Point of Care assessment of C-Reactive Protein and white blood cell count to identify bacterial aetiologies in malaria negative paediatric fevers in Tanzania

Helena Hildenwall, Florida Muro, Jaqueline Jansson, George Mtove, Hugh Reyburn, Ben Amos
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To assess the role of point of care assessment of C-reactive protein (CRP) and white blood cell (WBC) count to identify bacterial illness in Tanzanian children with nonsevere nonmalarial fever.


From the outpatient department of a district hospital in Tanzania 428 patients between 3 months and 5 years of age who presented with fever and a negative malaria test were enrolled. All had a physical examination and bacterial cultures from blood and urine. Haemoglobin, CRP and WBC were measured by point of care devices.


Positive blood cultures were detected in 6/428 (1.4%) children and urine cultures were positive in 24/401 (6.0%). Mean WBC was similar in children with or without bacterial illness (14,0x109, 95%CI 12.0-16.0 vs 12.0x109, 95%CI 11.4-12.7) while mean CRP was higher in children with bacterial illness (41.0 mg/L, 95%CI 28.3-53.6 vs 23.8mg/L, 95% CI 17.8-27.8). In ROC analysis, the optimum cut off value for CRP to identify bacterial illness was 19mg/l but with an area under the curve of only 0.62. Negative predictive values exceeded 80% while positive predictive values were under40%.


WBC and CRP levels had limited value in identifying children with bacterial infections. The positive predictive values for both tests were too low to be used as single tools for treatment decisions.