International Journal of Medicine and Medical Sciences
Subscribe to IJMMS
Full Name*
Email Address*

Article Number - B350B8A55734


Vol.10(1), pp. 9-13 , January 2018
https://doi.org/10.5897/IJMMS2017.1340
ISSN: 2006-9723


 Total Views: 0
 Downloaded: 0

Full Length Research Paper

The value of C–reactive protein in the diagnosis of septicaemia in children with malaria



Emmanuel Eyo Ekanem
  • Emmanuel Eyo Ekanem
  • Department of Paediatrics, University of Calabar, Calabar, Nigeria.
  • Google Scholar
Ador John Uniga
  • Ador John Uniga
  • Federal Medical Centre, Jalingo, Taraba State, Nigeria.
  • Google Scholar
Cosmas Akataekwe Obiora
  • Cosmas Akataekwe Obiora
  • Federal Medical Centre, Makurdi, Benue State, Nigeria.
  • Google Scholar
Angela Ekanem Oyo-Ita
  • Angela Ekanem Oyo-Ita
  • Department of Community Health, University of Calabar, Calabar, Nigeria.
  • Google Scholar
Helena Martin Omang
  • Helena Martin Omang
  • Department of Medical Microbiology, University of Calabar, Calabar, Nigeria.
  • Google Scholar







 Received: 19 October 2017  Accepted: 24 November 2017  Published: 31 January 2018

Copyright © 2018 Author(s) retain the copyright of this article.
This article is published under the terms of the Creative Commons Attribution License 4.0


Malaria and septicaemia, both major causes of infant and early childhood morbidity and mortality in Nigeria, often co-exist and are difficult to differentiate. This study was designed to test the hypothesis that C-reactive protein (CRP) levels could differentiate between malaria and malaria coexisting with septicaemia. One hundred and fifty-one children aged 6 to 60 months with fever without localising signs and 141 aged/sex-matched controls were studied. C-reactive protein levels in all the children were determined while the febrile children had their blood cultures done. ANOVA and students‘t’ test were used to determine the difference between groups. Sensitivity, negative predictive and positive predictive values for malaria coexisting unit septicaemia were calculated for various levels of CRP. One hundred and thirty (86.1%) of the subjects had malaria alone while 21 (13.9%) had malaria coexisting with septicaemia. Organisms isolated were mainly Enterobacteriaceae (7), Staphylococcus aureus (9), Salmonella spp. (4) and Streptococcus pneumoniae (1).  The mean serum CRP levels in subjects with malaria alone and malaria coexisting with septicaemia were 82.16 ± 44.94 mg/l and 108.44 ± 55.65 mg/l respectively (P=0.0176). At the diagnostic level of 90 mg/l (value just greater than the mean for malaria alone), CRP was highly sensitive (sensitivity 76.2%) in detecting septicaemia in 21 subjects with co-morbidity while specificity (36.9%) was low. It is concluded that CRP can differentiate between malaria and malaria with septicaemia.  In children with malaria, antibiotics should be started at the CRP level of ³ 90 mg/l.

Key words: Malaria, septicaemia, C-reactive protein, diagnosis.

Adepoju KA, Akpan GE (2017). Historical assessment of malaria hazard and mortality in Nigeria – cases and deaths: 1955-2015. Int. J. Environ. Bioener. 12(1):30-46.

 

Akpede GO, Abiodun PO, Sykes MR (1993). Malaria with bacteraemia in acutely febrile pre- school children without localising signs: Coincidence or association/complications. J. Trop. Med. Hyg. 3:146-50.

 
 

Bouree P, Botterel F, Lancon A (2000). Comparative study of ESR and CRP in acute malaria. Available at: 

View

 
 

Chhatriwala M, Patel B, Shah R, Shaikh N, Gokani R, Nilawar A (2014). Prognostic value of serum C - reactive protein in malaria IJBAR. (10):513-515.

 
 

Enyuma COA, Ekanem EE, Udo JJ, Asindi AA (2015). Haematological indices in febrile neonates with malaria in parasitaemia in Calabar. Niger. Med. J. (5):323-326.

 
 

John CC (2016). Malaria (Plasmodium). In: Behrman R E, Kliegman R M, Jenson H B (2000). eds. Nelson Textbook of Paediatrics. 20th ed. Philadelphia: W B Saunders Company (Publishers). pp. 1709-1721.

 
 

Kohli V, Singhi S, Sharma P, Ganguly, KN (1993). Value of serum C- reactive protein concentrations in febrile children without apparent focus. Ann. Trop. Pediatr. (4):373-378.

 
 

Landry A, Doherty P, Qullette S, Carter LJ. (2017). Causes and outcomes of markedly elevated C-reactive protein levels. Can. Fam. Phys. 63(6):e316-e323.

 
 

Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G (2003). 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definition Conference. Crit. Care Med. 29(4):530-538.
Crossref

 
 

Liu S, Ren J, Wu X, Ren H, Yan D, Wang G, Gu G, Li J, Xia Q, Han G (2013). Prelimminary case-control study to evaluate diagnostic values of C-reactive protein and erythrocyte sedimentation rate in differentiating active Crohn's disease from intestinal lymphoma, intestinal tuberculosis Behcet's syndrome. Am. J. Med. Sci. 346(6):467-472.
Crossref

 
 

McLellan D, Giebink GS (1986). Perspectives on occult bacteraemia in children. J. Pediatr. 109(1):1-8.
Crossref

 
 

Phillips RE, Looareesuwan S, Warrell DA, Lee SH, Karbwang J, Warrell MJ, White NJ, Swasdichai C, Weatherall DJ(1986). The importance of anaemia in cerebral and uncomplicated falciparum malaria: role of complications, dyserythropoiesis and iron sequestration. QJM: An Int. J. Med. 58(3-4):305-323.

 
 

Rasmussen NH, Rasmussen NL (1982). Predictive value of white bloodcell count and differential cell count to bacterial infections in children. Acta Pediatr. 5:775-778.
Crossref

 
 

Sabel KC, Hanson LA (1974). The clinical usefulness of C-reactive protein (CRP) determinations in bacterial meningitis and septicaemia in infancy. Acta Paediatr. 3:381-388.
Crossref

 
 

Tendencia EA (2004). Disk Diffusion In: Laboratory Manual of Standardized Methods for antimicrobial tests for bacteria isolated from aquatic animals and environment. Tigbavan, Ibilo; Aquaculture Dept, Southeast Asian Fisheries Development Centre. pp.13-29.

 
 

Tupchong K, Koyfman A, Foran M. (2015). Sepsis, severe sepsis, and septic shock: A review of the literature. Afr. J. Emergency Med. 5(3):127-135.
Crossref

 
 

Warrell DA, Molyneux ME, Beales PF (1990). Severe and complicated malaria: march 1988. Trans. Royal Soc. Trop. Med. Hyg. P 8.

 
 

Weinstein L, Swartz MN (1974). Pathophysiologic changes due to localization of Infections in Specific Organs. In: Weinstein L, Swartz MN, eds. Pathophysiologic (physiology) Mechanism of Diseases. 5th edn. Philadelphia: W.B Saunders (Publishers). pp. 389-510.

 
 

Whittle HC, Brown J, Marsh K, Greenwood BM, Seidelin P, Tighe H, Wedderburn L (1984). T-cell control of Epstein–Barr virus-infected B cells is lost during P. falciparum malaria. Nature 312(5993):449-450.
Crossref

 
 

World Health Organization (WHO) (1991). Basic malaria microscopy. World Health Organization. pp. 19-20.

 

 


APA Ekanem, E. E., Uniga, A. J., Obiora, C. A., Oyo-Ita, A. E., Omang, H. M. (2018). The value of C–reactive protein in the diagnosis of septicaemia in children with malaria. International Journal of Medicine and Medical Sciences, 10(1), 9-13.
Chicago Emmanuel Eyo Ekanem, Ador John Uniga , Cosmas Akataekwe Obiora, Angela Ekanem Oyo-Ita, Helena Martin Omang. "The value of C–reactive protein in the diagnosis of septicaemia in children with malaria." International Journal of Medicine and Medical Sciences 10, no. 1 (2018): 9-13.
MLA Emmanuel Eyo Ekanem, et al. "The value of C–reactive protein in the diagnosis of septicaemia in children with malaria." International Journal of Medicine and Medical Sciences 10.1 (2018): 9-13.
   
DOI https://doi.org/10.5897/IJMMS2017.1340
URL http://academicjournals.org/journal/IJMMS/article-abstract/B350B8A55734

Subscription Form