Procalcitonin and C reactive protein in infective endocarditis : correlation with etiology and prognosis. (2003 Apr)
procalcitonin and C reactive protein in infective endocarditis : correlation with etiology and prognosis . background : The aim of this study was to investigate the diagnostic values of serum procalcitonin ( PCT ) and C reactive protein ( CRP ) levels in infective endocarditis ( IE ) and to correlate them with the etiology of the disease and the prognosis of the patients . methods : fifty patients who were diagnosed as having IE based on Duke criteria ( major and / or minor ) were included in the study at the istanbul university cardiology institute and florence nightingale hospital . forty patients with bacteremia ( non IE ) and 50 healthy blood donors were also included in the study as the control group . during the 45 days of medical follow up , in those patients who had a response to medical therapy based on the results of left ventricular function tests , transesophageal echocardiography ( TEE ) and culture , among other factors , PCT and CRP levels were measured in 5 cm ( 3 ) blood samples obtained without anticoagulant when they were first admitted ( day 0 ) , as well as 24 h and 15 , 30 and 45 days after admission . In the patients who had valve replacement , 5 cm ( 3 ) blood samples without anticoagulant were similarly obtained on the day of admission , after 24 h and / or on the 15th day , and 1 day before …

Value of C reactive protein for detecting bacteremia in febrile patients objectives : mortality among bacteremic adults ranges between 14 … (1996 Nov)
value of C reactive protein for detecting bacteremia in febrile patients objectives : mortality among bacteremic adults ranges between 14 and 35 , and there is no biological clue to identify such patients a priori . As C reactive protein ( CRP ) blood level rises in children during bacteremia , we investigated its accuracy to identify bacteremic patients among febrile adults who were admitted to our hospital either for study or treatment . methods : patients older than 14 entering the emergency room with objective axilar temperature above 37 . 5 degrees C and admitted either for study or treatment were elligible for enrollment . after initial examination , samples were obtained for blood cultures and CRP measurement . follow up during hospitalization was assessed . All variables were related with one another by bivariant statistical methods performed with sigma horus hardware . after bivariant study we used the program BMDP statistical software ( 1991 ) to perform the multivariate study in its discriminant analysis . results : One hundred seventy four patients entered the study with an average age of 58 . 9 years ; 47 . 7 were over 65 years of age ; 88 of febrile syndromes were of infectious origin and among them , bacteremia ranged up to 17 . 2 . values of CRP were significantly related with the following variables : age : patients younger than 45 had average CRP concentrations of 9 . 5 mg , age over 45 had 17 . …

Approach to term neonates born after maternal intrapartum fever and unknown maternal group B streptococcus status : value of serum … (2007 Nov)
approach to term neonates born after maternal intrapartum fever and unknown maternal group B streptococcus status : value of serum C reactive protein and 16S rRNA gene PCR amplification . thirty six term neonates born after maternal intrapartum fever , with premature rupture of membranes 18 hours and unknown maternal group B streptococcus status had blood samples for complete blood count , C reactive protein , culture , and 16S rRNA gene polymerase chain reaction amplification . Only 2 neonates were symptomatic and none had leukopenia , C reactive protein 1 . 0 mg / dL , bacteremia , or positive polymerase chain reaction .

Procalcitonin does not discriminate infection from inflammation after allogeneic bone marrow transplantation. (2000 Dec)
procalcitonin does not discriminate infection from inflammation after allogeneic bone marrow transplantation . procalcitonin ( PCT ) is an early marker of bacterial infection but little is known about its value in neutropenic allogeneic bone marrow transplant ( BMT ) recipients . We collected plasma from 12 recipients of T cell depleted HLA matched related BMT recipients who had been treated preemptively with meropenem from the day after BMT for at least 15 days . PCT and C reactive protein ( CRP ) concentrations were determined on BMT days 1 , 5 , 8 , 12 , and 15 , and their relationship to inflammatory events ( IE ) , including mucositis , microbiologically and clinically defined infections , acute graft versus host disease ( GVDH ) , and unexplained fever , was then determined . The PCT concentrations were all low and never exceeded 4 microg / liter , unlike CRP concentrations , which spanned the full range up to 350 mg / liter . All patients had mucositis , and there was no significant difference between PCT concentrations associated with mucositis alone and those associated with an additional IE on BMT days 1 to 12 . however , on BMT day 15 , the mean concentrations of PCT were 0 . 37 / 0 . 05 microg / liter for the 10 patients that had an additional IE , compared with 0 . 11 / 0 . 03 microg / liter for the 2 patients with mucositis only …

Cytokine release patterns in elderly patients with systemic inflammatory response syndrome. (2007 Aug)
cytokine release patterns in elderly patients with systemic inflammatory response syndrome . background : information is scarce about the inflammatory responses to infection in elderly patients . objective : To investigate the inflammatory pattern in elderly patients with systemic inflammatory response syndrome ( SIRS ) . methods : We assessed the value of pro inflammatory cytokines ( TNF alpha , IL 6 , IL 1beta ) and C reactive protein ( CRP ) in elderly patients with SIRS at the time of consultation in the emergency room and on the fourth day of hospitalization . results : Of 100 patients with SIRS , 92 had a clinical suspicion of infection and 46 were microbiologically confirmed . basal TNF alpha and IL 6 levels were higher in patients with bacteremia ( p 0 . 001 and p 0 . 017 , respectively ) . basal levels of TNF alpha ( p 0 . 001 ) and fourth day levels of CRP ( p 0 . 004 ) , TNF alpha ( p 0 . 001 ) and IL 6 ( p 0 . 002 ) had a positive correlation with the length of hospitalization . higher IL 6 levels on the fourth day showed a correlation with mortality ( p 0 . 016 ) , while the other cytokines and CRP did not show this association . conclusion : febrile elderly patients showed an inflammatory response pattern to infection equivalent to that reported in younger patients . despite some limitations of …

The short term effects of treatment of chronic periodontitis on circulating levels of endotoxin , C reactive protein , tumor … (2004 Apr)
The short term effects of treatment of chronic periodontitis on circulating levels of endotoxin , C reactive protein , tumor necrosis factor alpha , and interleukin 6 . background : The acute phase response involves molecules including tumor necrosis factor alpha ( TNF alpha ) , interleukin 6 ( IL 6 ) , and C reactive protein ( CRP ) . This study aimed to determine whether subgingival scaling resulted in rapid changes in plasma concentrations of these molecules . methods : twenty three non smoking adults with chronic periodontitis received subgingival scaling for 60 minutes . venous blood samples were taken at 0 , 15 , 30 , 60 , and 120 minutes . TNF alpha and IL 6 were assayed from all samples and CRP from the baseline and final samples . lipopolysaccharide ( LPS ) was assayed at 0 , 15 , and 30 minutes using limulus lysate assay ( LAL ) and endocab Ig assays . results : LPS assays were suggestive of a transient low grade bacteremia , but changes in LPS approaching significance ( P 0 . 061 ) were seen with LAL only . there was a significant increase in circulating TNF alpha ( P 0 . 0387 ) and IL 6 ( P 0 . 0001 ) , and the degree of change in TNF alpha was correlated with the severity of periodontal breakdown ( P 0 . 001 ) . there was also a significant correlation between levels of IL 6 …

Correlation of serum opsonins with in vitro phagocytosis of streptococcus pneumoniae. (1985 Oct)
correlation of serum opsonins with in vitro phagocytosis of streptococcus pneumoniae . C reactive protein ( CRP ) , an acute phase reactant which binds to phosphocholine ( PC ) in the pneumococcal cell wall , and anti PC antibodies are protective against experimental pneumococcal bacteremia in mice . To determine the relative opsonic capacities of CRP and anti PC compared with those of antibodies against pneumococcal capsular polysaccharides ( anti PCP ) , we correlated in vitro opsonic activity for serotype 7F streptococcus pneumoniae with concentrations of CRP , anti PC , and anti type 7F PCP in human sera from 10 normal subjects and 38 patients with sickle cell ( SS ) disease , a high risk group for pneumococcal infection . opsonic activity , measured by a radiolabeled bacterial uptake assay , correlated with anti PCP levels but not with CRP or anti PC in both the normal subjects and patients with SS disease . addition of CRP to normal sera did not increase opsonic activity for serotypes 4 and 7F S . pneumoniae , although it did so for serotype 27 , a nonpathogenic strain unique for having PC in its capsule . CRP and anti PC were not effective opsonins when they bound to the pneumococcal cell wall rather than the capsule . The protective effects of CRP or anti PC against these serotypes may be produced by means other than complement dependent opsonization .

Cytokines value as a sepsis and mortality predictor in elderly patients with fever background AND objective : proinflammatory cytokines ( … (2003 Oct)
cytokines value as a sepsis and mortality predictor in elderly patients with fever background AND objective : proinflammatory cytokines ( IL 1beta , IL 6 , TNF alpha ) are excellent predictive factors of tissue damage , inflammation and infection . however , there is not sufficient data about their usefulness in elderly patients with acute septic pathology . Our objective was to identify the cytokines related to bacteremia and those that predicted a bad prognosis in elderly patients . patients AND method : prospective study carried out during 1999 . patients aged 60 years with temperature 38 C admitted to the emergency ward . We determined IL 1beta , IL 6 , TNF alpha and C reactive protein ( CRP ) ; cultures were done according to the infectious source . On the 4th day , cytokines and CRP were recorded again . The follow up was completed until cure or death . results : 50 patients were included ( 29 males ) . median age was 75 . 6 ( SD : 8 . 98 ) . The etiology was infectious in 44 ( 88 ) : respiratory in 29 ( 66 ) , urinary in 8 ( 18 ) and other sources in 7 . thirteen patients had bacteremia ( 32 ) : escherichia coli ( 4 ) , streptococcus pneumoniae ( 5 ) and others ( 4 ) . Ten patients died ( 20 ) . median values on admission were CRP : 6 . 67 …

C reactive protein in the diagnosis of melioidosis. (2004 May)
C reactive protein in the diagnosis of melioidosis . previous work suggested that C reactive protein ( CRP ) may be a useful test in the diagnosis of melioidosis , the infection caused by burkholderia pseudomallei . We reviewed patients with culture confirmed melioidosis to define the role of this inflammatory marker in the diagnosis of melioidosis . In 175 patients , we found that the admission CRP level may be normal or only mildly elevated , including patients with severe sepsis , fatal cases , and in relapsed melioidosis . In a multivariate analysis , sepsis and bacteremia were more strongly associated with mortality than CRP . admission levels of CRP are not a sensitive marker for the presence of melioidosis and a normal level cannot be used to exclude acute , chronic , or relapsed melioidosis in febrile patients in or from endemic regions .

Duration of fever and markers of serious bacterial infection in young febrile children. (2007 Jan)
duration of fever and markers of serious bacterial infection in young febrile children . background : despite the drastic change in the evaluation of the febrile young child due to the decreased incidence of serious bacterial infections ( SBI ) effected by haemophilus influenza type B and pneumococcal vaccine , there remains a small role for blood work in the evaluation of these patients . bacterial markers including white blood cell ( WBC ) count , absolute neutrophil count ( ANC ) and C reactive protein ( CRP ) have been studied and are widely used as predictors of SBI in febrile children . It has been suggested that CRP values should be interpreted cautiously when fever has been present 12 h based on the kinetics of this biological marker . This limitation has not been previously addressed with CRP , nor was it described with other markers , specifically WBC and ANC , therefore the purpose of the present paper was to assess WBC , ANC and CRP values as predictors of SBI in relation to duration of fever . methods : patients who presented to a pediatric emergency department between the ages of 1 and 36 months , with fever or 39 degrees C and no source of infection had a complete blood count ( CBC ) blood culture , and CRP level drawn . A urinalysis and / or urine culture was obtained when age and gender appropriate . A chest X ray was performed at the …

Markers of bacteremia in febrile neutropenic patients with hematological malignancies : procalcitonin and IL 6 are more reliable than C … (2004 Jul)
markers of bacteremia in febrile neutropenic patients with hematological malignancies : procalcitonin and IL 6 are more reliable than C reactive protein . since neutropenic patients with hematological malignancies are at high risk of contracting life threatening infections , specific markers of infection are needed in cases of febrile neutropenia . The study presented here assessed serum concentrations of C reactive protein ( CRP ) , procalcitonin ( PCT ) and interleukin 6 ( IL 6 ) in samples obtained from 31 febrile neutropenic patients . A total of 53 episodes were evaluated , and 18 of these were associated with positive blood culture results . procalcitonin and IL 6 concentrations differed significantly between bacteremic and non bacteremic episodes . procalcitonin values were 0 . 22 ng / ml interquartile range ( IR ) , 0 . 15 1 . 9 for patients with pneumonia without bacteremia , 0 . 22 ng / ml ( IR , 0 . 16 0 . 55 ) for patients with fever of unknown origin , 0 . 2 ng / ml ( IR , 0 . 13 0 . 57 ) for patients with non microbial fever and 1 . 8 ng / ml ( IR , 0 . 35 5 . 3 ) for patients with bacteremia . The differences between bacteremic and non bacteremic episodes had a P value of 0 . 003 using the Mann whitney test . For IL 6 the median values were 301 pg / ml ( …

Diagnostic significance of indium 111 granulocyte scintigraphy in febrile patients. (1987 Feb)
diagnostic significance of indium 111 granulocyte scintigraphy in febrile patients . sixty eight patients with fever of unknown origin , 32 patients with postoperative fever , and 26 patients with therapy resistant fever after bacteremia were investigated with 111in granulocyte scintigraphy for the detection of abscesses . The results showed that the value of 111in granulocyte scintigraphy in the detection of infectious foci vary in these three types of febrile conditions . The overall sensitivity and specificity were 86 . 5 and 87 . 8 , respectively . We observed , however , a relatively low predictive value of a positive result in the fever of unknown origin group ( 73 . 1 ) , and also a low predictive value of a negative result in the bacteremia group ( 66 . 7 ) . The C reactive protein ( CRP ) levels in patients with a true positive scintigram were significantly ( p less than 0 . 001 ) higher than in patients with a true negative scintigram . there was also a significant positive correlation ( p less than 0 . 01 ) between the serum CRP concentration and the intensity of the granulocyte accumulations . there was no correlation between the peripheral leukocyte count or the erythrocyte sedimentation rate ( ESR ) and the intensity of the granulocyte uptake . therefore CRP , but not the leukocyte count or ESR , appears useful for selecting the patients who benefit most from granulocyte scintigraphy .

Comparison of acute phase reactants in pediatric patients with fever. (1979 Feb)
comparison of acute phase reactants in pediatric patients with fever . We compared WBC count greater than or equal to 15 , 000 / cu mm ( high WBC count ) . wintrobe ESR greater than or equal to 30 mm / hr ( high ESR ) , temperature greater than or equal to 40 degrees C , and positive slide tests for C reactive protein ( CRP ) at a serum dilution of 1 : 50 in febrile , ambulatory children . The CRP test was performed with and without heat inactivation of serum . An excellent correlation was found between noninactivated and inactivated CRP test results . since the noninactivated CRP test can be done quickly , its results would be readily available in an outpatient setting . High ESR demonstrated the best balance of specificity and sensitivity for bacteremia , pneumonia , and other possible or proved bacterial illnesses . A positive CRP test was highly specific for these diagnoses but less sensitive than an ERS greater than or equal to 30 mm / hr . three combinations of acute phase reactants , high WBC count and / or high ESR , high ESR and / or positive CRP test , and high WBC count and / or high ESR and / or positive CRP test performed as well as high ESR alone . Each was less specific but more sensitive than high ESR for possible or proved bacterial illnesses . The evaluation of an ambulatory , …

Antibody response in six hacek endocarditis cases under therapy. (1998 Jul)
antibody response in six hacek endocarditis cases under therapy . The antibody response to bacteria of the so called hacek group , i . e . haemophilus spp . , actinobacillus actinomycetemcomitans , cardiobacterium hominis , eikenella corrodens and kingella kingae , was measured in sera of six patients with endocarditis . The corresponding isolates from their blood cultures were identified by conventional methods , including reactions for nitrate reduction and catalase as well as acid production from sugars . crude antigens were prepared by glycine extraction and sonification of the blood culture isolates , and used to determine titers by complement fixation . A patient with haemophilus parainfluenzae bacteremia received a short course of antibiotic therapy , and relapsed with spondylitis and endocarditis 5 months later . titers of sera against his own isolate rose from 1 : 40 to 1 : 320 and fell to 1 : 40 after therapy within one year . A patient with C . hominis endocarditis had a similarly prolonged course . The complement fixation titer against his own isolate was already 1 : 240 before antibiotics were administered . another patient with C . hominis endocarditis presented a titer of 1 : 320 2 weeks after the diagnosis . these three patients revealed C reactive protein values over 50 mg / l in the first serum sample . decrease of both antibody titers and C reactive protein values correlated with clinical improvement . Two patients with prosthetic valve replacement 5 months earlier …

Human C reactive protein protects mice from streptococcus pneumoniae infection without binding to pneumococcal C polysaccharide. (2007 Jan)
human C reactive protein protects mice from streptococcus pneumoniae infection without binding to pneumococcal C polysaccharide . human C reactive protein ( CRP ) protects mice from lethality after infection with virulent streptococcus pneumoniae type 3 . For CRP mediated protection , the complement system is required ; however , the role of complement activation by CRP in the protection is not defined . based on the in vitro properties of CRP , it has been assumed that protection of mice begins with the binding of CRP to pneumococcal C polysaccharide on S . pneumoniae and subsequent activation of the mouse complement system . In this study , we explored the mechanism of CRP mediated protection by utilizing two CRP mutants , F66A and F66A / E81A . Both mutants , unlike wild type CRP , do not bind live virulent S . pneumoniae . We found that passively administered mutant CRP protected mice from infection as effectively as the wild type CRP did . infected mice injected with wild type CRP or with mutant CRP lived longer and had lower mortality than mice that did not receive CRP . extended survival was caused by the persistence of reduced bacteremia in mice treated with any CRP . We conclude that the CRP mediated decrease in bacteremia and the resulting protection of mice are independent of an interaction between CRP and the pathogen and therefore are independent of the ability of CRP to activate mouse complement . It has been shown …

Production of C reactive protein in escherichia coli infected patients with liver dysfunction due to liver cirrhosis. (2005 Apr)
production of C reactive protein in escherichia coli infected patients with liver dysfunction due to liver cirrhosis . To assess the effect of liver dysfunction on the production of C reactive protein ( CRP ) , CRP levels were evaluated in patients with escherichia coli bacteremia with or without liver cirrhosis ( LC ) . thirty patients of each kind were selected as case and control groups , respectively . A matched control of 30 LC patients without acute infection was also included . In the patients with E . coli bacteremia , median CRP was 6 . 2 mg / dL ( range 0 . 2 22 . 1 ) in the LC patients and 14 . 6 mg / dL ( range 5 . 8 39 . 6 ) in the patients without liver dysfunction ( P 0 . 001 ) . In the advanced LC patients in child Pugh class C , median CRP was 5 . 0 mg / dL ( range 0 . 2 12 . 1 ) in patients with E . coli bacteremia and 0 . 5 mg / dL ( range 0 . 1 1 . 2 ) in patients without acute infection ( P 0 . 001 ) . Our data suggest that , although CRP levels are reduced in response to acute infection , production is nevertheless maintained even in patients with advanced liver dysfunction .

Procalcitonin used as a marker of infection in the intensive care unit. (1999 Apr)
procalcitonin used as a marker of infection in the intensive care unit . objective : To determine the value of procalcitonin ( proct ) as a marker of infection in critically ill patients . design : prospective , observational study . setting : medicosurgical department of intensive care ( 31 beds ) . patients : One hundred eleven infected and 79 noninfected patients . interventions : None . measurements AND MAIN results : proct and C reactive protein ( CRP ) concentrations were monitored daily . The best cutoff values for proct and CRP were 0 . 6 ng / mL and 7 . 9 mg / dL , respectively . compared with CRP , proct had a lower sensitivity ( 67 . 6 vs . 71 . 8 ) , specificity ( 61 . 3 vs . 66 . 6 ) , and area under the receiver operating characteristic curve ( 0 . 66 vs . 0 . 78 , p . 05 ) . The combination of proct and CRP increased the specificity for infection to 82 . 3 . In the infected patients , plasma proct , but not CRP , values were higher in nonsurvivors than in survivors . infected patients with bacteremia had higher proct concentrations than those without bacteremia , but similar CRP concentrations . proct levels were particularly high in septic shock patients . conclusions : proct is not a better marker of infection than CRP in critically ill patients , but it …

Levels of C reactive protein in patients with hematologic malignancies. (1986 Feb)
levels of C reactive protein in patients with hematologic malignancies . The levels of C reactive protein ( CRP ) were assayed in 282 serial sera of 70 patients with hematologic malignancies who were under antineoplastic medication , and surveyed with frequent blood cultures . The mean peak value of CRP in febrile patients with bacteriologically verified sepsis was 162 mg / l and differed significantly ( p less than 0 . 001 ) from that ( 23 mg / l ) of afebrile patients with negative blood cultures , but not from that ( 115 mg / l ) of febrile patients without confirmed bacteremia . All the values in afebrile patients with negative blood cultures were less than 100 mg / l ; 71 of their peak values were less than 40 mg / l . Thus the malignancy itself or its treatment did not considerably mount CRP response .

Monitoring of endotoxin , interleukin 6 and C reactive protein serum concentrations in neutropenic patients with fever. (1995 Jul)
monitoring of endotoxin , interleukin 6 and C reactive protein serum concentrations in neutropenic patients with fever . serum endotoxin , interleukin 6 ( IL 6 ) and C reactive protein ( CRP ) were serially determined in 26 patients with hematological malignancies and chemotherapy induced neutropenia who developed fever . endotoxin in serum was detected in 69 of the patients , with the highest values being recorded in patients with gram negative ( Gr ) bacteremia . High levels of IL 6 were found after start of fever , and in 6 / 9 patients with Gr bacteremia levels exceeded 200 ng / l in samples drawn within the first 72 hours . however , only in 2 / 17 patients with gram positive bacteremias and blood culture negative fever episodes did IL 6 exceed this concentration ( p 0 . 05 ) . High CRP values ( exceeding 100 mg / l ) did not discriminate between Gr and non Gr episodes ( 7 / 9 versus 10 / 17 , respectively ) . In patients with fever at day 3 5 ( n 15 ) , IL 6 values 100 ng / l were associated with fever continuing for more than 7 days after start of the episode ; contrarily , CRP values did not indicate the persistence of fever . determination of IL 6 may be a better test than CRP in monitoring the acute response to infection in the neutropenic patient . A combination of …

Interleukin 6 , interleukin 8 , interleukin 10 , and C reactive protein in febrile neutropenia in children with malignant … (2006 Jun)
interleukin 6 , interleukin 8 , interleukin 10 , and C reactive protein in febrile neutropenia in children with malignant diseases . AIM : To compare serum levels of interleukin 6 , interleukin 8 and interleukin 10 in bacteremic and non bacteremic episodes of febrile neutropenia in children with malignant diseases , and determine their changes and correlation with C reactive protein ( CRP ) . material AND methods : between january 2003 and June 2004 , we examined 41 episodes of febrile neutropenia in 24 children with malignant diseases who were receiving polychemotherapy . C reactive protein was measured at the onset of febrile episodes and on days 3 and 5 from beginning of therapy . The soluble interleukins 6 , 8 , and 10 were determined in the serum using enzyme bound immunosorbent analysis at the onset of fever and at 24 and 72 hours after initiation of an empiric antibiotic therapy . results : The CRP baseline levels differentiated the patients with unexplained fever from those with local infection but did not differentiate them from those with bacteremia . interleukin 8 at 24 hours differentiated bacteremic from non bacteremic episodes ( P 0 . 05 ) and at a cut off value of 130 pg / ml it had a sensitivity of 72 and a specificity of 84 to differentiate bacteremia . interleukin 10 at 24 hours yielded higher values in Gram ( ) bacteremia in comparison with the non bacteremic episodes ( P 0 . 001 …