Combined use of biomarkers for distinguishing between bacterial and viral etiologies in pediatric lower respiratory tract infections

Zhu, Guoji; Zhu, Jing; Song, Lei; Cai, Wenzhi; Wang, Jian

doi:10.3109/00365548.2014.987163

Cited by 18 publications

(25 citation statements)

References 29 publications

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“…The majority of these patients had clinical diagnosis of acute upper respiratory tract infection, pneumonia and acute gastroenteritis. This indicates absence of bacterial cause similar to published data from previous studies [7, 30, 31]. In these cases, clinicians should consider not to treat the child with antimicrobial drugs.…”

Section: Discussionsupporting

confidence: 89%

Profile of C-reactive protein, white cells and neutrophil populations in febrile children from rural north-eastern Tanzania

Mahende¹,

Ngasala²,

Lusingu³

et al. 2017

Pan Afr Med J

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IntroductionC-reactive protein (CRP), white blood cell (WBC) and absolute neutrophil counts (ANC) are important inflammatory biomarkers in the early diagnosis of infections. However, little is known on their profile and usefulness in fever case management in children attending outpatient clinic in rural north-eastern Tanzania.MethodsPatients aged between 2 and 59 months presenting with fever at Korogwe District Hospital were enrolled. Venous blood was collected for evaluation of serum CRP, WBC and ANC. Individual patient diagnosis was based on integrated management of childhood illness (IMCI) guidelines and laboratory investigations (blood and urine cultures).ResultsA total of 867 patients were enrolled, out of which 691 (79.7%) had complete clinical and laboratory data available for analysis. Acute upper respiratory tract infection 284 (41.1%), acute gastroenteritis 127 (18.4%) and pneumonia 100 (14.5%) were the most frequent diagnoses. The geometric mean levels of serum CRP, WBC and ANC were 10.4 (95% CI: 9.2 - 11.8), 11.5 (95% CI: 11.1 - 11.9) and 5.5 (95% CI: 5.2 - 5.8), respectively. CRP≤20, WBC≤15 (103cells/µL) and ANC≤10 103cells/µL) were observed in the majority of the patients with upper respiratory tract infection, pneumonia, acute gastroenteritis and non-specific febrile illness. Only serum CRP levels were positively correlated with positive blood cultures at a calculated cut-off value of 37.3 mg/L, giving a specificity of 77.8% and sensitivity of 74.2%.ConclusionCRP assessment together with IMCI guidelines may be useful in assisting the diagnosis and management of paediatric febrile infections in Tanzania.

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Section: Discussionsupporting

confidence: 89%

Profile of C-reactive protein, white cells and neutrophil populations in febrile children from rural north-eastern Tanzania

Mahende¹,

Ngasala²,

Lusingu³

et al. 2017

Pan Afr Med J

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“…CD35 is a membrane-bound complement regulator, and CD64 is an integral membrane glycoproteins of white blood cells. Both CD35 and CD64 are present at higher levels in children with bacterial versus viral lower respiratory tract infections [ 51 ]. In addition, presepsin, an immunologic biomarker related to bacterial phagocytosis, specifically elevates in response to bacterial infections [ 52 ].…”

Section: Bacterial Protein Biomarkersmentioning

confidence: 99%

“…The combined triple host protein assay comprising TRAIL, IP-10, and CRP for distinguishing between bacterial and viral infections is superior to single-biomarker methods [ 4 , 15 , 25 , 63 ], and has 93.5% sensitivity and 94.3% specificity [ 25 ]. Another approach using combinations of CRP + CD35 and CRP + CD64 was found to provide better discriminative power than a single biomarker or CRP + PCT and CRP + IL-6 for the differentiation of bacterial and viral lower respiratory tract infections in children [ 51 ]. Although some studies found that combined assessment did not improve assay results [ 64 ], combined approaches offer several promising possible avenues for improved diagnostic differentiation.…”

Section: Biomarker Combinationsmentioning

confidence: 99%

Differential Markers of Bacterial and Viral Infections in Children for Point-of-Care Testing

Tsao

Tsai

Liao

et al. 2020

Trends in Molecular Medicine

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Children suffering from infectious diseases, both bacterial and viral, are often treated with empirical antibiotics. Keeping in mind both the menace of microorganisms and antibiotic toxicity, it is imperative to develop point-of-care testing (POCT) to discriminate bacterial from viral infections, and to define indications for antibiotic treatment. This article reviews potential protein biomarkers and host-derived gene expression signatures for differentiating between bacterial and viral infections in children, and focuses on emerging multiplex POCT devices for the simultaneous detection of sets of protein biomarkers or streamlined gene expression signatures that may provide rapid and cost-effective pathogen-discriminating tools.

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“…Although, in most cases, a combination of traditional biomarkers, including WBC count, NP, ESR, CRP, and PCT, has been found to be poorly effective—or not at all effective—in increasing the sensitivity and specificity of a single biomarker [40], it has been presumed that combining new biomarkers with one or more of the traditionally used variables may yield better results. A positive example in this regard comes from a study by Erdman et al [41], who have investigated children with World Health Organization (WHO)-defined clinical CAP [42] and have found that the combined evaluation of CRP and chitinase 3-like-1, a soluble glycoprotein induced by cytokines and injurious stimuli [43] discriminated between end-point CAP and non-end-point CAP with 93% sensitivity (95% CI 76.5–98.8), 80.8% specificity (95% CI 72.6–87.1), a positive likelihood ratio of 4.9 (95% CI 3.4–7.1), a negative likelihood ratio of 0.083 (0.022–0.32), and a misclassification rate of 0.20 (standard error of 0.038).…”

Section: Differentiation Of Bacterial From Viral Capmentioning

confidence: 99%

Biomarkers in Pediatric Community-Acquired Pneumonia

Principi

Esposito

2017

IJMS

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Community-acquired pneumonia (CAP) is an infectious disease caused by bacteria, viruses, or a combination of these infectious agents. The severity of the clinical manifestations of CAP varies significantly. Consequently, both the differentiation of viral from bacterial CAP cases and the accurate assessment and prediction of disease severity are critical for effectively managing individuals with CAP. To solve questionable cases, several biomarkers indicating the etiology and severity of CAP have been studied. Unfortunately, only a few studies have examined the roles of these biomarkers in pediatric practice. The main aim of this paper is to detail current knowledge regarding the use of biomarkers to diagnose and treat CAP in children, analyzing the most recently published relevant studies. Despite several attempts, the etiologic diagnosis of pediatric CAP and the estimation of the potential outcome remain unsolved problems in most cases. Among traditional biomarkers, procalcitonin (PCT) appears to be the most effective for both selecting bacterial cases and evaluating the severity. However, a precise cut-off separating bacterial from viral and mild from severe cases has not been defined. The three-host protein assay based on C-reactive protein (CRP), tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), plasma interferon-γ protein-10 (IP-10), and micro-array-based whole genome expression arrays might offer more advantages in comparison with former biomarkers. However, further studies are needed before the routine use of those presently in development can be recommended.

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Combined use of biomarkers for distinguishing between bacterial and viral etiologies in pediatric lower respiratory tract infections

Abstract: The combined analysis improved diagnostic accuracy in children with bacterial and viral LRTIs.

Cited by 18 publications

References 29 publications

Profile of C-reactive protein, white cells and neutrophil populations in febrile children from rural north-eastern Tanzania

Profile of C-reactive protein, white cells and neutrophil populations in febrile children from rural north-eastern Tanzania

Differential Markers of Bacterial and Viral Infections in Children for Point-of-Care Testing

Biomarkers in Pediatric Community-Acquired Pneumonia

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