According to a study in Italy published in the February issue of Pediatrics International, four non-specific markers of inflammation (reactive protein C (CRP), procalcitonin, erythrocyte sedimentation rate (ESR) and number of white blood cells) in combination can help in the differential diagnosis of the bacterial etiology of viral pneumonia in young children.

According to the researchers, if all or most of these indicators are high, the bacterial etiology is very likely, however, low levels of these parameters cannot exclude the bacterial nature of the disease.

The study determined the levels of C-reactive protein, procalcitonin, ESR and the number of leukocytes, as well as an X-ray examination of the thoracic organs in children with community-acquired pneumonia (PV).

The study involved 101 children (mean age 3.6 years) with community-acquired pneumonia confirmed by radiology. An etiological diagnosis was made in 68 children (67%), mainly on the basis of serological studies.

According to the data obtained, in the case where the level of RRF is greater than 100 mg / l, the number of leukocytes is greater than 15 × 109 / l, the level of procalcitonin is greater than 10 ng / ml and the ESR is greater than 65 mm / h, the ratio of the probability of obtaining a positive result in the differential diagnosis between pneumococcus and viral community, acquired pneumonia is 2.7 or more and 3.9 between atypical and viral VP.

If the level of one of the indicators exceeds certain values (for example, CRP greater than 200 mg / l, white blood cells greater than 22 × 109 / l, procalcitonin greater than 18 ng / ml or ESR greater than 90 mm / h), the probability ratio of a positive result is 3.4 or more.

The researchers note that none of the 4 markers of inflammation and any possible combination of the above indicators does not allow a differential diagnosis of community-acquired pneumococcal pneumonia and CAP caused by atypical pathogens.

During the study, no radiological feature was detected with various etiologies of pneumonia. The age of the patients was an important prognostic factor in the viral etiology of the disease - for example, 86% of viral pneumonia was diagnosed in children under 5 years of age.

Thus, this study found that CRP, procalcitonin, leukocyte count and ESR individually are of limited value in the differential diagnosis of viral bacterial pneumonia in children. At the same time, the combination of the above parameters is sensitive and specific enough to recommend its routine clinical use.