title: Fecal calprotectin: can be used to distinguish between bacterial and viral gastroenteritis in children?
abstract: OBJECTIVE
  Fecal calprotectin is used as a good indicator of intestinal mucosal inflammation. The aim of this study is to evaluate the diagnostic value of fecal calprotectin (f-CP) for the etiology of acute gastroenteritis in children.
  
  
  METHODS
  All patients presenting with acute diarrhea (<18 years) who had 3 or more soft or watery stools per day were enrolled in this study. Stool microscopic examination and cultures for bacteria and parasites were performed. Polymerase chain reaction test was also applied to stool samples for viruses (Rotavirus, Adenovirus, Norwalk, and Astrovirus). The level of f-CP was carried out by using enzyme-linked immunosorbent assay test.
  
  
  RESULTS
  Eighty-four patients with diarrhea were enrolled. The f-CP level was higher in patients with microscopic examination positive (n=17) (median with interquartile range, 1610.0 [908.8-2100] mg/L) than in patients with microscopic examination negative (n=67) (123.8 [25.0-406.3] mg/L) (P<.001). Concentrations of f-CP in patients with stool culture positive (1870.0 [822.5-2100] mg/L) were significantly elevated compared with the concentrations of the patient with virus detected in stool (95.0 [21.3-240.9] mg/L) (P<.001). In the diagnosis for bacterial acute gastroenteritis, the area under the receiver operating characteristic curve for f-CP was 0.867 (95% confidence interval, 0.763-0.971), sensitivity was 88.9%, and specificity was 76.0% if the threshold was taken as 710 mg/L.
  
  
  CONCLUSIONS
  We conclude that f-CP, which is useful, valuable, noninvasive, easily and rapidly measured laboratory test along with simple microscopic examination of stool, can be used as an indicator of intestinal inflammation and to distinguish the bacterial gastroenteritis from the viral gastroenteritis.
authors.affiliation: Department of Pediatric Emergency Care, Faculty of Medicine, Dokuz Eylul University, İzmir, Turkey. Electronic address: mduman@deu.edu.tr.
authors.forename: Murat
authors.initials: M
authors.lastname: Duman
authors.affiliation: Department of Pediatric Neurology, Tepecik Training and Research Hospital, İzmir, Turkey.
authors.forename: Pinar
authors.initials: P
authors.lastname: Gencpinar
authors.affiliation: Department of Medical Microbiology, Dokuz Eylul University, İzmir, Turkey.
authors.forename: Meral
authors.initials: M
authors.lastname: Biçmen
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, İzmir, Turkey.
authors.forename: Nur
authors.initials: N
authors.lastname: Arslan
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, İzmir, Turkey.
authors.forename: Ömer
authors.initials: Ö
authors.lastname: Özden
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, İzmir, Turkey.
authors.forename: Özlem
authors.initials: Ö
authors.lastname: Üzüm
authors.affiliation: Department of Pediatric Emergency Care, Faculty of Medicine, Dokuz Eylul University, İzmir, Turkey.
authors.forename: Durgül
authors.initials: D
authors.lastname: Çelik
authors.affiliation: Department of Medical Microbiology, Dokuz Eylul University, İzmir, Turkey.
authors.forename: A Arzu
authors.initials: AA
authors.lastname: Sayıner
authors.affiliation: Department of Medical Microbiology, Dokuz Eylul University, İzmir, Turkey.
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Gülay
mesh_terms: D000208:Acute Disease; D019540:Area Under Curve; D001424:Bacterial Infections / Q000175:diagnosis* / Q000382:microbiology; D015415:Biomarkers / Q000032:analysis; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000382:microbiology*; D004797:Enzyme-Linked Immunosorbent Assay; D005243:Feces / Q000737:chemistry / Q000382:microbiology*; D005260:Female; D005759:Gastroenteritis / Q000382:microbiology*; D006801:Humans; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis*; D008297:Male; D011446:Prospective Studies; D060888:Real-Time Polymerase Chain Reaction; D018709:Statistics, Nonparametric; D014777:Virus Diseases / Q000175:diagnosis* / Q000821:virology
chemical_list: D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex