The Diagnostic Significance of Hemogram Indicators and Serum Markers of Inflammation in Serious Bacterial Infections in Children Under 5 Years of Age
https://doi.org/10.15690/vsp.v15i1.1502
Abstract
Background: Diagnosis of serious bacterial infections (SBI) in young children is a difficult task for pediatricians.
Objective: Our aim was to determine regularities of the change of hemogram indicators and serum markers of inflammation for the differential diagnostics of SBI in children under the age of 5 years.
Methods: The comparative retrospective study is carried out. We analyzed diagnostic characteristics of laboratory markers of SBI during the examination of 306 children with pyretic fever. We determined the number of leukocytes, neutrophils, immature granulocytes, reticulocyte hemoglobin equivalent, C-reactive protein (CRP) and procalcitonin.
Results: The study of CRP content has the greatest diagnostic accuracy at differential diagnostics of SBI in children with infectious fever at the height of disease. It is established that the positive result of CRP ( 37 mg/L) increases the probability of SBI in patient from 17.6% to 70%, and the negative result (< 37 mg/L) reduces the probability of SBI to 4%.
Conclusion: Cut-off values of the laboratory parameters obtained in our study can be used when assessing the post-test probability of SBI in children with infections accompanied by pyretic fever.
About the Authors
O. S. MelnichukRussian Federation
Moscow
T. V. Kulichenko
Russian Federation
Moscow
N. A. Mayanskiy
Russian Federation
Moscow
A. Ye. Malakhova
Russian Federation
Moscow
References
1. Girodias JB, Bailey B. Approach to the febrile child: A challenge bridging the gap between the literature and clinical practice. Paediatr Child Health. 2003;8:76–82.
2. Баранов А. А. Лихорадочные синдромы у детей. Под ред. АА Баранова, ВК Таточенко, МД Бакрадзе. М.: Союз педиатров России. 2011.25 с.
3. Hay AD, Heron J, Ness A. ALSPAC study team. The prevalence of symptoms and consultations in pre-school children in the Avon Longitudinal Study of Parents and Children (ALSPAC): a prospective cohort study. Fam. Pract. 2005;22:367–374.
4. Craig JC, Williams GJ, Jones M, Codarini M, Macaskill P, Hayen A et al. The accuracy of clinical symptoms and signs for the diagnosis of serious bacterial infection in young febrile children: prospective cohort study of 15781 febrile illnesses. BMJ. 2010;340:1594.
5. Galetto-Lacour A, Gervaix A. Identifying severe bacterial infection in children with fever without source. Expert Rev. Anti Infect. Ther. 2010;8(11):1231–1237.
6. Trainor JL, Hampers LC, Krug SE, Listernick R. Children with first time simple febrile seizures are at low risk of serious bacterial illness. Acad Emerg Med. 2001;8(8):781–787.
7. Baraff LJ. Management of fever without source in infants and children. Ann Emerg Med. 2000;36(6):602–614.
8. Baraff LJ. Clinical policy for children younger than three years presenting to the emergency department with fever. Ann Emerg Med. 2003;42(4):546–549.
9. Schouten JA, Prins JM, Bonten M, Degener JE, Janknegt R, Hollander JM et al. Optimizing the antibiotics policy in the Netherlands. VIII. Revised SWAB guidelines for antimicrobial therapy in adults with community acquired pneumonia. Ned Tijdschr Geneeskd. 2005;149(45):2495–2500.
10. van de Sande-Bruinsma N, Grundmann H, Verloo D, Tiemersma E, Monen J, Goossens H, Ferech M. Antimicrobial drug use and resistance in Europe. Emerg Infect Dis. 2008 Nov;14(11):1722–30.
11. Greenhow TL, Hung YY, Herz AM. Changing epidemiology of bacteremia in infants aged 1 week to 3 months. Pediatrics. 2012;129(3):590–596.
12. Waddle E, Jhaveri R. Outcomes of febrile children without localizing signs after pneumococcal conjugate vaccine. Arch Dis Child. 2009;94(2):144–147.
13. Wilkinson M, Bulloch B, Smith M. Prevalence of occult bacteremia in children aged 3 to 36 months presenting to the emergency department with fever in the post pneumococcal conjugate vaccine era. Acad Emerg Med. 2009;16(3):220–225.
14. Bass JW, Steele RW, Wittler RR, Weisse ME, Bell V, Heisser AH et al. Antimicrobial treatment of occult bacteremia: a multicenter cooperative study. Pediatr Infect Dis J. 1993;12(6):466–473.
15. Murphy CG, van de Pol AC, Harper MB, Bachur RG. Clinical predictors of occult pneumonia in the febrile child. Acad Emerg Med. 2007;14(3):243–249.
16. Bonadio WA. The history and physical assessments of the febrile infant. Pediatr Clin North Am. 1998;45(1):65–77.
17. McCarthy PL, Sharpe MR, Spiesel SZ, Dolan TF, Forsyth BW, DeWitt TG et al. Observation scale to identify serious illness in febrile children. Pediatrics. 1982;70 (5):802–809.
18. McCarthy PL, Lembo RM, Baron MA, Fink HD, Cicchetti DV. Predictive value of abnormal physical examination findings in ill appearing and well appearing febrile children. Pediatrics. 1985; 76(2):167–171.
19. Elhassanien AF, Hesham AA, Alrefaee F. Fever without source in infants and young children: dilemma in diagnosis and management. Risk Manag Healthc Policy. 2013;6:7–12.
20. 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):672–677.
21. Weimann A, Weimann K, Lun A. Laboratory haematological changes in the field of intensive care medicine — the extended differential blood count. Anasthesiol Intensivmed Notfallmed Schmerzther. 2009;44(3):164–170.
22. Fischer JE, Bachmann LM, Jaeschke R. A readers’ guide to the interpretation of diagnostic test properties: clinical example of sepsis. Intens Care Med. 2003;29(7):1043–1051.
23. Perkins NJ, Perkins NJ, Schisterman EF. The inconsistency of ‘optimal’ cutpoints obtained using two criteria based on the receiver operating characteristics curve. Am J Epidemiol. 2006;163:670–675.
24. Attia J. Moving beyond sensitivity and specificity: using likelihood ratios to help interpret diagnostic tests. Austr Prescr. 2003;26(5):111–113.
25. Pulliam PN, Attia MW, Cronan KM. C-reactive protein in febrile children 1 to 36 months of age with clinically undetectable serious bacterial infection. Pediatrics. 2001;108(6):1275–1279.
26. Galetto-Lacour A, Zamora SA, Gervaix A. Bedside procalcitonin and C-reactive protein tests in children with fever without localizing signs of infection seen in a referral center. Pediatrics. 2003;112(5):1054–1060.
27. Isaacman DJ, Burke BL. Utility of the serum C-reactive protein for detection of occult bacterial infection in children. Arch Pediatr Adolesc Med. 2002;156(9):905–909.
28. Lacour AG, Gervaix A, Zamora SA, Vadas L, Lombard PR, Dayer JM, Suter S. Procalcitonin, IL-6, IL-8, IL-1 receptor antagonist and C-reactive protein as identificators of serious bacterial infections in children with fever without localising signs. Eur J Pediatr. 2001;160 (2):95–100.
29. Wu JY, Lee SH, Shen CJ, Hsieh YC, Yo PH, Cheng HY et al. Use of serum procalcitonin to detect bacterial infection in patients with autoimmune diseases: a systematic review and meta-analysis. Arthritis Rheum. 2012;64(9):3034–3042.
30. von Lilienfeld-Toal M, Dietrich MP, Glasmacher A, Lehmann L, Breig P, Hahn C et al. Markers of bacteremia in febrile neutropenic patients with hematological malignancies: procalcitonin and IL-6 are more reliable than C-reactive protein. Eur J Clin Microbiol Infect Dis. 2004;23(7):539–544.
31. Luaces-Cubells C, Mintegi S, Garcia-Garcia JJ, Astobiza E, Garrido-Romero R, Velasco-Rodriguez J, Benito J. Procalcitonin to detect invasive bacterial infection in non-toxic-appearing infants with fever without apparent source in the emergency department. Pediatr Infect Dis J. 2012;31(6):645–647.
32. van Rossum AM, Wulkan RW, Oudesluys-Murphy AM. Pro calcitonin as an early marker of infection in neonates and children. Lancet Infect Dis. 2004;4(10):620–630.
33. Баранов АА, Семикина ЕЛ, Мельничук ОС, Гордеева ОБ, Намазова-Баранова ЛС, Морозова НА, Кожевникова ОВ, Геворкян АК, Маянский НА. Показатели ретикулоцитарных индексов у здоровых детей. Вопросы диагностики в педиатрии. 2010;2(4):17–21.
34. Маянский НА, Балабанов АС, Копыльцова ЕА, Лукоянова ОЛ, Мельничук ОС, Блинова ТА, Семикина ЕЛ. Референсные интервалы лейкоцитов и тромбоцитов у детей, полученные с помощью автоматического гематологического анализатора. Вопросы диаг ностики в педиатрии. 2011;3(6):5–10.
35. Маянский НА, Семикина ЕЛ. Гепцидин: основной регулятор обмена железа и новый диагностический маркер. Вопросы диагностики в педиатрии. 2009;1 (1):18–23.
36. Schoorl M, Snijders D, Schoorl M, Boersma WG, Bartels PC. Temporary impairment of reticulocyte haemoglobin content in subjects with community acquired pneumonia. Int J Lab Hematol. 2012;34(4):390–395.
Review
For citations:
Melnichuk O.S., Kulichenko T.V., Mayanskiy N.A., Malakhova A.Ye. The Diagnostic Significance of Hemogram Indicators and Serum Markers of Inflammation in Serious Bacterial Infections in Children Under 5 Years of Age. Current Pediatrics. 2016;15(1):74-81. (In Russ.) https://doi.org/10.15690/vsp.v15i1.1502