Diagnostic utility of C reactive protein and widal test with hematological parameters for sepsis in children attending a tertiary care hospital, South India

Dhananjaya C.D, Sunil B.N.


Background: Sepsis is a major problem in Children and Clinical criteria alone could not establish the diagnosis of childhood sepsis. It is extremely important to make an early diagnosis of sepsis for the prompt institution of anti-microbial therapy, which improves outcomes. Objective: The aim of this study is to determine the diagnostic utility of C - reactive protein (CRP) in combination with hematological parameters of CBC as early diagnostic marker in detection infections in children. Methodology: This prospective study was conducted on children attending pediatric OPD or admitted as inpatient at Oxford Medical College Hospital, Bengaluru, Karnataka. Blood specimens were obtained from each child prior to commencement of antibiotics for sepsis work up and subjected to CBC, CRP and Widal test. Results: 274 (54.4%) out of 503 children were boys and majority 77.9% of the study population were belonging to Under 5 age group. The mean difference observed between the groups of CRP positive and negative children for all the components of the Complete Blood Count was statistically significant except for Monocytes and Eosinophils which tells that these variables were significant predictors of sepsis in the children. Conclusion: The combination of total WBC count along with CRP could be a reliable diagnostic tool to detect the presence of Infections in children. Routine ordering of CRP for detection of Infection in febrile children will increase the probability of correct diagnosis and help the pediatrician in more accurate and effective management of sepsis in children.

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Balmuth F, Henretig FM, Alpern ER. Fever. In: RG Bachur& KN Shaw (eds.) Fleisher & Ludwig’s Textbook of Pediatric Emergency Medicine, 7th edition. Lippincott Williams and Wilkins. Philadelphia, PA, USA.2016. p. 176- 85.

Harper MB. Update on the management of the febrile infant. Clinic PediatEmerg Med. 2004;5(1):5-12.DOI: https://doi.org/10.1016/j.cpem.2003.11.008

Abrahamsen SK, Haugen CN, Rupali P, Mathai D, Langeland N, Eide GE et al. Fever in the tropics: aetiology and case-fatality-a prospective observational study in a tertiary care hospital in South India. BMC InfectDis. 2013;13(1):355. DOI: 10.1186/1471-2334-13-355.

Singhi S, Chaudhary D, Varghese GM, Bhalla A, Karthi N, Kalantri S, Peter JV, Mishra R, Bhagchandani R, Munjal M, Chugh TD. Tropical fevers: Management guidelines. Indian J Critical Care Med: Indian Soc Critical Care Med. 2014;18(2):62. DOI: 10.4103/0972-5229.126074.

Ansar W, Ghosh S. C-reactive protein and the biology of disease. Immunol Res. 2013;56(1):131-42. DOI: 10.1007/s12026-013-8384-0.

Lima-Junior JC, Rodrigues-da- Silva RN, Pereira VA, Storer FL, Perce-da-Silva DS, Fabrino DL, et al. Cells and mediators of inflammation (C-reactive protein, nitric oxide, platelets and neutrophils) in the acute and convalescent phases of uncomplicated Plasmodium vivax and Plasmodium falciparum infection.Mem Inst Oswaldo Cruz. 2012;107 (8):1035-41. DOI:10.1590/s0074-02762012000800012.

Dong Q, Wright JR. Expression of C-reactive protein by alveolar macrophages. J Immunol. 1996 Jun 15;156 (12):4815-20.

Harpaz R, Edelman R, Wasserman SS, Levine MM, Davis JR, Sztein MB. Serum cytokine profiles in experimental human malaria. Relationship to protection and disease course after challenge. J Clin Invest. 1992; 90 (2):515-23. DOI:10.1172 /JCI115889

Chandrashekara S. C-reactive protein: An inflammatory marker with specific role in physiology, pathology, and diagnosis. Internet J Rheumatol Clinic Immunol. 2014 30;2(S1).

Gillespie SH, Dow C, Raynes JG, Behrens RH, Chiodini PL, McAdam KP. Measurement of acute phase proteins for assessing severity of Plasmodium falciparum malaria. J Clinic Pathol. 1991;44(3):228-31.DOI:10.1136/jcp.44.3.228

Hurt N, Smith T, Tanner M, Mwankusye S, Bordmann G, Weiss NA, et al. Evaluation of C-reactive protein and haptoglobin as malaria episode markers in an area of high transmission in Africa. Trans R Soc Trop Med Hyg. 1994;88 (2):182-6. DOI:10.1016 /0035-9203 (94) 90287-9

Clark IA, Budd AC, Alleva LM, Cowden WB. Human malarial disease: a consequence of inflammatory cytokine release. Malar J. 2006;5:85. DOI: 10.1186 /1475-2875-5-85

Utuk Eno-ObongEdet, I.E.E., Udo Jacob Jackson, Okpokowuruk Frances Samuel. Relationship between Serum C-reactive Protein Levels and Severity of Plasmodium falciparum Malaria in Children Seen in South Nigeria. Int J Trop Dis Health, 2014;4(10):1078-1087.

Pulliam PN, Attia MW, Cronan KM. C-reactive protein in febrile children 1 to 36 months of age with clinically undetectable serious bacterial infection. Pediat. 2001;108(6):1275-9.

Andreola B, Bressan S, Callegaro S, Liverani A, Plebani M, Da Dalt L. Procalcitonin and C-reactive protein as diagnostic markers of severe bacterial infections in febrile infants and children in the emergency department. Pediatr Infect Dis J. 2007;26 (8): 672-7. DOI: 10.1097/INF.0b013e31806215e3

Olaciregui I, Hernández U, Muñoz JA, Emparanza JI, Landa JJ. Markers that predict serious bacterial infection in infants under 3 months of age presenting with fever of unknown origin. Arch Dis Child. 2009;94 (7):501-5. DOI: 10.1136/adc.2008.146530. Epub 2009 Jan 21.

Olaciregui I, Hernández U, Muñoz JA, Emparanza JI, Landa JJ. Markers that predict serious bacterial infection in infants under 3 months of age presenting with fever of unknown origin. Arch Dis Child. 2009;94 (7):501-5. DOI: 10.1136/adc.2008.146530. Epub 2009 21.

Kossiva L, Gourgiotis DI, Douna B, Marmarinos A, Sdogou T, Tsentidis C. Composite bacterial infection index in the evaluation of bacterial versus viral infection in children: A single centre study. PediatTherapeut. 2014;4(2).DOI: 10.4172/2161-0665. 1000203

Bhat YR, Rao A. The performance of haematological screening parameters and CRP in early onset neonatal infections. J Clinic Diagnos Res. 2010 30;4 (6):3331-6.

Abhilasha Garg, Dr Chandan Kr. Agrawal, Dr Narendra Mogra, Pooja Kanwat, Dr AbhaPatni. Haematological Parameters in Neonatal Sepsis. J Med Sci Clinic Res 2015;3(10):8102-8108.

Kishore P, Dayanand K, Chandrashekar V, Mukhi B, Ghosh S, Kumari S, Gowda D, Achur R. C-reactive protein levels as a potential diagnostic marker during malarial infections. Europe J Pharmaceut Med Res. 2018;5(5):361-7.


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