Use of serum procalcitonin as a marker of bacterial infection in infants presenting with acute diarrhea

Bacterial infection may be a causative factor in some cases of infantile diarrhea, and can cause sepsis with acute organ dysfunction, which is considered a major threat to life. There is a need for an effective and accurate biochemical marker to support or exclude the diagnosis of bacterial infection as routine laboratory tests lack both sensitivity and specificity in correctly identifying which patients should receive antibiotics, and most confirmatory microbiological test results are not available for 24 hours. The present study aimed to determine plasma PCT level in infants with acute diarrhea to evaluate its tote as a marker of bacterial infection and hence to detect cases that may benefit from early institution of antimicrobial drugs. This study was carried out in the gastroenterology unit, and the intensive care wilt of Pediatric department, Tanta faculty of medicine, and started at January 2002, and ended by July 2002. It was conducted on 53 infants [35 ware males and 18 females], and their ages ranged from 6-24 months. The following investigations were made immediately alter admission: 1- Complete blood count, 2- Blood urine, and stool bacterial aerobic and anaerobic cultures [culture of ear discharge was done in cases with otitis media], 3-Cerebrospinal fluid [CSF] examination and culture were done in cases with positive blood cultures, 4- Serum C- reactive protein [CRP] and plasma concentration of procalcitonin [PCT], and 5- Chest X-ray. The patients warn classified into 2 groups, those who have negative microbiological cultures, 31 cases [group I], and others with positive cultures, 22 cases [group II]. It was found that in infants proved to have bacterial infection with positive cultures had significantly elevated serum PCT and CRP mole than the infants who had negative bacterial cultures [1.41 +/- 0.64, and 48.18 +/- 17.8 versus 0.53 +/- 0.23 and 5.6 7 +/- 2.47 respectively, p < 0.001]. Group II had significantly higher total leukocytic count [TLC] and lower platelet count than group I [13.5 +/- 3.58, and 161.41 +/- 79.56 versus 5.41 +/- 1.082 and 247.35 +/- 79.033 respectively]. We found that no significant difference between cases with and without bacteremia as regard to TCL, CRP, and PCT, but platelet count was significantly lower in cases of bacteremia than in others with no bacteremia [t=3.72 and p =0.001]. Serum PCT levels were found to be correlated significantly with the duration of diarrhea in infants proved to have bacterial growth on different cultures, but not with TLC, platelet count, or CRP. We concluded and recommended that:1] PCT is a useful indicator of bacterial infection among cases presenting with acute infantile diarrhea in which bacteria may be the causative underlying factor or complicating such cases, so it can help in selecting cases that need lipid administration of antibacterial agents. 2] PCT should be added to the required laboratory investigations as CRP, TLC, and platelet count in all cases of acute infantile diarrhea suspected to have bacterial etiology or in those who are critically ill, because most microbiological tests need time and couldn't help in emergency situations

Anti-inflammatory effects of salmeterol, compared to beclomethasone, and sustained-release theophylline measured by serum levels of tumor necrosis factor-alpha, and eosinophilic cationic protein in asthmatic children

Inhaled steroids are increasingly used in the management of asthma and although effective, they may cause systemic side effects. Theophylline is among the least expensive drugs used to treat asthma and consequently it remains a commonly used drug for this indication in many countries. In industrialized countries, the advent of inhaled corticosteroids, beta-2 agonists, and leukotriene modifying drugs has significantly diminished the extent to which theophylline is used. In addition to their bronchodilating effects, long acting inhaled beta2 agonists have recently been shown to have some anti-inflammatory properties. This work was designed to study the anti inflammatory effects of salmeterol compared to beclomethasone and theophylline by measuring of serum levels of tumor necrosis factor-alpha [TNF-alpha] and eosinophilic cationic protein [ECP] in children with mild and moderate to severe asthma. The study was carried out in The Chest and Allergy Unit, Pediatric Department, Tanta University Hospital, from October 2000 to January 2003. It comprised ninety asthmatic children who were presented by mild, and moderate to severe attack of asthma exacerbations, their ages ranged from 6-15 years. The asthmatic children were classified into 2 groups: Group I: Included thirty children with mild asthmatic attack with FEV1 of 70-80% of the expected normal value for age and sex at the time of presentation. These patients were subdivided into three sub-groups to receive one of the following drugs for eight weeks: Inhaled beclomethasone dipropionate by metered dose inhaler [MDI] in a dose of 200 microgram / 8 hours [Steroid subgroup-I], oral sustained-release theophylline in a dose of 15 mg / kg / day [12 Hourly] [Theophylline subgroup-I], and Inhaled long acting beta 2 agonist [Salmeterol] by MDI in a dose of 50 microgram [2 buffs] / 12 hours [Salmetemi subgroup-I]. Group II: Included sixty children with moderate to severe asthma exacerbation with FEV1 less than 70% of the expected values for the age and sex. Conventional therapy was given as required to these patients to control the exacerbations of the asthmatic attack, and to achieve FEV1 of 70-80% of the expected normal values of their age and sex. Then the patients were subdivided to three sub-groups [Steroid subgroup-Il, Theophylline subgroup-Il, and Salmeterol subgroup-Il] to receive either one of the three drug modalities by the same dose and for the same duration as mentioned before in children with mild asthma [group I]. Absolute eosinophilic count [AEC], serum levels of eosinophilic cationic protein [ECP] and tumor ncrosis factor-alpha [TNF-alpha] were measured at presentation during the acute exacerbation and 8 weeks after beginning of the different treatment modalities. We concluded that beclomethasone dipropionate had effectively diminished serum levels of TNF-alpha and ECP to a greater extent than the Ophylline and salmeterol in children with bronchial asthma. Long acting theophylline also diminished significantly serum levels of TNF-alpha and ECP at a lower than customarily recommended blood theophylline level after 8 weeks of regular treatment. On the other hand, salmeterol decreased serum levels of TNF-alpha and ECP in asthmatic children but this reduction was not significant after 8 weeks of regular administration in cases of mild and moderately severe asthma