CD64 and CD169 could help differentiate bacterial from viral infections in Emergency Department

Abstract

Background: The identification of a bacterial, viral or even non-infectious cause is essential in the management of febrile syndrome in the emergency department (ED) setting, especially in epidemic contexts such as flu or CoVID-19. Objectives: The aim of this study was to assess discriminative performances of two biomarkers, CD64 on neutrophils (nCD64) and CD169 on monocytes (mCD169), using a new flow cytometry procedure, in patients presenting with fever to the ED. Human leucocyte antigen-DR on monocytes (mHLA-DR), HLA-ABC ratio (rHLA-ABC), and CD64 on monocytes (mCD64) were also assessed. Methods: 85 adult patients presenting with potential infection were included during the 2019 flu season in the ED of La Timone Hospital. They were divided into four diagnostic outcomes according to their clinical records: no-infection, bacterial infection, viral infection and co-infection. Results: mCD169 was elevated in patients suffering from Flu A virus or Respiratory Syncytial Virus, while nCD64 was mainly found elevated in subjects with Streptococcus pneumoniae. In total, 38 (45%) patients were diagnosed with bacterial infections, 11 (13%) with viral infections and 29 (34%) with co-infections. nCD64 and mCD169 showed 90% and 80% sensitivity, and 78% and 91% specificity, respectively, for identifying patients with bacterial or viral infections. Other biomarkers had lower discriminative performances. Conclusions: nCD64 and mCD169 have potential for accurately distinguishing bacterial and acute viral infections. Combined in an easy and rapid flow cytometry procedure, they constitute a potential improvement for infection management in the ED setting, and could even help for the triage of patients during emerging epidemics.

Validation of a Quick Flow Cytometry-Based Assay for Acute Infection Based on CD64 and CD169 Expression. New Tools for Early Diagnosis in COVID-19 Pandemic

“…In this group, both biomarker values were comparable with the observed in the HC group, pointing to the exclusive role of CD169Mo ratio as a marker for acute viral infection, which normalizes after infection chronicity. This assay has the potential to detect acute viral and bacterial coinfection when both CD64N and CD169Mo are increased ( 12 ), as observed in two cases of ACov-2 in our cohort.…”

“…The present work shows a cut-off value of 3.3 in both biomarkers, very similar to that described previously ( 14 ). However, this assay is not specific to ACov-2 infection since CD169Mo was increased in acute parainfluenza, human respiratory syncytial, and C-hepatitis virus infections at emergency units ( 12 , 15 ).…”

“…The study was assessed by the regional ethic committee (CEIC, code 2020.167). Previously, the utility of the CD64 and CD169 expression to differentiate between bacterial and viral infection at the emergency unit has been shown ( 12 ). In order to validate the assay in an independent cohort, several groups were established: firstly, a group of admitted patients with acute infection was recruited for the study, 12 with active bacterial infection (ABI) with confirmed bacterial pathogen isolation or recovery after antibiotic treatments and 24 patients with active SARS-CoV-2 infection (ACov-2), all the patients included in the group were tested for specific-SARS-CoV-2 polymerase chain reaction (PCR) prior admission; secondly, a group of 18 patients followed in the Infectious Disease Unit with antiretroviral-controlled chronic HIV infection (all of them without viral load at the moment of the assay) and finally, a group of healthy controls (HC) without evidence of infection were included ( n = 29).…”

Future Biomarkers for Infection and Inflammation in Febrile Children

“…An accurate diagnosis of bacterial or viral infection within 1 hour using flow cytometry was possible using a set of surface proteins on neutrophils and monocytes, including Fcg receptor I (FcgRI/ CD64), FcgRII/CD32, complement receptor 1 (CR1/CD35), HLA-class-I, and the receptor for complement-derived anaphylatoxin C5a (C5aR/CD88) (67). CD32, CD35 and CD88 all have a higher expression on both neutrophils and monocytes in bacterial infections compared to viral infections, whereas HLA-class-I and CD169 on monocytes were increased in viral infections rather than bacterial infections (71,72). These studies only included adults, no data on the pediatric population is available.…”

One-step White Blood Cell Extracellular Staining Method for Flow Cytometry

“…It has been shown that monitoring the expression of CD169 on monocytes (mCD169), CD64 on neutrophils (nCD64), and HLA-DR on monocytes (mHLA-DR) by flow cytometry can be indicative of viral or bacterial infection, or sepsis, respectively. We therefore established a panel consisting of antibodies targeting these three markers and evaluated the one-step method in subjects with infection and septic conditions by measuring the expression of the three infection-related markers (Bourgoin et al, 2019a(Bourgoin et al, , 2019b(Bourgoin et al, , 2020a(Bourgoin et al, , 2020b(Bourgoin et al, , 2020c(Bourgoin et al, , and 2021Bedin et al, 2020;Michel et al, 2020).…”