Reactive Protein Response Research Articles

C Reactive Protein Response in Severe Acute Malnutrition with Infection

Background: Nearly half of all deaths in children under-five are attributable to malnutrition, translating into the loss of about 3 million young lives a year. The interaction between malnutrition and infection can create a potentially lethal cycle of worsening illness and deteriorating nutritional status. They have altered defense mechanisms during an early infections process, with an increased synthesis of some acute phase proteins including CRP.
 Objectives: Objective of the study was to identify whether CRP response is helpful in early detection of infection in severe SAM. It may also help to reduce childhood mortality associated with SAM.
 Methods: This cross-sectional study was conducted with total 50 SAM patients who were admitted in the Gastroenterology Hepatology and Nutrition unit of Dhaka Shishu (Children) Hospital from October 2010 to March 2011. Immediately after admission, clinical evaluation and management was started after sending several investigations along with serum CRP. Re-evaluation of serum CRP was done approximately after 7 days. Data were analyzed by using SPSS version 24.
 Results: Among the 50 SAM patients, 29 patients were presented with oedema(group-A) and 21 patients were without oedema (group-B). Majority (40) were below 2 years of age with male predominance. Thirty-five patients were partially immunized [69% in group-A and 71.4% in group-B]. During initial assessment, 46% children were hypothermic and76% were hypoglycemic. Nutritional status (z score) weight-for-age, height/length-for-age, weight for height/length in group-A were -4.56±1.00, -4.27±1.97, -2.71±0.97 and in group- B were -4.65±0.78, -5.06±2.34, -2.58±1.00 respectively. Pneumonia (42%) and diarrhoea (36%) were more common. Increased WBC count was found in 80% patients; and only 10% had low hemoglobin level (<5 gm/dl). Majority (44%) of them had pulmonary infection which was found in their chest X-rays. Immediately after admission serum CRP were high [mean CRP 39.44(±16.04)] in all most all patients, irrespective of their types of malnutrition. After 7 days of management, their CRP became normal [07.24 (± 2.75)], p=<0.001. Mean CRP was less [34.90 (±16.60)] in group-A than in group-B [45.72 (±13.16)] on admission and the finding was statistically significant, p=<0.001.
 Conclusion: Plasma level of CRP constitute a good screening test for the presence of infection in malnourished children and act as a sensitive indicator of recovery from infection and malnutrition.
 DS (Child) H J 2020; 36(2): 125-133

Variation in C - reactive protein response according to host and mycobacterial characteristics in active tuberculosis.

BackgroundThe C - reactive protein (CRP) response is often measured in patients with active tuberculosis (TB) yet little is known about its relationship to clinical features in TB, or whether responses differ between ethnic groups or with different Mycobacterium tuberculosis (M.tb) strain types. We report the relationship between baseline serum CRP prior to treatment and disease characteristics in a metropolitan population with TB resident in a low TB incidence region.MethodsPeople treated for TB at four London, UK sites between 2003 and 2014 were assessed and data collected on the following characteristics: baseline CRP level; demographics (ethnicity, gender and age); HIV status; site of TB disease; sputum smear (in pulmonary cases) and culture results. The effect of TB strain-type was also assessed in culture-positive pulmonary cases using VNTR typing data.ResultsThree thousands two hundred twenty-two patients were included in the analysis of which 72 % had a baseline CRP at or within 4 weeks prior to starting TB treatment. CRP results were significantly higher in culture positive cases compared to culture negative cases: median 49 mg/L (16–103 mg/L) vs 19 mg/L (IQR 5–72 mg/L), p = <0.001. In those with pulmonary disease, smear positive cases had a higher CRP than smear negative cases: 67 mg/L (31–122 mg/L) vs 24 mg/L (7–72 mg/L), p < 0.001. HIV positive cases had higher baseline CRPs than HIV negative cases: 75 mg/L (26–136 mg/L) vs 37 mg/L (10–88 mg/L), p <0.001. Differing sites of disease were associated with differences in baseline CRP: locations that might be expected to have a high mycobacterial load (e.g. pulmonary disease and disseminated disease) had a significantly higher CRP than those such as skin, lymph node or CNS disease, where the mycobacterial load is typically low in HIV negative subjects. In a multivariable log-scale linear regression model adjusting for host characteristics and M.tb strain type, infection with the East African Indian strain was associated with significantly lower baseline-CRP (fold-change in CRP 0.51 (0.34–0.77), p < 0.01).ConclusionsHost and mycobacterial factors are strongly associated with baseline CRP response in tuberculosis. This analysis suggests that there are important differences in innate immune response according to ethnicity, Mtb strain type and site of disease. This may reflect differing mycobacterial loads or host immune responses.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1612-1) contains supplementary material, which is available to authorized users.

Patients with systemic lupus erythematosus and Jaccoud's arthropathy: a clinical subset with an increased C reactive protein response?

Jaccoud's arthropathy is a chronic deforming synovitis occurring in a subset of patients with systemic lupus erythematosus (SLE). To evaluate whether patients with SLE and Jaccoud's arthropathy behave differently in their acute phase reaction from patients with SLE without Jaccoud's arthropathy, a prospective study was carried out on 72 consecutive patients with SLE. Patients were assessed for Jaccoud's arthropathy according to a protocol, disease activity was scored, and laboratory tests, including tests for C reactive protein, were performed. Seven patients were classified as having definite Jaccoud's arthropathy. In those patients the serum concentrations of C reactive protein were higher than in those without Jaccoud's arthropathy, whereas disease activity scores and treatment were comparable. Additionally, patients with Jaccoud's arthropathy had a longer disease duration and a longer history of arthritis than those without, whereas IgM rheumatoid factor was observed more often. The increased concentration of C reactive protein in patients with Jaccoud's arthropathy is compatible with a persistent inflammatory reaction. Serial testing of C reactive protein in combination with other laboratory parameters may be a guideline for treatment in patients with SLE and Jaccoud's arthropathy.

Sequential study of C reactive protein in neonatal septicaemia using a latex agglutination test.

The usefulness of serial study of C reactive protein in the early detection of neonatal septicaemia was evaluated in a neonatal unit using a commercially available latex agglutination slide test as a rapid screening method and electroimmunoassay as a reference method for C reactive protein determination. A positive latex test was obtained in 11 infants with verified septicaemia (positive blood culture), two infants with clinically evident infection but without bacteriological confirmation, one infant with recurrent chest infection due to Pseudomonas aeruginosa, and one infant who showed signs of birth asphyxia with meconium aspiration, but was not infected. Positive latex test results correlated with raised concentrations of C reactive protein, measured by immunoassay. In some instances, however, concentrations of C reactive protein in excess of 12 mg/100 ml gave weaker agglutination results in the slide test, which could be interpreted as negative results. In a sequential study of the infected infants, 6.3% of the values recorded on a slide test were false negatives. In contrast, false positive values were observed on a slide test in 1.9% of 27 non-infected infants. The higher percentage of false negative values may be due to the presence of excess antigen in the sera of some infected children. It is suggested that the latex test should be carried out on suitable dilutions of serum. Although the slide test may reliably indicate infection at an early stage in neonates, the C reactive protein response is non-specific, as seen in a non-infected infant who showed signs of birth asphyxia with meconium aspiration. Provided the non-specific nature of the C reactive protein response is recognised, the latex test may be a useful serum measurement for early diagnosis of neonatal septicaemia of the newborn. The test has the advantage of being performed easily, quickly, and cheaply.

Assay of beta-lactam antibiotics when used therapeutically in combination with aminoglycosides.

Cytokines released from activated mononuclear leukocytes are involved in triggering the acute phase response and many of the inflammatory manifestations of ulcerative colitis and Crohn9s disease. The ability of circulating monocytes from patients with ulcerative colitis and Crohn9s disease to generate the cytokines interleukin 1 beta (IL 1 beta) and tumour necrosis factor alpha (TNF alpha), both spontaneously and in response to stimulation by lipopolysaccharide, was compared. IL 1 beta generation in response to lipopolysaccharide was significantly higher in Crohn9s disease than in ulcerative colitis and normal controls, with a dramatic increase in patients with active disease. There was a significant reduction in lipopolysaccharide stimulated TNF alpha generation in ulcerative colitis patients compared with Crohn9s disease and normal control subjects. IL 1 beta and TNF alpha release correlated significantly with serum C reactive protein and serum alpha 1 acid glycoprotein in Crohn9s disease. The ability of conditioned medium from monocytes in Crohn9s disease to enhance release of alpha 1 acid glycoprotein from the liver cell line HepG2 in culture was assessed. There was a significant positive correlation between TNF alpha and IL 1 beta presence in the supernatant and alpha 1 acid glycoprotein production. The differences in the cytokine profile in patients with Crohn9s disease compared with ulcerative colitis suggest an intrinsic difference in the ability to produce cytokines in patients with these two forms of inflammatory bowel disease, and may explain features such as the enhanced ability to generate a brisk C reactive protein response in Crohn9s disease.