Potential Biomarkers for Predicting Bloodstream Bacterial Infection in Tanzanian Children
Ng’weina Francis Magitta1,2* and Meshack Denson Shimwela3
1Ifakara Health Institute (IHI), Biomedical and Laboratory Sciences Thematic Group, Dar es Salaam, Tanzania
2Department of Biochemistry, Mbeya College of Health and Allied Sciences, University of Dar es Salaam, Mbeya, Tanzania
3Department of Internal Medicine, Amana Regional Referral Hospital, Dar es Salaam, Tanzania
*Corresponding Author: Ng’weina Francis Magitta, Ifakara Health Institute (IHI), Biomedical and Laboratory Sciences Thematic Group,
Dar es Salaam, Tanzania.
February 13, 2018; Published: March 20, 2018
Background: Bloodstream bacterial infection is a major cause of morbidity and mortality among children in Africa. The existing
biomarkers have limited sensitivity and specificity. Irrational use of antibiotics in non-malarial fevers increases healthcare cost, mor
bidity and accelerate antibiotic resistance.
Objective: To identify potential biomarkers for bloodstream bacterial infection in children for developing a point-of-care diagnostic
test in limited-resource setting.
Methods: We obtained blood from children aged less than 5 years with clinically-suspected septicaemia. Blood cultures were per
formed by BACTECTM
technique followed by bacterial identification using conventional methods and PCR. Using ELISA we analysed
previously reported serum biomarkers for bloodstream bacterial infection; procalcitonin (PCT) and C-reactive protein (CRP), lipo-
polysaccharide (LPS) and lipoteichoic acid (LTA).
Results: We recruited 79 children, 54% were male, mean age of 34 months. Almost all patients had fever, with a mean duration of
sickness of 3.8 days; 92% completed age-appropriate vaccines; 67% received prior antibiotic therapy and 20% had altered con-
sciousness. Using box plot, LTA displayed the most sensitivity compared to LPS, PCT and CRP. Further, we used receiver-operating
characteristic (ROC) curves to evaluate the performance of the markers based on the subset analysis of 25 samples using quantitative
PCR results as a reference. The curves displayed similar sensitivity for PCT and LPS with area under the curve (AUC) of 0.69. Consis
tently, CRP did not perform well in both analyses.
Conclusion: Both PCT and LPS showed acceptable diagnostic thresholds for septicaemia. However, large-powered studies are re-
quired for validation prior to their use in clinical practice.
Keywords: Biomarkers; Bloodstream Bacterial Infection; Procalcitonin; C-Reactive Protein; Lipopolysaccharide; Lipoteichoic Acid
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