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Abstract

White blood cells count (WBC) is routinely used to assess children with fever, though the test has low sensitivity. The C-reactive protein (CRP) has a higher sensitivity for the diagnosing of bacterial infection. However, there is a lack of information about conditions where WBC is normal while CRP is increased. We aimed to identify the prevalence of this phenomenon and to describe its clinical features. The study included children aged 3mo ���¢�������� 18y who presented at our emergency department with fever during 2018-2020. Included were children with CRP>15 mg/ dL, a value considered highly specific for bacterial disease. Patients were divided into two groups: normal versus abnormal blood count (age-adjusted). Out of 15,961 children, 1173 were diagnosed with CRP> 15 mg/dL (7.3%). A bacterial diagnosis was determined for 74.5% of the 471 (40.1%) children with normal WBC, who had longer duration of fever (p = 0.008); were more likely to be of Arab/African descent (P = 0.011); had more GI symptoms (P = 0.017); and fewer fever ���¢�������¥ 39.50c (P = 0.035). In terms of final diagnoses, they were less likely to have pneumonia or urinary tract infections and more likely to have bacterial enteritis (p<0.001). In conclusion, approximately 40% of patients with CRP > 15 mg/dl had a normal WBC, and the majority a bacterial infection. Children with diarrhea at presentation, fever > 2 days, fever < 39.5, and who were of Arab/African descent were at increased likelihood for normal leukocytes; for these cases CRP should be routinely considered alongside WBC. Table 1 ���¢�������� Final diagnoses among pediatric patients with fever and CRP���¢�������¥15 mg/dL. Patients are divided into 2 groups: normal leukocyte count ("discrepancy group") and abnormal leukocyte count ("both abnormal").

Biography

Dr. Tarek Zoabi is an expert in the field of pediatrics and inflammatory conditions. He is a senior physician at Schneider Children's Medical Center of Israel, one of the largest tertiary headache clinics in Israel. During the last decades he has published many studies who dealt with the pathophysiology and clinical aspects of inflammatory and infectious diseases among pediatric patients. He is a member of international pediatrics and rheumatology societies and a regular participant in international congress in the field of pediatrics.