C-reactive protein in childhood non-typhi Salmonella gastroenteritis with and without bacteremia
Journal
Pediatric Infectious Disease Journal
Journal Volume
19
Journal Issue
8
Pages
754-755
Date Issued
2000
Author(s)
Abstract
C-REACTIVE PROTEIN IN CHILDHOOD NON-TYPHI SALMONELLA GASTROENTERITIS WITH AND WITHOUT BACTEREMIA Non -typhiSalmonella species are the most common bacterial pathogens of gastroenteritis in Taiwan. 1 Except in immunocompromised patients most Salmonella infections are limited to the gastrointestinal tract, and it generally is agreed that Salmonella gastroenteritis should not be treated with antibiotics because these agents do not shorten the course of illness; rather, they lengthen the period of asymptomatic excretion. 2, 3 In children with secondary bacteremia and/or extraintestinal foci, an appropriate antibiotic is usually needed. No simple clinical data or laboratory tests allows for the reliable detection of Salmonella gastroenteritis with secondary bacteremia rapidly. 4–9 Serum C-reactive protein (CRP) is an acute phase reactant that increases in the presence on inflammation caused by infection and/or tissue injury. 10 Usually the greater the tissue destruction, the higher is the CRP value. Previous reports 11, 12 either indicated that the determination of CRP may be a useful tool to predict bacterial gastroenteritis or suggested that a low CRP (100 mg/l, with a mean of 83.5 mg/l. Of the 22 children in Group B 1 (4.5%) child had a CRP concentration 100 mg/l, with a mean of 65.6 mg/l. There was a considerable overlap between the 2 patient groups and no significant difference (P = 0.361) was found. Forty-three (17.6%) of 246 children in Group A had a white blood cell count of >15 000 cells/mm 3, and so did 6 (22.7%) of 22 children in Group B. Band form cells were higher in Group B, but 10 (45.5%) patients in this group had no band form cells, whereas 55 (22.4%) patients in Group A had no band form cells.Table 2: Relationship between serogroup and secondary bacteremia in children with Salmonella gastroenteritisTable 3: CRP level and white blood cell count in children with Salmonella gastroenteritisDiscussion. Results from this study indicated that serum CRP values were elevated in most children with Salmonella gastroenteritis and that there was no significant difference between the children with and without secondary bacteremia. We had assumed that the CRP might be higher in children with secondary bacteremia. The CRP remains elevated with ongoing inflammation and tissue destruction, but with resolution it declines rapidly, because of a relatively short half-life of 4 to 7 h. 10, 13, 14 The timing of measurement of CRP can affect the results. In this retrospective study the timing of CRP measurement was at the time of hospitalization, which was not the same time for disease process in each case. This bias may influence the interpretation of the results. The reported frequency of bacteremia in children with non-typhi Salmonella gastroenteritis is variable. 2–6, 15, 16 In this study the frequency of secondary bacteremia was 8.2%, which was similar to that of previous reports from Taiwan. 17, 18 In general a higher incidence of bacteremia has been found in children younger than 1 year of age with a peak in 0- to 2-month age group. 4, 5, 16 However, the present study indicated that no significant difference in terms of secondary bacteremia was found between the children younger than 3 months or 1 year of age and those older. In previous reports the Salmonella serotype was highly related to the rate of bacteremia. 4–6, 17, 18 In this study serogroup D was the most invasive serogroup in causing secondary bacteremia. These results support the findings of a study by Huang et al. 17 from Taiwan. In their study 19 a genotype of Salmonella dublin was shown to be more invasive than the others. However, in our previous study 18Salmonella typhimurium and Salmonella schwarzengrund (serogroup B) were the other two invasive serotypes, in addition to S. dublin (serogroup D). In summary, even though CRP determination may be reliable in predicting bacterial gastroenteritis, our results indicate that by serum CRP value alone, non-typhiSalmonella gastroenteritis with secondary bacteremia cannot be differentiated from isolated Salmonella gastroenteritis.
SDGs
Type
journal article