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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
The diagnostic and prognostic accuracy of five markers of serious bacterial infection in Malawian children with signs of severe infection
PLoS ONE, Volume 4, No. 8, Article e6621, Year 2009
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Description
Background: Early recognition and prompt and appropriate antibiotic treatment can significantly reduce mortality from serious bacterial infections (SBI). The aim of this study was to evaluate the utility of five markers of infection: C-reactive protein (CRP), procalcitonin (PCT), soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), CD163 and high mobility group box-1 (HMGB1), as markers of SBI in severely ill Malawian children. Methodology and Principal Findings: Children presenting with a signs of meningitis (n = 282) or pneumonia (n = 95), were prospectively recruited. Plasma samples were taken on admission for CRP, PCT, sTREM-1 CD163 and HMGB1 and the performance characteristics of each test to diagnose SBI and to predict mortality were determined. Of 377 children, 279 (74%) had SBI and 83 (22%) died. Plasma CRP, PCT, CD163 and HMGB1 and were higher in HIV-infected children than in HIV-uninfected children (p<0.01). In HIV-infected children, CRP and PCT were higher in children with SBI compared to those with no detectable bacterial infection (p<0.0005), and PCT and CD163 were higher in non-survivors (p = 0.001, p = 0.05 respectively). In HIV-uninfected children, CRP and PCT were also higher in children with SBI compared to those with no detectable bacterial infection (p<0.0005), and CD163 was higher in non-survivors (p = 0.05). The best predictors of SBI were CRP and PCT, and areas under the curve (AUCs) were 0.81 (95% CI 0.73-0.89) and 0.86 (95% CI 0.79-0.92) respectively. The best marker for predicting death was PCT, AUC 0.61 (95% CI 0.50-0.71). Conclusions: Admission PCT and CRP are useful markers of invasive bacterial infection in severely ill African children. The study of these markers using rapid tests in a less selected cohort would be important in this setting. © 2009 Carrol et al.
Authors & Co-Authors
Carrol, Enitan D.
Malawi, Blantyre
Malawi-liverpool-wellcome Trust Clinical Research Programme
United Kingdom, Liverpool
University of Liverpool
Mankhambo, Limangeni A.
Malawi, Blantyre
Malawi-liverpool-wellcome Trust Clinical Research Programme
Malawi, Zomba
University of Malawi
Jeffers, Graham
United Kingdom, Liverpool
University of Liverpool
Parker, Deborah
United Kingdom, Leicester
Glenfield Hospital
Guiver, Malcolm
United Kingdom, London
Public Health England
Newland, Paul
United Kingdom, Liverpool
Alder Hey Children's Nhs Foundation Trust
Banda, Daniel Lawadi
Malawi, Blantyre
Malawi-liverpool-wellcome Trust Clinical Research Programme
Antonio, C.
Malawi, Blantyre
Malawi-liverpool-wellcome Trust Clinical Research Programme
Chinamale, M.
Malawi, Blantyre
Malawi-liverpool-wellcome Trust Clinical Research Programme
Jere, L.
Malawi, Blantyre
Malawi-liverpool-wellcome Trust Clinical Research Programme
Mnapo, D.
Malawi, Blantyre
Malawi-liverpool-wellcome Trust Clinical Research Programme
Munthali, V.
Malawi, Blantyre
Malawi-liverpool-wellcome Trust Clinical Research Programme
Nyalo, Flora
Malawi, Blantyre
Malawi-liverpool-wellcome Trust Clinical Research Programme
Simwinga, J.
Malawi, Blantyre
Malawi-liverpool-wellcome Trust Clinical Research Programme
Kaole, M.
Malawi, Blantyre
Malawi-liverpool-wellcome Trust Clinical Research Programme
Manyika, A.
Malawi, Blantyre
Malawi-liverpool-wellcome Trust Clinical Research Programme
Phiri, Kamija Samuel
Malawi, Blantyre
Malawi-liverpool-wellcome Trust Clinical Research Programme
Molyneux, Elizabeth M.
Malawi, Zomba
University of Malawi
Heyderman, Robert Simon
Malawi, Blantyre
Malawi-liverpool-wellcome Trust Clinical Research Programme
Molyneux, Malcolm Edward
Malawi, Blantyre
Malawi-liverpool-wellcome Trust Clinical Research Programme
Hart, Charles Anthony
United Kingdom, Liverpool
University of Liverpool
Statistics
Citations: 77
Authors: 21
Affiliations: 6
Identifiers
Doi:
10.1371/journal.pone.0006621
e-ISSN:
19326203
Research Areas
Infectious Diseases
Maternal And Child Health
Study Design
Cohort Study