C-reactive protein velocity discriminates between acute viral and bacterial infections in patients who present with relatively low CRP concentrations

Abstract Background To assess the utility of C-reactive protein (CRP) velocity to discriminate between patients with acute viral and bacterial infections who presented with relatively low CRP concentrations and were suspected of having a bacterial infection. Methods We analyzed a retrospective cohort of patients with acute infections who presented to the emergency department (ED) with a relatively low first CRP measurement (CRP1) ≤ 31.9 mg/L and received antibiotics shortly after. We then calculated C-reactive protein velocity (CRPv), milligram per liter per hour, for each patient based on CRP1 and the second CRP value (CRP2) measured within the first 24 h since admission. Finally, we compared CRPv between patients with bacterial and viral infections. Results We have presently analyzed 74 patients with acute bacterial infections and 62 patients with acute viral infections at the mean age of 80 and 66 years respectively, 68 male and 68 female. CRP1 did not differ between both groups of patients (16.2 ± 8.6 and 14.8 ± 8.5 for patients with viral and bacterial infections respectively, p value = 0.336). However, the CRP2 was significantly different between the groups (30.2 ± 21.9 and 75.6 ± 51.3 for patients with viral and bacterial infections respectively, p-value < 0.001) and especially the CRPv was much higher in patients with acute bacterial infections compared to patients with acute viral infections (0.9 ± 1.2 and 4.4 ± 2.7 respectively, p-value < 0.001). Conclusion CRPv and CRP2 are useful biomarkers that can discriminate significantly between patients who present with acute bacterial and viral infections, and relatively low CRP concentration upon admission who were suspected of having a bacterial infection.

Download Full-text

Monitoring both serum amyloid protein A and C-reactive protein as inflammatory markers in infectious diseases

Clinical Chemistry ◽

10.1093/clinchem/39.2.293 ◽

1993 ◽

Vol 39 (2) ◽

pp. 293-297 ◽

Cited By ~ 79

Author(s):

T Nakayama ◽

S Sonoda ◽

T Urano ◽

T Yamada ◽

M Okada

Keyword(s):

Inflammatory Markers ◽

Bacterial Infections ◽

Viral Infections ◽

Protein A ◽

Acute Stage ◽

Serum Amyloid ◽

Amyloid Protein ◽

C Reactive Protein ◽

Reactive Protein ◽

The Mean

Abstract We examined serum amyloid protein A (SAA) and C-reactive protein (CRP) as inflammatory markers of viral and bacterial infections. Both acute-phase reactants increased in the acute stage and thereafter decreased in the convalescent stage. In viral infections, the mean serum concentrations of SAA during the acute stage were 141 mg/L in infections with adenovirus, 77 mg/L with measles virus, 63 mg/L with influenza virus, 55 mg/L with parainfluenza virus, 31 mg/L with respiratory syncytial virus, and 31 mg/L in aseptic meningitis. The mean serum concentration of CRP was 19 mg/L for adenovirus infection and < 7 mg/L in all other viral infections. The SAA concentrations were 5- to 11-fold greater than the CRP concentrations. Both the SAA and the CRP concentrations were higher in bacterial infections than in viral infections. Changes in the concentrations of serum SAA paralleled those in serum CRP in bacterial infection; during the course of viral infection, however, serum SAA tended to disappear more quickly than CRP did. SAA appears to be a clinically useful marker of inflammation in acute viral infections, with or without significant changes in the CRP concentration.

Download Full-text

Cytokines and Chemokines as Biomarkers of Community-Acquired Bacterial Infection

Mediators of Inflammation ◽

10.1155/2013/190145 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 27

Author(s):

Michal Holub ◽

David A. Lawrence ◽

Nancy Andersen ◽

Alžběta Davidová ◽

Ondřej Beran ◽

...

Keyword(s):

Bacterial Infection ◽

Bacterial Infections ◽

Viral Infections ◽

Elevated Serum ◽

Serum Concentrations ◽

C Reactive Protein ◽

Reactive Protein ◽

Cytokines And Chemokines ◽

Luminex Technology ◽

Limited Usefulness

Routinely used biomarkers of bacterial etiology of infection, such as C-reactive protein and procalcitonin, have limited usefulness for evaluation of infections since their expression is enhanced by a number of different conditions. Therefore, several inflammatory cytokines and chemokines were analyzed with sera from patients hospitalized for moderate bacterial and viral infectious diseases. In total, 57 subjects were enrolled: 21 patients with community-acquired bacterial infections, 26 patients with viral infections, and 10 healthy subjects (control cohorts). The laboratory analyses were performed using Luminex technology, and the following molecules were examined: IL-1Ra, IL-2, IL-4, IL-6, IL-8, TNF-α, INF-γ, MIP-1β, and MCP-1. Bacterial etiology of infection was associated with significantly (P<0.001) elevated serum concentrations of IL-1Ra, IL-2, IL-6, and TNF-αin comparison to levels observed in the sera of patients with viral infections. In the patients with bacterial infections, IL-1Ra and IL-8 demonstrated positive correlation with C-reactive protein, whereas, IL-1Ra, TNF-α, and MCP-1 correlated with procalcitonin. Furthermore, elevated levels of IL-1Ra, IL-6, and TNF-αdecreased within 3 days of antibiotic therapy to levels observed in control subjects. The results show IL-1Ra as a potential useful biomarker of community-acquired bacterial infection.

Download Full-text

Thrombocytosis as a Predictor of Serious Bacterial Infection in Febrile Infants

Journal of Nepal Health Research Council ◽

10.33314/jnhrc.v16i41.1673 ◽

2019 ◽

Vol 16 (41) ◽

pp. 401-404

Author(s):

Deepak Mishra ◽

Amit Kumar Das ◽

Ram Hari Chapagain ◽

Nitu Kumari Jha ◽

Ganesh Kumar Rai

Keyword(s):

Bacterial Infection ◽

Bacterial Infections ◽

Diagnostic Marker ◽

Common Finding ◽

P Value ◽

C Reactive Protein ◽

Cross Sectional ◽

Reactive Protein ◽

Young Infants

Background: Most of the febrile infants <90 days old will have no more than a mild viral infection but there is a substantial minority that will be diagnosed as having serious bacterial infection at a reported prevalence of 10–14%. A simple, readily available, inexpensive diagnostic marker that yields results quickly and also accurately identifies bacterial infections in febrile infants would be of great value in management of these infants. This study aims to assess the role of thrombocytosis in predicting serious bacterial infection in young febrile infants beyond neonatal period.Methods: A hospital based cross-sectional observational study was conducted from May 2016 to April 2017 on 76 febrile infants of age group 29-90 days in Kanti Children’s Hospital.Results: The incidence of serious bacterial infection was found 43 (56.6%). Thrombocytosis, elevated C-reactive protein and pyuria were significantly higher in serious bacterial infection cases (p value <0.05). Thrombocytosis alone had the sensitivity of only 53.5%, but had specificity of 90.9%. Elevated C-reactive protein had the best sensitivity (81.4%). Combination of leukocytosis, elevated C-reactive protein, pyuria and thrombocytosis had better sensitivity (93.0%) than these parameters alone. The overall ability of platelet count to identify infants with SBI was only moderate (AUC: 0.722). Elevated C-reactive protein was found to have better ability to identify infants with serious bacterial infection (AUC: 0.846).Conclusions: Thrombocytosis is a common finding in young infants diagnosed with serious bacterial infection. It has however, moderate ability in identifying infants with serious bacterial infection. Combining thrombocytosis with elevated C-reactive protein, leukocytosis and pyuria has better sensitivity in diagnosing serious bacterial infection than these individual parameters alone. Hence, combining these parameters may help in early prediction of febrile young infants at risk of serious bacterial infection.Keywords: Febrile young infants; serious bacterial infection; thrombocytosis.

Download Full-text

Procalcitonin Serum Level in Patients Aged 3-36 Months With Focal Fever Referred to Hospitals in Western Iran in 2020

Avicenna Journal of Clinical Microbiology and Infection ◽

10.34172/ajcmi.2021.18 ◽

2021 ◽

Vol 8 (3) ◽

pp. 98-101

Author(s):

Ali Keramati ◽

Sahereh Garaei ◽

Shiva Roshankhah ◽

Mojtaba Esmaeli

Keyword(s):

Serum Level ◽

Bacterial Infection ◽

Plasma Levels ◽

Bacterial Infections ◽

Viral Infections ◽

High Sensitivity ◽

Pediatric Emergency ◽

Reactive Protein ◽

Level Measurement ◽

The Mean

Background: Diagnosing viral and bacterial infectious diseases in children is of great importance. The conventional treatment for the given diseases has been proven relatively impractical and, therefore, finding a practical diagnostic method seems necessary. Measuring procalcitonin (PCT) levels in the blood is one of those useful tests which have high sensitivity and specificity compared to other methods. Moreover, many researchers have emphasized that the level of PCT in bacterial infections is significant. Therefore, PCT level measurement can be adopted as a highly effective factor for distinguishing bacterial infections from viral ones. Our study aimed to evaluate the plasma levels of PCT in children aged 3-36 months. Methods: In this study which was conducted in 2020 in Kermanshah, Iran, 49 children aged 3-36 months having focal fever and referring to the pediatric emergency department of Mohammad Kermanshahi and Imam Reza hospitals in Kermanshah were examined. Distinguishing bacterial infection from viral one was first made by a pediatrician using CBC diff-ESR-CRP tests. Results: The mean serum level of PCT in bacterial infections was significantly higher than that in viral infections. Furthermore, the mean of white blood cell (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) in bacterial infection was significantly higher than that in viral infection. Conclusions: According to our study findings, plasma levels of PCT could have been considered as a diagnostic indicator of the infection. Therefore, it was recommended that the evaluation of PCT plasma levels in children with infection be performed in early stages of the disease. However, it was also suggested that this evaluation be conducted after performing further investigations in this field.

Download Full-text

THE OCCURRENCE DURING ACUTE INFECTIONS OF A PROTEIN NOT NORMALLY PRESENT IN THE BLOOD

Journal of Experimental Medicine ◽

10.1084/jem.73.2.191 ◽

1941 ◽

Vol 73 (2) ◽

pp. 191-200 ◽

Cited By ~ 67

Author(s):

Colin M. MacLeod ◽

Oswald T. Avery

Keyword(s):

Human Serum ◽

Bacterial Infections ◽

Normal Human Serum ◽

C Reactive Protein ◽

Reactive Protein ◽

Acute Infections ◽

Immunological Specificity ◽

Normal Human ◽

Immunological Reactions ◽

Acute Bacterial Infections

The C-reactive protein present in the albumin fraction of the serum of patients during certain acute bacterial infections is highly antigenic upon injection into rabbits. The antiserum thus prepared reacts specifically with this protein and does not react with the proteins of normal human serum. Immunological specificity has been demonstrated by both precipitin and complement-fixation tests. Antiserum prepared in rabbits to the C-reactive protein from human sources also reacts specifically with the similar protein in the serum of monkeys acutely ill with experimental pneumococcus infection. By means of immunological reactions it is possible to detect amounts of reactive protein which are too small to yield a visible precipitate in tests with the C polysaccharide. Certain of the properties are discussed which distinguish the C-reactive protein from the proteins of normal human serum.

Download Full-text

C-Reactive Protein Is an Independent Predictor of 30-Day Bacterial Infection Post-Liver Transplantation

Biomolecules ◽

10.3390/biom11081195 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1195

Author(s):

Jiong Yu ◽

Xiaowei Shi ◽

Jing Ma ◽

Ronggao Chen ◽

Siyi Dong ◽

...

Keyword(s):

Liver Transplantation ◽

Bacterial Infection ◽

Systemic Inflammation ◽

Bacterial Infections ◽

Cox Regression ◽

Prognostic Models ◽

C Reactive Protein ◽

Reactive Protein ◽

Clinically Significant ◽

The Relationship

The relationship between aseptic systemic inflammation and postoperative bacterial infection is unclear. We investigated the correlation of systemic inflammation biomarkers with 30-day clinically significant bacterial infections (CSI) after liver transplantation (LT). This retrospective study enrolled 940 patients who received LT and were followed for 30 days. The primary end point was 30-day CSI events. The cohort was divided into exploratory (n = 508) and validation (n = 432) sets according to different centers. Area under the receiver operated characteristic (AUROC) and Cox regression models were fitted to study the association between baseline systemic inflammation levels and CSI after LT. A total of 255 bacterial infectious events in 209 recipients occurred. Among systemic inflammation parameters, baseline C-reactive protein (CRP) was independently associated with 30-day CSI in the exploratory group. The combination of CRP and organ failure number showed a good discrimination for 30-day CSI (AUROC = 0.80, 95% CI, 0.76–0.84) and the results were confirmed in an external verification group. Additionally, CRP levels were correlated with bacterial product lipopolysaccharide. In conclusion, our study suggests that pre-transplantation CRP is independent of other prognostic factors for 30-day CSI post-LT, and can be integrated into tools for assessing the risk of bacterial infection post-LT or as a component of prognostic models.

Download Full-text

Type I Interferon in Children with Viral or Bacterial Infections

Clinical Chemistry ◽

10.1093/clinchem/hvaa089 ◽

2020 ◽

Vol 66 (6) ◽

pp. 802-808 ◽

Cited By ~ 2

Author(s):

Sophie Trouillet-Assant ◽

Sébastien Viel ◽

Antoine Ouziel ◽

Lucille Boisselier ◽

Philippe Rebaud ◽

...

Keyword(s):

Bacterial Infection ◽

Bacterial Infections ◽

Viral Infections ◽

Type I Interferon ◽

Area Under The Curve ◽

Pediatric Emergency ◽

Type I ◽

Discriminative Performance ◽

Antibiotic Overuse ◽

Reactive Protein

Abstract Background Fever is one of the leading causes of consultation in the pediatric emergency department for patients under the age of 3 years. Distinguishing between bacterial and viral infections etiologies in febrile patients remains challenging. We hypothesized that specific host biomarkers for viral infections, such as type I-interferon (IFN), could help clinicians’ decisions and limit antibiotic overuse. Methods Paxgene tubes and serum were collected from febrile children (n = 101), age from 7 days to 36 months, with proven viral or bacterial infections, being treated at pediatric emergency departments in France. We assessed the performance of an IFN signature, which was based on quantification of expression of IFN-stimulated genes using the Nanostring® technology and plasma IFN-α quantified by digital ELISA technology. Results Serum concentrations of IFN-α were below the quantification threshold (30 fg/mL) for 2% (1/46) of children with proven viral infections and for 71% (39/55) of children with bacterial infections (P < 0.001). IFN-α concentrations and IFN score were significantly higher in viral compared to bacterial infection (P < 0.001). There was a strong correlation between serum IFN-α concentrations and IFN score (p-pearson = 0.83). Both serum IFN-α concentration and IFN score robustly discriminated (Area Under the Curve >0.91 for both) between viral and bacterial infection in febrile children, compared to C-reactive protein (0.83). Conclusions IFN-α is increased in blood of febrile infants with viral infections. The discriminative performance of IFN-α femtomolar concentrations as well as blood transcriptional signatures could show a diagnostic benefit and potentially limit antibiotic overuse. Clinical Trials Registration clinicaltrials.gov (NCT03163628).

Download Full-text

C-reactive protein and procalcitonin for antimicrobial stewardship in COVID-19

Infection ◽

10.1007/s15010-021-01615-8 ◽

2021 ◽

Author(s):

Isabell Pink ◽

David Raupach ◽

Jan Fuge ◽

Ralf-Peter Vonberg ◽

Marius M. Hoeper ◽

...

Keyword(s):

Antibiotic Therapy ◽

Bacterial Infection ◽

Bacterial Infections ◽

Roc Analysis ◽

Secondary Infection ◽

C Reactive Protein ◽

Laboratory Findings ◽

Secondary Bacterial Infection ◽

Reactive Protein ◽

Tract Infections

Abstract Purpose Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory coronavirus 2 (SARS-CoV-2) has spread around the world. Differentiation between pure viral COVID-19 pneumonia and secondary infection can be challenging. In patients with elevated C-reactive protein (CRP) on admission physicians often decide to prescribe antibiotic therapy. However, overuse of anti-infective therapy in the pandemic should be avoided to prevent increasing antimicrobial resistance. Procalcitonin (PCT) and CRP have proven useful in other lower respiratory tract infections and might help to differentiate between pure viral or secondary infection. Methods We performed a retrospective study of patients admitted with COVID-19 between 6th March and 30th October 2020. Patient background, clinical course, laboratory findings with focus on PCT and CRP levels and microbiology results were evaluated. Patients with and without secondary bacterial infection in relation to PCT and CRP were compared. Using receiver operating characteristic (ROC) analysis, the best discriminating cut-off value of PCT and CRP with the corresponding sensitivity and specificity was calculated. Results Out of 99 inpatients (52 ICU, 47 Non-ICU) with COVID-19, 32 (32%) presented with secondary bacterial infection during hospitalization. Patients with secondary bacterial infection had higher PCT (0.4 versus 0.1 ng/mL; p = 0.016) and CRP (131 versus 73 mg/L; p = 0.001) levels at admission and during the hospital stay (2.9 versus 0.1 ng/mL; p < 0.001 resp. 293 versus 94 mg/L; p < 0.001). The majority of patients on general ward had no secondary bacterial infection (93%). More than half of patients admitted to the ICU developed secondary bacterial infection (56%). ROC analysis of highest PCT resp. CRP and secondary infection yielded AUCs of 0.88 (p < 0.001) resp. 0.86 (p < 0.001) for the entire cohort. With a PCT cut-off value at 0.55 ng/mL, the sensitivity was 91% with a specificity of 81%; a CRP cut-off value at 172 mg/L yielded a sensitivity of 81% with a specificity of 76%. Conclusion PCT and CRP measurement on admission and during the course of the disease in patients with COVID-19 may be helpful in identifying secondary bacterial infections and guiding the use of antibiotic therapy.

Download Full-text

Evolution of laboratory markers for systemic bacterial infections

Terapevticheskii arkhiv ◽

10.17116/terarkh20178911105-110 ◽

2017 ◽

Vol 89 (11) ◽

pp. 105-110

Author(s):

N L Ryabkova ◽

N N Vezikova

Keyword(s):

Bacterial Infection ◽

Proinflammatory Cytokines ◽

Bacterial Infections ◽

C Reactive Protein ◽

Reactive Protein ◽

Laboratory Markers ◽

Systemic Bacterial Infection

The paper reviews the data available in the literature on existing laboratory markers for systemic bacterial infection, among which C-reactive protein, proinflammatory cytokines, procalcitonin test, and presepsin receive primary emphasis.

Download Full-text

THE HISTOCHEMICAL NITROBLUE TETRAZOLIUM REDUCTION TEST IN THE DIFFERENTIAL DIAGNOSIS OF ACUTE INFECTIONS

PEDIATRICS ◽

10.1542/peds.48.2.259 ◽

1971 ◽

Vol 48 (2) ◽

pp. 259-267

Author(s):

James R. Humbert ◽

Melvin I. Marks ◽

William E. Hathaway ◽

Christine H. Thoren

Keyword(s):

Bacterial Infections ◽

Viral Infections ◽

Nitroblue Tetrazolium ◽

Suspected Infection ◽

Acute Infections ◽

Nitroblue Tetrazolium Reduction ◽

Leukocyte Counts ◽

Nbt Reduction ◽

Acute Bacterial Infections ◽

Neutrophil Dysfunction

Nitroblue tetrazolium (NBT) reduction by phagocytic leukocytes was investigated histochemically in 296 subjects with and without infections. Among 130 patients with noninfectious diseases, osteogenesis imperfecta patients and their relatives, and hemophiliacs frequently displayed high NBT-reduction values in their neutrophils. Four percent of the other noninfected patients yielded NBT-reduction values higher than normal in their neutrophils and were considered to have "false-positive" NBT-reduction tests. Most patients with acute bacterial infections (83%) showed an increased percentage of NBT-positive neutrophils. In patients who did not respond to a bacterial infection by increasing their percentage of NBT-positive neutrophils, there was suggestive evidence of a state of neutrophil dysfunction. Eighty-four percent of patients with viral or tuberculous infections demonstrated normal percentages of NBT-positive neutrophils. Acute bacterial infections were most often associated with a high percent of NBT-positive neutrophils, while low values predominated in viral infections regardless of the patient's total leukocyte counts. The NBT histochemical test would appear to be a useful adjunct to microbiologic techniques in establishing the diagnosis in patients with suspected infection.

Download Full-text