A Normal C Reactive Protein and Significant Bacterial Infection in Children with Fever - Literature review Example

 Introduction: C – Reactive protein, a test that measures the amount of blood protein, indicates an acute inflammatory process (Zieve et al, 2008). Zieve et al, (2008) noted that the level of C – Reactive protein (CRP) rises with the presence of systemic inflammatory process. CRP test is considered as a general test that can disclose the existence of inflammation; however, specific locations where inflammatory process takes place cannot be specified through this examination (Zieve et al, 2008). In addition to the white blood cell (WBC) count, C – reactive protein can be used as a parameter to support a diagnosis of infection (Chan et al, 2003; Hsiao and Baker 2005; Pratt and Attia, 2007). In response to the elevated cytokine levels, C – Reactive protein, an acute phase reactant is synthesized by the liver (Andreola et al, 2007). After the onset of tissue injury and inflammation, C – Reactive protein is produced within 4 – 6 hours following the injury, and it doubles every hour before it peaks around 36 hours. In response to this, C – Reactive protein has been studied as a sensitive marker of bacterial infection (Andreola et al, 2007). Chan et al (2003) noted that in response to infection, no definite correlation between infection and changes in the levels of CRP has been documented despite of large increase that occur. Additionally, Chan et al added that using low levels of CRP to exclude the presence of infections remains to be controversial. C – Reactive protein can also be used in checking flare – ups of inflammatory diseases, and to confirm the efficacy of anti – inflammatory medication (Zieve et al, 2008). However, Zieve et al noted that low levels of CRP do not ensure that no inflammation is present in the body. Abnormal C – Reactive protein result is maybe due to variety of conditions. This include cancer, connective tissue diseases, heart attack, infection, inflammatory bowel disease (IBD), lupus, pneumococcal pneumonia, rheumatoid arthritis, rheumatic fever, tuberculosis, and many others (Zieve et al, 2008). A positive CRP can also be noted during the last half of pregnancy. On the other hand, the use of oral contraceptive pills also provides a positive CRP test result (Zieve et al, 2008). One of the most common reasons for Emergency Department (ED) visit is fever. Fever accounts to approximately 10 – 35% of admissions in children younger than three years of age (Nuttall, 2003; Andreola et al., 2007; Behjati 2008; Liu et al, 2008). In this age group, severe bacterial infections or SBI represents to about 10 – 25%; however, Andreola et al (2007) noted that this diagnosis is frequently confusing especially with the absence of localising findings. Hence, a need for specific and sensitive laboratory markers for infection is required because of the presence of the clinical findings such as body temperature (Nuttall, 2003; Andreola et al., 2007). More than a decade ago, an algorithm which incorporates with laboratory findings, such as white blood cell count and absolute neutrophil count was published and was proven to be useful in the medical practice especially in the identification children who are at higher risk of severe bacterial illness (Nuttall, 2003; Andreola et al, 2007). Additional markers such as C – reactive protein (CRP) and procalcitonin (PCT) are maybe useful (Nuttall, 2003; Andreola et al, 2007). History of C – Reactive Protein In 1930, CRP is discovered by Tillett and Francis as C – Polysaccharide fraction called as fraction C from the sera of an acutely ill patient (Carlan, 2003). In 1941, fraction C was found to be a peptide instead of a polysaccharide, thus renamed as C reactive peptide. In 1950, it was reported that CRP can be detected in more than 70 types of disorders (Carlan, 2003). Carlan added that CRP can be normal in invasive bacterial disease, and produces the largest, the most rapid, and most quantifiable acute response to inflammation and infection. Literature Review To find out whether a normal C reactive protein can safely exclude significant bacterial infection and sepsis in children with fever, Kawamura and Nishida (1995) in their study entitled the usefulness of serial C – reactive protein measurement in managing neonatal infection noted recent advances in scientific research that enabled them to measure C – reactive protein in a short span of time having higher sensitivity with the use of minimal amount of blood. Hence, Kawamura and Nishida noted that C reactive protein can be measured several times a day without experiencing its side effects. Serial changes in C – reactive protein were evaluated in this study by utilising 108 term infants and 240 preterm newborn infants who are suspected of having an infection. Kawamura and Nishida noted that the changing patterns of C – reactive values of protein were compared with the clinical outcome. To diagnose an infection, the negative predictive value in term infant was 99% with sensitivity of 61.5%, and on the other hand, for preterm infants, the negative predictive value was 97.8% with the corresponding sensitivity of 75%. Kawamura and Nishida (1995) reported that when the changing pattern of C – reactive protein and clinical findings did not suggest evidence of infection, the antibiotic therapy that was started at birth was discontinued. This resulted to mean duration of antibiotic administration for 3 days in the term infants and 4 days in the preterm infants. Kawamura and Nishida (1995) concluded that recognising the changing pattern of C – reactive protein can be very useful in the exclusion of infection and minimising antibiotic therapy that is unnecessary in neonatal infection management. Kono et al (2002) made an evaluation on the practical value of initial C – Reactive Protein (CRP) in the diagnosis of bacterial infection in children. In their study, Kono et al (2002) made use of eleven children composed of six boys and five girls with age ranging from 3 months through 3 years with an initial level of CRP of Read More