A model for predicting risk of serious bacterial infection in febrile infants younger than 3 months of age.

BACKGROUND: The objective of this study was to construct a model for predicting the risk of serious bacterial infection (SBI) in febrile infants. METHODS: A total of 135 febrile infants younger than 3 months of age who met the inclusion criteria were assessed on the following: physical appearance, complete blood count, serum C-reactive protein (CRP), urinalysis, stool smears for white blood cell (WBC) count if diarrhea was apparent, and blood and urine cultures. Chest X-rays were performed if respiratory symptoms were evident. Cerebrospinal fluid was analyzed if central nervous system infection was suspected. RESULTS: Of the 135 infants, 34 were diagnosed with SBI. Data from 99 infants were used to construct a model for predicting SBI by multivariate logistic regression. Sex (male), spun urine WBC count (>or= 10 per high-powered field [400x]) and CRP (>or= 3.6 mg/L) were significantly related to SBI. A probability cut-off of 0.265 was selected, where values below and above the cut-off reflected low and high SBI risk respectively. Data from the remaining 36 infants were used to test model validity. Both sensitivity and specificity were 77.8% for predicting SBI using this model. CONCLUSION: These findings suggest that sex, serum CRP concentration and spun urine WBC count can be used to accurately predict SBI in febrile infants aged less than 3 months of age.

The diagnostic value of serum interleukins 6 and 8 in children with acute gastroenteritis.

OBJECTIVES: Early identification of the pathogen causing acute gastroenteritis in children helps the physicians managing the disease and prevents unnecessary antibiotic treatment. C-reactive protein (CRP), interleukin (IL) 6 and IL-8 play a major role in immune responses and have been studied in a large number of infectious and noninfectious inflammatory diseases. The purpose of this study was to determine the serum IL-6 and IL-8 concentrations early in the course of acute gastroenteritis to see if these cytokines were useful diagnostic markers in differentiating viral from bacterial gastroenteritis. METHODS: Interleukin 6, IL-8 and CRP were measured in 18 patients with bacterial gastroenteritis, 21 patients with viral gastroenteritis and 17 healthy children. RESULTS: Interleukin 6 and CRP concentrations in patients with bacterial gastroenteritis were significantly higher than those in patients with viral gastroenteritis and healthy controls (P < 0.001). IL-8 concentrations in patients with viral and bacterial gastroenteritis were both increased and were not statistically different. IL-6 and IL-8 levels had diagnostic sensitivities of 79% and 50% and specificities of 86% and 67%, respectively. The combination of IL-6 and CRP had a sensitivity of 94%, specificity of 71%, a positive predictive value of 74% and a negative predictive value of 93.75%. CONCLUSIONS: Serum IL-6 may be a useful marker for early differentiation of viral and bacterial gastroenteritis in children, especially in combination with CRP.

Serum interleukin-5 measurements for monitoring acute asthma in children.

Cytokine-mediated interactions among the inflammatory cells may play a role in the pathogenesis of bronchial asthma. Interleukin-5 (IL-5) is a major cytokine in the recruitment of neutrophils to the area of inflammation. Serum IL-5 is a marker of disease activity and treatment efficacy in bronchial asthma. To understand the role of IL-5 in disease activity in acute asthma, changes in serum concentrations of IL-5 elaborated by activated eosinophil before and after prednisolone therapy with clinical improvement were determined in the present study. Circulating levels of IL-5 in 16 normal control subjects and in sera from 22 allergic asthmatic children with acute exacerbation and in stable condition were determined by using commercially available assay kits. The mean concentration of serum IL-5 was higher in patients with acute exacerbation (6.30 +/- 2.21 pg/mL) and in stable asthmatics (5.55 +/- 2.23 pg/mL) compared to control group subjects (4.81 +/- 0.54 pg/mL; p > 0.05). However, the difference was not statistically significant between the acute exacerbation and stable asthmatics groups (p > 0.05). Serum IL-5 is a poor indicator of disease activity in acute asthma; therefore, monitoring serum IL-5 concentration is of limited value. The clinical value of serum IL-5 as a marker of disease activity remains to be established.

Tumor necrosis factor-alpha and interleukin-10 in viral and bacterial gastroenteritis in children.

BACKGROUND: Gastroenteritis is a common cause of hospitalization and is associated with high morbidity in children. C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-alpha) and interleukin-10 (IL-10) are primary mediators of inflammation, and have been implicated in many infectious and non-infectious inflammatory diseases. The main objective of this study was to identify serum markers in viral and bacterial gastroenteritis. METHODS: Thirty-one patients admitted to a pediatric infection ward with gastroenteritis and definite pathogens were enrolled in the study: 17 patients had viral gastroenteritis and 14 bacterial gastroenteritis. Serum levels of TNF-alpha, IL-10 and CRP were measured in these 31 patients, and in a control group of 15 healthy children. RESULTS: Serum concentrations of TNF-alpha and CRP were significantly greater in patients with bacterial gastroenteritis than in patients with viral gastroenteritis and healthy controls (p < 0.001). Concentrations of IL-10 were increased, but not significantly, in patients with viral or bacterial gastroenteritis (p = 0.577 vs controls). Regarding diagnosis, the measurement of TNF-alpha and CRP levels was 78.6% and 92.0% sensitive, respectively; and 88.2% and 58.8% specific, respectively. CONCLUSION: Serum TNF-alpha concentration may be a useful marker for distinguishing between viral and bacterial gastroenteritis.

Elevated levels of soluble adhesion molecules in sera of patients with acute bronchiolitis.

The mechanisms of migration of neutrophils into the airway lumen are crucial in the development of airway injury of acute bronchiolitis and are mediated by adhesion molecules. In this study, we have attempted to evaluate the role of serum concentrations of the soluble form of intercellular adhesion molecule-1 (sICAM-1) in the disease activity in acute bronchiolitis and in respiratory syncytial virus (RSV) infection. Circulating levels of sICAM-1 in sera from 10 normal control subjects, and from 47 hospitalized acute bronchiolitis patients at admission, and from 25 patients on the day of discharge were determined by use of commercially available enzyme-linked immunosorbent assay kits. The mean serum level of sICAM-1 in bronchiolitis patients was significantly higher than in the 10 healthy control infants (345.8 +/- 99.7 microg/mL vs 237.1 +/- 81.7 microg/mL; p<0.05). However, the mean sICAM-1 concentration was similar between RSV-positive and RSV-negative patients (337.5 +/- 99.6 microg/mL vs 350.9 +/- 101.1 microg/mL; p=0.65). Although the mean clinical severity score of RSV-positive patients was significantly higher than that of RSV-negative patients (5.94 +/- 1.83 vs 3.48 +/- 1.70; p<0.05). The improvement of clinical severity score was not well correlated with the change of sICAM-1 level (r=0.22). This study provides evidence that serum levels of sICAM-1 are increased in acute bronchiolitis and further confirms the role of adhesion molecules involved in the pathogenesis of the disease. However, the serum concentrations of the soluble adhesion molecules could not reliably reflect the clinical severity of the disease.

Serum interleukin-6 level as a diagnostic test in children with sepsis.

BACKGROUND: This study was performed to determine the serum concentrations of interleukin-6 (IL-6) during the early course of bacterial infections disease in children, and to evaluate the usefulness of IL-6 as a diagnostic test alone and in combination with C-reactive protein (CRP). METHODS: We measured serum IL-6 values in 3 groups of children on their first day of admission, from January 2001 to December 2001: group 1, patients with clinical and microbiological evidence of sepsis (n = 13); group 2, patients with clinical and chest radiographical evidence of pneumonia (n = 18); and group 3, patients with no signs of infection (control group) (n = 16). Kruskal-Wallis tests were used to compare the difference of IL-6 values between groups and control subjects. RESULTS: IL-6 values were significantly higher in groups 1 and 2 compared with those in the control group (p < 0.001). No significant differences were found between the groups 1 and 2. As a diagnostic test, IL-6 (> or = 20 pg/mL) alone yielded a sensitivity of 68%, a specificity of 88%, a positive predictive value of 71%, and a negative predictive value of 58%. A combined parameter of IL-6 (> or = 20 pg/mL) and CRP (> or = 1 mg/dL) yielded a sensitivity of 94%, a specificity of 63%, a positive predictive value of 79%, and a negative predictive value of 87%. CONCLUSION: IL-6 levels increase in children with sepsis. In combination with CRP, IL-6 seems to be a valuable parameter in the early diagnosis of pediatric infections.

Coagulase-negative staphylococcal bacteremia in critically ill children: risk factors and antimicrobial susceptibility.

Coagulase-negative staphylococci (CoNS) are the most common microorganisms isolated from blood cultures in childern, and determining whether there is true bacteremia or merely contamination is a clinical dilemma. A total of 67 episodes of CoNS-positive blood cultures in pediatric and neonatal intensive care units were evaluated during a 3-year period in order to find the possible risk factors involved and the antimicrobial susceptibility of CoNS isolates. In this study, 37 episodes were judged to be infections as opposed to 30 that were not. In comparison with individuals without infection, patients with true infection of CoNS stayed longer in the hospital (32 +/- 32.9 vs 10.7 +/- 9.3 days, p = 0.001), had more surgical procedures (32.4% vs 6.7%, p = 0.014), received more antibiotic treatments in the recent 2 weeks (37.8% vs 0%, p < 0.001), underwent more central venous catheter insertions (86.4% vs 10%, p < 0.001), received more parenteral nutrition (37.8% vs 3.3%, p = 0.001), had higher C-reactive protein profiles (4.8 +/- 5.4 vs 0.6 +/- 0.9 mg/dL, p < 0.001), and had higher neutrophil proportion (58.1% vs 44.3%, p = 0.001). However, there were no significant differences in corticosteroid therapy, hemoglobin level, total leukocyte count, and platelet count. All strains of the infection group were resistant to cefazolin, cefotaxime, penicillin, and erythromycin. Nonetheless, all isolates were susceptible to vancomycin. The percentage of multiple-resistant CoNS in the infection group was 96.9%. Empirical therapy with vancomycin for CoNS bacteremia in critically ill children is therefore recommended.

Circulating adhesion molecules in sera of asthmatic children.

Infiltration of cells into the lung in asthma is regulated by several expressions of cell adhesion molecules (CAMs) on cells present in the airways, and may play a role in the pathogenesis of bronchial asthma. We sought to evaluate the role of serum concentrations of the soluble forms of intercellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (sVCAM-1), and E-selectin (sE-selectin) in the control of disease activity in acute asthma. Circulating levels of sICAM-1, sVCAM-1, and sE-selectin in sera from 15 normal control subjects and from 20 allergic asthmatic children with acute exacerbations who had returned to stable condition were determined by using commercially available enzyme-linked immunosorbent assay kits. The mean concentration of serum sICAM-1 levels was significantly higher during an acute exacerbation of asthmatic children than in those with stable asthma (19.41 +/- 10.65 ng/mL vs. 13.46 +/- 5.44 ng/mL; P < 0.001) or in control subjects (9.83 +/- 2.02 ng/mL; P < 0.001). For sVCAM-1 and sE-selectin, the mean serum concentration of sVCAM-1 was slightly higher in children during an acute exacerbation asthma than when stable. However, the differences did not reach statistical significance. The mean serum concentrations of sVCAM-1 and sE-selectin in acute asthma or stable asthma were significantly higher than in control subjects. This study provides further evidence that serum concentrations of sICAM-1, sVCAM-1, and sE-selectin are increased in acute asthma. These findings further confirm that leukocyte endothelial adhesion plays a role in inflammatory airway disease.