title: Point-of-care assessment of C-reactive protein and white blood cell count to identify bacterial aetiologies in malaria-negative paediatric fevers in Tanzania.
abstract: To assess the role of point-of-care (PoC) assessment of C-reactive protein (CRP) and white blood cell (WBC) count to identify bacterial illness in Tanzanian children with non-severe non-malarial fever.
  
  
  
  From the outpatient department of a district hospital in Tanzania, 428 patients between 3 months and 5 years of age who presented with fever and a negative malaria test were enrolled. All had a physical examination and bacterial cultures from blood and urine. Haemoglobin, CRP and WBC were measured by PoC devices.
  
  
  
  Positive blood cultures were detected in 6/428 (1.4%) children and urine cultures were positive in 24/401 (6.0%). Mean WBC was similar in children with or without bacterial illness (14.0 × 109, 95% CI 12.0-16.0 × 109 vs. 12.0 × 109, 95% CI 11.4-12.7 × 109), while mean CRP was higher in children with bacterial illness (41.0 mg/l, 95% CI 28.3-53.6 vs. 23.8 mg/l, 95% CI 17.8-27.8). In ROC analysis, the optimum cut-off value for CRP to identify bacterial illness was 19 mg/l but with an area under the curve of only 0.62. Negative predictive values exceeded 80%, while positive predictive values were under 40%.
  
  
  
  WBC and CRP levels had limited value in identifying children with bacterial infections. The positive predictive values for both tests were too low to be used as single tools for treatment decisions.
authors.affiliation: Global Health, Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.|Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Helena
authors.initials: H
authors.lastname: Hildenwall
authors.affiliation: Kilimanjaro Christian Medical University College, Moshi, Tanzania.
authors.forename: Florida
authors.initials: F
authors.lastname: Muro
authors.affiliation: Global Health, Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Jaqueline
authors.initials: J
authors.lastname: Jansson
authors.affiliation: Joint Malaria Programme, St Augustine's Hospital, Muheza, Tanzania.|National Institute for Medical Research, Amani Centre, Muheza, Tanga, Tanzania.
authors.forename: George
authors.initials: G
authors.lastname: Mtove
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Hugh
authors.initials: H
authors.lastname: Reyburn
authors.affiliation: Joint Malaria Programme, St Augustine's Hospital, Muheza, Tanzania.
authors.forename: Ben
authors.initials: B
authors.lastname: Amos
mesh_terms: D001419:Bacteria; D001424:Bacterial Infections / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D002097:C-Reactive Protein / Q000378:metabolism*; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology; D006801:Humans; D007223:Infant; D007958:Leukocyte Count; D007962:Leukocytes / Q000378:metabolism*; D008288:Malaria; D008297:Male; D010372:Pediatrics; D019095:Point-of-Care Systems; D012372:ROC Curve; D012016:Reference Values; D013636:Tanzania
chemical_list: D002097:C-Reactive Protein
keywords: C-reactive protein; children; fever; infection; leucocytes; point-of-care test