Comparison of the Eosinophil Count to C –reactive protein, Leukocyte Count, and Neutrophil Count for the detection of bacterial infection in ill-appearing children with fever admitted to the Emergency Department

Introduction. From late 19th century to the present day, several authors have investigated the value of low eosinophil count as a biomarker of bacterial infection. In this study, we examined the value of eosinopenia for diagnosing bacterial infection in ill-appearing children admitted to the pediatric emergency department.

Methods. Retrospective review of the medical records of children age 1 month to 14 years who appeared ill on admission to the emergency department (ED). Data collected included; C-reactive protein (CRP) level leukocyte, neutrophil, eosinophil counts, results of microbiological tests, radiologic evaluation, and treatment given in the ED. Final outcome data were also collected.

Results. In total, 878 met our case definition and inclusion criteria. 521 patients had confirmed or presumed bacterial infection and 355 patients had presumed or confirmed viral infection. Nineteen patients died; all had bacterial infections. Neutrophil, eosinophil counts and CRP level were independent risk factors for bacterial infection in the multivariate analysis (p<0.05). The receiver operating characteristics (ROC) curves analysis for discriminating bacterial and viral infection showed that the eosinophil count (≤50 cells/µL) (area under the ROC curve [AUROC] 0.671; 95% Confidence Interval [CI]: 0.639-0.702) was similar to the neutrophil count (AUROC 0.655; 95% CI: 0,622-0.686), and CRP level

(AUROC 0.710; 0.678-0.740) (p>0.05). The sensitivities of the leukocyte, neutrophil, and eosinophil counts and CRP level were 57.5%, 62.9%, 61%, and 57.1%, respectively. The specificities of them were 59.1%, 63.3%, 67%, and 77.4%, respectively.

Conclusion. In our study population, although the accuracies of eosinophil, neutrophil counts, and CRP level were not enough, they had similar in distinguishing viral from bacterial infection in ill appearing febrile children. By comparison the leukocyte count had limited predictive value.

eosinopenia, CRP, acute phase reactants, childhood

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