title: Value of serum C-reactive protein concentrations in febrile children without apparent focus.
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.
authors.affiliation: Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: V
authors.initials: V
authors.lastname: Kohli
authors.forename: S
authors.initials: S
authors.lastname: Singhi
authors.forename: P
authors.initials: P
authors.lastname: Sharma
authors.forename: N K
authors.initials: NK
authors.lastname: Ganguly
mesh_terms: D016470:Bacteremia / Q000150:complications / Q000175:diagnosis; D001424:Bacterial Infections / Q000150:complications / Q000175:diagnosis; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D005335:Fever of Unknown Origin / Q000097:blood* / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications / Q000175:diagnosis; D010033:Otitis Media / Q000150:complications / Q000175:diagnosis; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014552:Urinary Tract Infections / Q000150:complications / Q000175:diagnosis
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein