The value of Creactive protein in the diagnosis of septicaemia in children with malaria

Malaria and septicaemia, both major causes of infant and early childhood morbidity and mortality in Nigeria, often co-exist and are difficult to differentiate. This study was designed to test the hypothesis that C-reactive protein (CRP) levels could differentiate between malaria and malaria coexisting with septicaemia. One hundred and fifty-one children aged 6 to 60 months with fever without localising signs and 141 aged/sex-matched controls were studied. C-reactive protein levels in all the children were determined while the febrile children had their blood cultures done. ANOVA and students‘t’ test were used to determine the difference between groups. Sensitivity, negative predictive and positive predictive values for malaria coexisting unit septicaemia were calculated for various levels of CRP. One hundred and thirty (86.1%) of the subjects had malaria alone while 21 (13.9%) had malaria coexisting with septicaemia. Organisms isolated were mainly Enterobacteriaceae (7), Staphylococcus aureus (9), Salmonella spp. (4) and Streptococcus pneumoniae (1). The mean serum CRP levels in subjects with malaria alone and malaria coexisting with septicaemia were 82.16 ± 44.94 mg/l and 108.44 ± 55.65 mg/l respectively (P=0.0176). At the diagnostic level of 90 mg/l (value just greater than the mean for malaria alone), CRP was highly sensitive (sensitivity 76.2%) in detecting septicaemia in 21 subjects with co-morbidity while specificity (36.9%) was low. It is concluded that CRP can differentiate between malaria and malaria with septicaemia. In children with malaria, antibiotics should be started at the CRP level of ³ 90 mg/l.