Potential usefulness of C-reactive protein and procalcitonin determination in patients admitted for neurological disorders in rural Democratic Republic of Congo

Abstract

In low-resource hospitals of central Africa, neurological disorders are frequent and etiologies very diverse. The difficulty to identify invasive bacterial infections in this setting results in major antibiotic overuse. Biomarkers such as C-reactive protein (CRP) and procalcitonin (PCT) may help discriminate these conditions. We retrospectively determined the concentrations of CRP and PCT in the sera of patients consecutively enrolled from 2012 to 2015 in an etiological study on neurological disorders at the rural hospital of Mosango, Democratic Republic of Congo. Invasive bacterial infection had been diagnosed by the demonstration of a bacterial pathogen in cerebrospinal fluid or blood cultures or the presence of radiological pneumonia. Sera of 313 (89.2%) and 317 (90.3%) of the 351 enrolled participants were available for determination of CRP and PCT concentrations respectively. Areas under the receiver operating characteristic curves for invasive bacterial infection, diagnosed in 19 tested cases, were 94.3% for CRP and 91.7% for PCT. No single case had a normal CRP concentration (<10 mg/L). Our data, although limited, suggest that CRP or PCT concentrations may help discriminate invasive bacterial infections in patients with neurological disorders in tropical settings and that normal CRP values could assist in withholding antibiotics.

Diagnostic Accuracy of Procalcitonin in Bacterial Infections of the CNS: An Updated Systematic Review, Meta-Analysis, and Meta-Regression*

“…eTable 2 (http://links.lww.com/CCM/H384) summarizes the main characteristics of studies included in this systematic review and meta-analysis. A total of 3,766 critically ill patients were included in the analysis, among whom 2,614 were children or neonates (69%) and 801 adults (21%), whereas 351 patients were a group of a mixed population including both children older than 5 years and adults (22). To evaluate the accuracy of procalcitonin for diagnosing CNS bacterial infections, five studies (23)(24)(25)(26)(27) focused on diagnostic performance of CSF procalcitonin; 11 studies only on serum procalcitonin (22,(28)(29)(30)(31)(32)(33)(34)(35)(36)(37) and seven studies focused on diagnostic accuracy of both serum and CSF procalcitonin (38)(39)(40)(41)(42)(43)(44).…”

High frequency of Taenia solium antigen positivity in patients admitted for neurological disorders in the Rural Hospital of Mosango, Democratic Republic of Congo.

“…However, transport and storage were rigorously monitored during the study and other serological investigations on the same stored samples did provide plausible results [22]. Alternatively, this may have been related to differences in the circulating strains of T solium, parasitic load or host characteristics compared to settings where the antibody-detection assay was validated [23].…”

Combining C‐reactive protein and quick sequential organ failure assessment (qSOFA) to improve prognostic accuracy for sepsis and mortality in adult inpatients: A systematic review

“…21 Critically, CRP is one of the first biomarkers to rise in response to infection, with CRP blood levels rising 6 h after stimulus. 21,24 Studies have demonstrated the use of CRP for assisting clinicians in determining bacterial infection severity in Nepal 19 and rural Congo, 25 in guiding antibiotic use for febrile patients in low resource settings, [26][27][28][29] and most recently in estimating COVID-19 severity. 30 Including CRP in qSOFA may improve qSOFA's sensitivity and ability to identify patients at high-risk of mortality or sepsis.…”

“…Other acute phase reactants such as interleukin-1 beta, tumor necrosis factor-alpha, procalcitonin, and interferon gamma can also act as inflammatory biomarkers. [31][32][33][34][35][36] However, CRP testing is very accessible, relatively inexpensive, and well-established in low-resource clinical settings, 19,22,23,[25][26][27]29,30 making it an ideal choice for combination with qSOFA, a rapid and simple bedside scoring system. 3,37 Current evidence evaluating the performance of a combined qSOFA and CRP score is limited.…”