Serum Neopterin Concentration in Children with Viral Gastroenteritis

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Abstract Increased neopterin concentrations are observed in many diseases in which cellular immunity is stimulated. Gastroenteritis is still a major cause of childhood morbidity and mortality worldwide. Over 75% of all cases are caused by viral infections. Therefore a non-specific, quick, sensitive, cheap and easy-to-perform marker of viral infection, such as neopterin concentration in serum, would be a cost-effective method of identifying patients with gastroenteritis into probable viral etiology and therefore it would optimize treatment and reduce inappropriate antibiotic treatment. This study evaluated whether serum neopterin concentration can be a reliable marker of viral etiology of gastroenteritis in children. The study group consisted of 67 children: 29 girls and 38 boys, aged from 0.1 to 16.1 years with symptoms of gastroenterits and with confirmed rotavirus or adenovirus infection; the control group consisted of 105 healthy children. Clinical examinations and laboratory test including whole blood count, serum C-reactive protein, procalcitonin, and creatinine concentration were conducted. The serum neopterin level was analyzed by Elisa. Serum neopterin concentration in the study group varied from 6.03 to 171 nmol/L (median 23.7 nmol/L) and it was significantly higher than in the control group (from 2.88 to 14.8 nmol/L; median 4.73 nmol/L) (P <0.001). Neopterin concentration was above the normal value (>11 nmol/L) in 58 children from the study group and only in 6 from the control group (86.6% sensitivity and 94.3% specificity). Serum neopterin concentration did not differ significantly between children with rotavirus and adenovirus infection (P = 0.47). The correlation between serum neopterin and C-reactive protein concentrations was of borderline significance (rs = 0.23, p = 0.06); and there was no correlation between serum concentrations of neopterin and procalcitonin, white blood count, lymphocytes count, monocytes count or the body temperature. Serum neopterin concentration is highly increased in children suffering from viral gastroenteritis, regardless of the virus type. When a cut-off of 11.0 nmol/L neopterin was applied, comparison yields 86.6% sensitivity and 94.3% specificity for the diagnosis of viral gastroenteritis in pediatric patients. Further studies are necessary for other etiological agents of gastroenteritis.