White blood cell count, C‐reactive protein and erythrocyte sedimentation rate in respiratory syncytial virus infection of the lower respiratory tract

Abstract

Laboratory findings such as white blood cell (WBC) count, C‐reactive protein (CRP) concentration and erythrocyte sedimentation rate (ESR) level in patients with bronchiolitis, bronchopneumonia and lobar pneumonia caused by respiratory syncytial virus (RSV) were studied. The diagnosis of having RSV infection of the lower respiratory tract was made on the presence of RSV antigen in nasopharyngeal specimens by means of enzyme immunoassay, on chest X‐ray appearances and clinical manifestations. The WBC counts in the lobar pneumonia cases (n = 25, 12 288 ± 6296/mm3) were significantly greater than those for the bronchiolitis (n = 52, 9562 ± 2720/mm3) and bronchopneumonia (n = 43, 8369 ± 3714/mm3) cases. The concentrations of CRP in lobar pneumonia cases (n = 25, 6.5 ± 7.3 mg/dL) were significantly greater than those in the bronchiolitis (n = 52, 1.9 ± 2.0 mg/dL) and bronchopneumonia (n = 43, 2.1 ± 2.4 mg/dL) cases. The ESR levels in the lobar pneumonia cases (n = 24, 43.8 ± 29. mm/h) were also significantly higher than those in the bronchiolitis (n = 34, 20.1 ± 12.3 mm/h) and bronchopneumonia (n = 40, 24.7 ± 15.9 mm/h) cases. There were no significant differences in the WBC counts, the CRP concentrations and ESR levels between the bronchiolitis and bronchopneumonia cases. These results suggest that the RSV lobar pneumonia cases are coinfected with some bacterial organisms more heavily than in the RSV bronchiolitis and bronchopneumonia cases.

Incidence of respiratory viruses in preterm infants submitted to mechanical ventilation

“…PUTTO et al (1986) 26 , studying 154 children with fever, reported that values of CRP between 20 and 40 mg/L may be found in both viral and bacterial infections, and that levels over 40 mg/L detect 79% of the bacterial infections, with 90% specificity. SAIJO et al (1996) 27 observed that most of the children with infection caused by RSV present a low CRP level. A low CRP level suggests a single viral infection and depending upon the clinical and radiological course, enables the suspension of antibiotic therapy and a reduction in the hospital stay.…”

“…The concentration of C-reactive protein (CRP) (immunonephelometry) was also determined from blood samples. CRP values > 40 mg/L were considered suggestive of bacterial or mixed viralbacterial infection 18,27 . Chest radiographs were done when necessary.…”

Evaluation of Acute-phase Reactants, Immunologic Markers and other Clinical and Laboratory Parameters in Patients with Pneumonia and Non-pneumonic Lower Respiratory Tract Infections

“…A few studies with varied sample sizes have analyzed the CRP levels in patients with pneumonia and OALRTI in children [34,35] , in adults [1,[36][37][38][39] and in the elderly [40] , all of which found higher levels of CRP in the former patients. Among the many clinical and laboratory parameters analyzed, we also found CRP to be the variable most tightly related to the diagnosis of pneumonia and the most useful parameter for the differentiation between these two conditions in the univariate, multivariate and ROC curve analyses.…”

C-Reactive Protein and Respiratory Viral Infection

“…Various studies have reported haematological characteristics, including abnormal elevation or reduction in the number of haemoglobin molecules or platelets, based on the causative virus [7,8]. For example, it was observed that patients with RSV pneumonia were more co-infected by bacteria than those with RSV bronchiolitis and bronchopneumonia, so that patients with RSV pneumonia had elevated levels of WBC count, CRP and erythrocyte sedimentation rate (ESR) than those with bronchiolitis or bronchopneumonia [9]. Among these proteins, CRP is the most representative of acute phase reactants [10,11].…”

“…Although elevated CRP levels indicate bacterial infection [12], it was reported to be still insufficient to conclude as direct evidence that virus causes elevation of CRP levels [13]. However, infection of RV such as RSV is prone to co-infection with other bacteria or viruses, and CRP level increases together [9], so that identification of levels of biomarker proteins such as CRP can be an important indirect indication for viral infection. However, similar levels may be observed in patients with inflammatory diseases or in those infected with certain viral strains (e.g., adenovirus and influenza) [14,15].…”