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Objective: to study the diagnostic significance and determination of serum C-reactive protein (CRP) levels in patients with community acquired pneumonia (CAP) at the time of diagnosis and compared it with CRP of healthy controls.
Methodology: This study was conducted from December 2005 to Dec 2009 on 162 adult patients and 30 (males=15, females=15) healthy controls. All microbiological assays were performed according to standardized procedures; whereas CRP was measured in serum samples by an automated turbidimetric method with normal reference of ≤ 5.0 mg/L.
Results: A total of 85 patients (52.46%) had an identifiable etiology with bacterial pathogens as the causative agents, 31 (19.31%) had viral origin, 10 (6.17%) had other bacterial pathogens and 36 patients (22.22%) with negative microbiological findings. Mean serum CRP levels were 101±15.60 mg/L, 84.50±12.60 mg/L,76.50±11.60 mg/L and 90.35±11.50 mg/L, 85.10±10.15 mg/L & 79.10±15.20 mg/L for Klebsiella pneumonia, Streptococcus pneumonia, Haemophilus influenzae alone and in combination with other pathogens respectively. Mean serum CRP was 60.45±9.10 mg/L in viral etiology only and 4.10 ± 2.25 mg/L in controls. CRP values were comparable in different etiologic groups of bacterial origin, except Streptococcus pneumoniae and Klebsiella pneumoniae groups (P<0.05), whereas highly significant when compared viral etiology, other pathogens (P<0.01) and negative microbiological findings (P<0.001).
Conclusion: In adult patients with CAP and bacterial pneumonic pathogens as the causative agents, serum CRP levels are greater, ranging between 76.50±11.60 to 101±15.60 mg/L and thus seems to predict severity of illness and assisting in deciding the appropriate site of care, whether hospital or home.
Key Words: C-reactive protein (CRP), Community-acquired pneumonia (CAP), bacterial pathogens.
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2. Macfarlane J, Holmes W, Gard P, Macfarlane R, Rose D, Weston V, et al. Prospective study of the incidence, aetiology and outcome of adult lower respiratory tract illness in the community. Thorax 2001;56:109-14.
3. Van de Lisdonk EH, Van den Bosch WJHM, Huygen FJA, Lagro-Janssen ALM, eds. Ziekten in de huisartspraktijk [Diseases in general practice]. Maarsen: Elsevier/Bunge, 1999.
4. Almirall J, Bolíbar I, Toran P, Pera G, Boquet X, Balanzó X and Sauca G. Contribution of C-Reactive Protein to the Diagnosis and Assessment of Severity of Community-Acquired Pneumonia. Chest 2004;125: 1335-42.
5. Almirall J, Bolý´bar I, Vidal J, Sauca G, Coli P, Niklasson B, Bartlome M, Balanzò X. Epidemiology of community-acquired pneumonia in adults: a population-based study. Eur Respir J 2000; 15:757–63.
6. Bruns AHW, Oosterheert JJ, Hak E, Hoepelman AIM. Usefulness of consecutive C-reactive protein measurements in follow-up of severe community-acquired pneumonia. Eur Respir J 2008; 32: 726–32.
7. Fry AM, Shay DK, Holman RC, Curns AT, Anderson LJ. Trends in hospitalizations for pneumonia among persons aged 65 years or older in the United States, 1988–2002. JAMA 2005; 294: 2712–9.
8. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community acquired pneumonia in adults. Clin Infect Dis 2007; 44: Suppl. 2, S27–S72.
9. Woodhead M, Blasi F, Ewig S, Huchon G, Leven M, Ortqvist A, et al. Guidelines for the management of adult lower respiratory tract infections. Eur Respir J 2005; 26: 1138–80.
10. Metlay JP, Kapoor WN, Fine MJ. Does this patient have community-acquired pneumonia? Diagnosing pneumonia by history and physical examination. JAMA 1997; 278:1440-5.
11. Melbye H, Straume B, Aasebo U, Dale K. Diagnosis of pneumonia in adults in general practice. Relative importance of typical symptoms and abnormal chest signs evaluated against a radiographic reference standard. Scand J Prim Health Care 1992; 10:226-33.
12. Clyne B, Olshaker JS. The C-reactive protein. J Emerg Med 1999; 17: 1019–25.
13. American Thoracic Society. Guidelines for the initial management of adults with community-acquired pneumonia: diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med 2001; 163:1730–54.
14. Kerttula Y, Leinonen M, Koskela M, Makela PH. The aetiology of pneumonia: application of bacterial serology and basic laboratory methods. J Infect, 1987; 14:21–30.
15. Hedlund J, Hansson LO. Procalcitonin and C-reactive protein levels in community-acquired pneumonia: correlation with etiology and prognosis. Infection 2000; 28:68–73.
16. Castro-Guardiola A, Armengou-Arxe A, Viejo-Rodriguez A, Penarroja-Matutano G, Garcia-Bragado F. Differential diagnosis between community-acquired pneumonia and non-pneumonia diseases of the chest in the emergency ward. Eur J Intern Med 2000; 11:334–9.
17. O¨rtqvist A, Hedlund J, Wretlind B, Carlstrom A, Kalin M. Diagnostic and prognostic value of interleukin-6 and C-reactive protein in community-acquired pneumonia. Scand J Infect Dis 1995; 27:457–62.
18. Smith RP, Lipworth BJ, Cree IA, Spiers EM, Winter JH:. C-Reactive protein: a clinical marker in community-acquired pneumonia. Chest 1995; 108:1288–91.
19. Smith RP, Lipworth BJ. C-Reactive protein in simple community- acquired pneumonia. Chest 1995; 107:1028–31.
20. Coelho L, Póvoa P, Almeida E, Fernandes A, Mealha R, Moreira P, Sabino H. Usefulness of C-reactive protein in monitoring severe community-acquired pneumonia clinical course. Crit Care 2007; 11: R92.
21. Menendez R, Cavalcanti M, Reyes S, Mensa J, Martinez R, Marcos MA, Filella X, Niederman M, Torres A. Markers of treatment failure in hospitalized community-acquired Pneumonia. Thorax 2008; 63: 447–52.
22. Fine MJ, Smith DN, Singer DE. Hospitalization decision in patients with community-acquired pneumonia: a prospective cohort study. Am J Med 1990; 89:713–21.
23. Luna CM. C-Reactive Protein in Pneumonia: Let Me Try Again. Chest 2004;125:1192-5.
24. Tillett WS, Francis T Jr. Serological reactions in pneumonia with non-protein somatic fraction of pneumococcus. J Exp Med 1930; 52:561–71.
25. Morley JJ, Kushner I. Serum C-reactive protein levels in disease. Ann N Y Acad Sci 1982; 389:406–18.
26. Melbye H, Straume B, Brox J. Laboratory test for pneumonia in general practice: the diagnostic values depend on the duration of illness. Scand J Prim Health Care 1992; 10:234–40.
27. Macfarlane J, Prewett J, Rose D, Gard P, Cunningham R, Saikku P, et al. A prospective, case control study of the aetiology of community-acquired lower respiratory tract infections in adults who fail to improve with initial antibiotics. Brit Med J 1997; 315:1206–10.
28. Speer CP, Ninjo A, Gahr M. Elastase-alfa-1 proteinase inhibitor: an early indicator of septicemia and bacterial meningitis in children. J Pediatr 1987; 111:667–71.
29. Ewig S. Community-acquired pneumonia: epidemiology, risk, and prognosis. In: Torres A, Woodhead M, eds. Pneumonia. Geneva, Switzerland: European Respiratory Society, 1997; 13–35.
30. Holmberg H, Bodin L, Jonsson I, Krook A Rapid aetiological diagnosis of pneumonia based on routine laboratory features. Scand J Infect Dis 1990; 22:537–45.
31. Kragsbjerg P, Jones I, Vikerfors T, Holmberg, H. Diagnostic value of blood cytokine concentrations in acute pneumonia. Thorax 1995; 50:1253–7.
32. Garcia V. zquez E, Martinez JA, Mensa J, Sánchez F, Marcos MA, de Roux A, Torres A. C-reactive protein levels in community-acquired pneumonia. Eur Respir J 2003; 21:702–5.
33. Kauppinen MT, Saikku P, Kujala P, Herva E, Syrjala H. clinical picture of community-acquired Chlamydia pneumoniae pneumonia requiring hospital treatment: a comparison between chlamydial and pneumococcal pneumonia. Thorax 1996; 51:185–9.