Serum C-Reactive Protein, Erythrocyte Sedimentation Rate, and White Blood Cell Count in Acute Hematogenous Osteomyelitis of Children

Abstract

Objective. The aim of this prospective study was to compare the clinical value of the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and white blood cell (WBC) count in diagnosis and follow-up of acute hematogenous osteomyelitis in children. Design. Forty-four children aged 2 weeks to 14 years with bacteriologically confirmed acute hematogenous osteomyelitis were examined. Staphylococcus aureus was responsible in 39 cases (89%), Haemophilus influenzae type b in 3 cases (7%), pneumococcus in 1 case (2%), and a microaerophilic streptococcus in 1 case (2%). ESR was measured at the time of admission and on days 3, 5, 7, 10, 14, 19, and 29 of treatment, and CRP was measured on the same days as ESR but also on days 2, 9, 12, 17, and 23. WBC count was examined at the time of admission and on days 5, 10, 19, and 29. Results. ESR was elevated (≥20 mm/h) initially in 92% of the cases; the mean value was 45 mm/h, and the peak values (mean 58 mm/h) were reached on days 3 to 5. After this the levels slowly returned to normal in approximately 3 weeks (mean 18 days). CRP was elevated (>19 mg/L) at the time of admission in 98% of the cases, the mean value being 71 mg/L. The peak CRP value was reached on day 2 (mean 83 mg/L). The decrease was very rapid, normal values being reached within a week (mean 6.9 days). The WBC count was a poor indicator of acute hematogenous osteomyelitis, since only 35% of the children had leukocytosis (WBCs > 12 x 109/L) at the time of admission. Conclusions. In patients with acute hematogenous osteomyelitis, CRP increased and especially decreased significantly faster than ESR, reflecting the effectiveness of the therapy given and predicting recovery more sensitively than ESR or WBC count.

A disease that is difficult to diagnose and treat: evaluation of 343 spondylodiscitis cases

“…The levels of acute-phase reactants are usually high. 17,18 Hamidi et al 19 reported a significant difference in the levels of acute-phase reactants between patients with pyogenic spondylodiscitis and those with brucellar or tuberculous spondylodiscitis. In our study, the levels of acute-phase reactants were increased in all three groups, but the highest levels were observed in patients with tuberculous spondylodiscitis.…”

“…The levels of acute-phase reactants are usually high. 17,18 Hamidi et al. 19 reported a significant difference in the levels of acute-phase reactants between patients with pyogenic spondylodiscitis and those with brucellar or tuberculous spondylodiscitis.…”

Acute Multifocal Nonhematogenous Methicillin-Sensitive Staphylococcus aureus Osteomyelitis in a Healthy Adolescent: An Atypical Presentation

“…Our patient presented with symptoms classic for osteomyelitis. Laboratory findings seen in osteomyelitis include leukocytosis and elevated inflammatory markers [ 19 ]. He did have leukocytosis but not anemia and thrombocytopenia, thus excluding leukemia and low immunity [ 8 ].…”

Role of serum and synovial procalcitonin in differentiating septic from non-septic arthritis- a prospective study

“…Widely accepted markers are ESR/CRP/WBC count, but they lack sensitivity and specificity. 6,7 Recently, many studies have shown that serum procalcitonin (PCT) levels rise rapidly in response to bacterial endotoxins. 8e10 It can be used to differentiate septic from non-septic conditions.…”