Publication: Performance of C-reactive protein and procalcitonin to distinguish viral from bacterial and malarial causes of fever in Southeast Asia
Issued Date
2015
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eng
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Mahidol University
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BioMed Central
Bibliographic Citation
BMC Geriatrics. Vol.15, (2015), 511
Suggested Citation
Yoel Lubell, Blacksell, Stuart D., Susanna Dunachie, Ampai Tanganuchitcharnchai, Thomas Althaus, Wanitda Watthanaworawit, Paris, Daniel H., Mayfong Mayxay, Peto, Thomas J., Dondorp, Arjen M., White, Nicholas J., Day, Nicholas P.J., François Nosten, Newton, Paul N., Paul Turner Performance of C-reactive protein and procalcitonin to distinguish viral from bacterial and malarial causes of fever in Southeast Asia. BMC Geriatrics. Vol.15, (2015), 511. doi:10.1186/s12879-015-1272-6 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/3084
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Title
Performance of C-reactive protein and procalcitonin to distinguish viral from bacterial and malarial causes of fever in Southeast Asia
Abstract
Background: Poor targeting of antimicrobial drugs contributes to the millions of deaths each year from malaria,
pneumonia, and other tropical infectious diseases. While malaria rapid diagnostic tests have improved use of
antimalarial drugs, there are no similar tests to guide the use of antibiotics in undifferentiated fevers. In this study
we estimate the diagnostic accuracy of two well established biomarkers of bacterial infection, procalcitonin and Creactive
protein (CRP) in discriminating between common viral and bacterial infections in malaria endemic settings
of Southeast Asia.
Methods: Serum procalcitonin and CRP levels were measured in stored serum samples from febrile patients
enrolled in three prospective studies conducted in Cambodia, Laos and, Thailand. Of the 1372 patients with a
microbiologically confirmed diagnosis, 1105 had a single viral, bacterial or malarial infection. Procalcitonin and CRP
levels were compared amongst these aetiological groups and their sensitivity and specificity in distinguishing
bacterial infections and bacteraemias from viral infections were estimated using standard thresholds.
Results: Serum concentrations of both biomarkers were significantly higher in bacterial infections and malaria than in
viral infections. The AUROC for CRP in discriminating between bacterial and viral infections was 0.83 (0.81–0.86) compared
with 0.74 (0.71–0.77) for procalcitonin (p < 0.0001). This relative advantage was evident in all sites and when stratifying
patients by age and admission status. For CRP at a threshold of 10 mg/L, the sensitivity of detecting bacterial infections
was 95 % with a specificity of 49 %. At a threshold of 20 mg/L sensitivity was 86 % with a specificity of 67 %. For
procalcitonin at a low threshold of 0.1 ng/mL the sensitivity was 90 % with a specificity of 39 %. At a higher threshold of
0.5 ng/ul sensitivity was 60 % with a specificity of 76 %.
Conclusion: In samples from febrile patients with mono-infections from rural settings in Southeast Asia, CRP was a highly
sensitive and moderately specific biomarker for discriminating between viral and bacterial infections. Use of a CRP rapid
test in peripheral health settings could potentially be a simple and affordable measure to better identify patients in need
of antibacterial treatment and part of a global strategy to combat the emergence of antibiotic resistance.