Association of C-Reactive Protein With Bacterial and Respiratory Syncytial Virus–Associated Pneumonia Among Children Aged <5 Years in the PERCH Study
| Autor: | Azwifarwi Mudau, Zhenke Wu, Henry C. Baggett, Daniel R. Feikin, W. Abdullah Brooks, Alice Kamau, Rasheed Salaudeen, Juliet O. Awori, Khalequ Zaman, Stephanie Cascio, Peter V. Adrian, Locadiah Kuwanda, Lawrence Mwananyanda, Doli Goswami, James Chipeta, Mengying Li, James Mwansa, Pongpun Sawatwong, Donald M. Thea, Laura L. Hammitt, Hasan Ashraf, David R. Murdoch, Hubert P. Endtz, Julia Rhodes, Charatdao Bunthi, Geoff Kahn, Susan A. Maloney, Trevor P. Anderson, Phil Seidenberg, Stephen R. C. Howie, Uma Onwuchekwa, Amanda J. Driscoll, Somwe Wa Somwe, Shabir A. Madhi, Boubou Tamboura, Maria Deloria Knoll, Grant A. Mackenzie, Daniel E. Park, Pasakorn Akarasewi, Karen L. Kotloff, Jessica McLellan, Nasreen Mahomed, Christine Prosperi, Joanne L. Mitchell, Nana Kourouma, Mamadou Sylla, Orin S. Levine, Micah Silaba Ominde, Eunice M. Machuka, Katherine L. O'Brien, Vicky L. Baillie, Milagritos D. Tapia, Arifin Shamsul, Martin Antonio, Nora L. Watson, Susan C. Morpeth, E Wangeci Kagucia, Mohammed Ziaur Rahman, Nicholas Fancourt, David P. Moore, Sidi Kazungu, Melissa M. Higdon, Andrea DeLuca, Aliou Toure, Geoffrey Kwenda, Scott L. Zeger, Michelle J. Groome, Somsak Thamthitiwat, Angela Karani, Lokman Hossain, Yasmin Jahan, Samba O. Sow, Syed M. A. Zaman, Jane Crawley, Tham T Le, J. Anthony G. Scott, Anek Kaewpan, Somchai Chuananon, Ruth A. Karron, Bernard E. Ebruke, Wei Fu |
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| Přispěvatelé: | Medical Microbiology & Infectious Diseases |
| Rok vydání: | 2017 |
| Předmět: |
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0301 basic medicine Microbiology (medical) Pneumonia Viral 030106 microbiology Oropharynx Respiratory Syncytial Virus Infections Polymerase Chain Reaction Sensitivity and Specificity Virus C-reactive protein 03 medical and health sciences 0302 clinical medicine Nasopharynx Pneumonia Bacterial medicine Humans 030212 general & internal medicine bacteria Lung biology business.industry pneumonia Infant Newborn Area under the curve Bacterial pneumonia RSV Infant medicine.disease respiratory tract diseases 3. Good health Community-Acquired Infections Pneumonia Infectious Diseases medicine.anatomical_structure ROC Curve Case-Control Studies Child Preschool Respiratory Syncytial Virus Human Immunology biology.protein Etiology biomarker Biomarker (medicine) Supplement Article Female business Biomarkers |
| Zdroj: | Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America Clinical Infectious Diseases, 64, S378-S386. Oxford University Press |
| ISSN: | 1537-6591 1058-4838 |
| DOI: | 10.1093/cid/cix150 |
| Popis: | Background Lack of a gold standard for identifying bacterial and viral etiologies of pneumonia has limited evaluation of C-reactive protein (CRP) for identifying bacterial pneumonia. We evaluated the sensitivity and specificity of CRP for identifying bacterial vs respiratory syncytial virus (RSV) pneumonia in the Pneumonia Etiology Research for Child Health (PERCH) multicenter case-control study. Methods We measured serum CRP levels in cases with World Health Organization–defined severe or very severe pneumonia and a subset of community controls. We evaluated the sensitivity and specificity of elevated CRP for “confirmed” bacterial pneumonia (positive blood culture or positive lung aspirate or pleural fluid culture or polymerase chain reaction [PCR]) compared to “RSV pneumonia” (nasopharyngeal/oropharyngeal or induced sputum PCR-positive without confirmed/suspected bacterial pneumonia). Receiver operating characteristic (ROC) curves were constructed to assess the performance of elevated CRP in distinguishing these cases. Results Among 601 human immunodeficiency virus (HIV)–negative tested controls, 3% had CRP ≥40 mg/L. Among 119 HIV-negative cases with confirmed bacterial pneumonia, 77% had CRP ≥40 mg/L compared with 17% of 556 RSV pneumonia cases. The ROC analysis produced an area under the curve of 0.87, indicating very good discrimination; a cut-point of 37.1 mg/L best discriminated confirmed bacterial pneumonia (sensitivity 77%) from RSV pneumonia (specificity 82%). CRP ≥100 mg/L substantially improved specificity over CRP ≥40 mg/L, though at a loss to sensitivity. Conclusions Elevated CRP was positively associated with confirmed bacterial pneumonia and negatively associated with RSV pneumonia in PERCH. CRP may be useful for distinguishing bacterial from RSV-associated pneumonia, although its role in discriminating against other respiratory viral-associated pneumonia needs further study. |
| Databáze: | OpenAIRE |
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