[Total white blood cell count, erythrosedimentation rate and C-reactive protein for the detection of serious bacterial infections in 0- to 90-day-old infants with fever without a source]. / Leucocitos en sangre, eritrosedimentación y proteína C reactiva en pacientes de 0 a 90 días de edad con fiebre sin focalización.

INTRODUCTION: Total white blood cell count (WBC), erythrosedimentation rate (ESR) and C-reactive protein (CRP) are frequently used by primary care physicians attending infants < 90 days old with fever without localizing signs to distinguish those with a serious bacterial infection (SBI). The main objective of this study was to obtain the diagnostic values of these parameters in infants with fever. PATIENTS AND METHODS: We analyzed previously healthy infants aged 0 to 90 days old and fever with no source of infection admitted to the emergency room and/or hospitalized. The main outcome measure was the presence or absence of a SBI (urinary tract infection, bacteremia, meningitis, pneumonia, enteritis) and diagnostic values of WBC, ESR and CRP. RESULTS: A total of 103 infants met the inclusion criteria. Of these, 22 infants (21.3%) had a SBI, the most common being urinary tract infection. Absolute neutrophil count (ANC) and WBC had an area under the ROC curve (AUC) of 0.6 (95% CI: 0.46-0.73) and 0.55 (95% CI: 0.44-0.68) respectively. An ANC>or=10,000/microl had a sensitivity and specificity of 9% (95% CI: 1-21) and 92.5% (95% CI: 86-98) respectively. A WBC>or=15,000/microl had a sensitivity and specificity of 13.6% (95% CI: 1-28) and 85% (95% CI: 77-93) respectively. CRP showed an AUC of 0.71 (95% CI: 0.55-0.86) and a best cut-off point of 2 mg/dL (sensitivity 53% [95% CI: 29-76] and specificity of 85% [95% CI: 75-94]). ESR>or=20 mm/hour had an AUC, sensitivity and specificity of 0.53 (95% CI: 0.37-0.7), 38% (95% CI: 16-62) and 75% (95% CI: 65-85) respectively. CONCLUSIONS: None of these parameters alone, commonly used by physicians, is a reliable diagnostic tool to rule out SBI in infants<90 days old with fever without source of infection.

Leucocitos en sangre, eritrosedimentación y proteína C reactiva en pacientes de 0 a 90 días de edad con fiebre sin focalización / Total white blood cell count, erythrosedimentation rate and C-reactive protein for the detection of serious bacterial infections in 0- to 90-day-old infants with fever without a source

Introducción: El clínico usa con frecuencia la cuenta total de leucocitos en sangre, la velocidad de sedimentación globular (VSG) y la proteína C reactiva (PCR) para tratar de detectar infecciones bacterianas serias (IBS) en lactantes con fiebre sin foco aparente. El objetivo es evaluar los valores diagnósticos de estas pruebas en lactantes con fiebre. Pacientes y métodos: Análisis de pacientes de 0 a 90 días de edad, previamente sanos, evaluados por fiebre sin foco. El desenlace de interés fue la presencia o ausencia de una IBS (uroinfección, bacteriemia, neuroinfección, neumonía, enteritis) y su relación con la cuenta de leucocitos, VSG y PCR. Resultados: Cumplieron criterios de inclusión 103 pacientes. De éstos, 22 (21,3 %) presentaron una IBS, siendo la uroinfección la más común. Los neutrófilos totales y los leucocitos resultaron en valores del área bajo la curva de las características operador receptor (abc-ROC) de 0,6 (intervalo de confianza del 95 % [IC 95 %] : 0,46-0,73) y 0,55 (IC 95 %: 0,44-0,68), respectivamente. La sensibilidad y especificidad de la cuenta de neutrófilos ≥ 10.000/μl fue del 9 % (IC 95 %: 1-21) y del 92,5 % (IC 95 %: 86-98), respectivamente, mientras que la cuenta total de leucocitos ≥ 15.000/μl presentó un 13,6 % (IC 95 %: 1-28) y un 85 % (IC 95 %: 77-93), respectivamente. La PCR presentó el abc-ROC de 0,71 (IC 95 %: 0,55-0,86) con punto de corte a 2 mg/dl (sensibilidad del 53 % [IC 95 %: 29-76] y especificidad del 85 % [IC 95 %: 75-94]), mientras que la VSG ≥ 20 mm/h concluyó con abc-ROC de 0,53 (IC 95 %: 0,37-0,7), sensibilidad del 38 % (IC 95 %: 16-62) y especificidad del 75 % (IC 95 %: 65-85). Conclusiones: Ninguno de estos parámetros, comúnmente usados por los clínicos, alcanza valores diagnósticos aceptables para detectar IBS en niños de 0 a 90 días de edad con fiebre (AU)

Introduction: Total white blood cell count (WBC), erythrosedimentation rate (ESR) and C-reactive protein (CRP) are frequently used by primary care physicians attending infants < 90 days old with fever without localizing signs to distinguish those with a serious bacterial infection (SBI). The main objective of this study was to obtain the diagnostic values of these parameters in infants with fever. Patients and methods: We analyzed previously healthy infants aged 0 to 90 days old and fever with no source of infection admitted to the emergency room and/or hospitalized. The main outcome measure was the presence or absence of a SBI (urinary tract infection, bacteremia, meningitis, pneumonia, enteritis) and diagnostic values of WBC, ESR and CRP. Results: A total of 103 infants met the inclusion criteria. Of these, 22 infants (21.3 %) had a SBI, the most common being urinary tract infection. Absolute neutrophil count (ANC) and WBC had an area under the ROC curve (AUC) of 0.6 (95 % CI: 0.46-0.73) and 0.55 (95 % CI: 0.44-0.68) respectively. An ANC ≥ 10,000/μl had a sensitivity and specificity of 9 % (95 % CI: 1-21) and 92.5 % (95 % CI: 86-98) respectively. A WBC ≥ 15,000/μl had a sensitivity and specificity of 13.6 % (95 % CI: 1-28) and 85 % (95 % CI: 77-93) respectively. CRP showed an AUC of 0.71 (95 % CI: 0.55-0.86) and a best cut-off point of 2 mg/dL (sensitivity 53 % [95 % CI: 29-76] and specificity of 85 % [95 % CI: 75-94]). ESR ≥ 20 mm/hour had an AUC, sensitivity and specificity of 0.53 (95 % CI: 0.37-0.7), 38 % (95 % CI: 16-62) and 75 % (95 % CI: 65-85) respectively. Conclusions: None of these parameters alone, commonly used by physicians, is a reliable diagnostic tool to rule out SBI in infants < 90 days old with fever without source of infection (AU)

Exoftalmos unilateral y lupus eritematoso sistémico / Unilateral exophthalmos and systemic lupus erythematosus

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