) and Citrobacter(1) for UTI and Acinetobacter species in meningitis. Duration of temperature, CRP and band count were significantly higher in children with SBI as compared to those without SBI (P value < 0.05) The two groups were not significantly different in characteristics like age, sex, degree of fever, TLC, ANC, and Yale observation score. Higher CRP suggests greater inflammatory response in SBI. CRP had higher sensitivity (95.2%) and negative predictive values (95%) than TLC, ANC and band count. The area under the Receiver Operating Characteristic curve (SE, 95% CI) was highest for CRP 0.7 (0.07; 0.550-0.841) and statistically significant (P value = 0.01). CRP> 12.8 mg/dL (multilevel likelihood ratio analysis-P value < 0.001) was highly significant in predicting SBI in our study which is comparable to other reports. [2] Thus, CRP may serve as a rapid screening tool in early recognition and management of children with SBI.

 
   References Top

1.Isaacman DJ, Burke BL. Utility of the serum C-reactive protein for detection of occult bacterial infection in children. Arch Pediatr Adolesc Med 2002;156:905-9.  Back to cited text no. 1
    
2.Pullian PN, Attia MW, Cronan KM. C Reactive protein in febrile children 1-36 months of age with clinically undetectable serious bacterial infections. Pediatrics 2001;108:1275-9.  Back to cited text no. 2
    
3.Lacour AG, Gervaix A, Zamora SA. Procalcitonin, IL-6, IL-8, IL-1 receptor antagonist and C-reactive protein as indicators of serious bacterial infections in children with fever without localizing infections. Eur J Pediatr 2001;160:95-100.  Back to cited text no. 3
    
4.Kohli V, Singhi S, Sharma P, Ganguly N. Value of C-reactive protein in febrile children without apparent focus. Ann Trop Paediatr 1993;13:373-8.  Back to cited text no. 4
    
5.Sharma M, Goel N, Chaudhary U, Aggarwal R, Arora DR. Bacteraemia in children. Indian J Pediatr 2002;69:1029-32.  Back to cited text no. 5
    

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Correspondence Address:
Abhinav Grover
University College of Medical Sciencses and Guru Tegh Bahadur Hospital, Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-777X.107174

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2008 Journal of Global Infectious Diseases | Published by Wolters Kluwer - Medknow
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