SERUM C-REACTIVE PROTEIN AND C3 COMPLEMENT PROTEIN-LEVELS IN SEVERELYMALNOURISHED NIGERIAN CHILDREN WITH AND WITHOUT BACTERIAL-INFECTIONS

Bacterial infections are the major determinants of fatality in severe protein-energy malnutrition (PEM). Unfortunately, these infections are difficult to diagnose clinically. C-reactive protein (CRP) levels wer e determined in 17 infected and 10 non-infected Nigerian children with severe PEM and compared with age/sex-matched apparently healthy contr ols. The aim was to study the response of this acute phase protein to bacterial infections as well as to assess its value in the diagnosis o f infections in severe PEM. C3 complement protein levels were also det ermined in the same group of subjects. The major organisms isolated in samples from these subjects were S. aureus and the coliforms. Mean CR P level in the non-infected children with severe PEM was 13.8 +/- 6.21 mg/l and rose to 159.83 +/- 124.07 mg/l in the presence of infection. The mean value in healthy non-infected controls was 2.01 +/- 0.96 mg/ l. The difference in the mean CRP levels between the infected and non- infected PEM children was statistically significant at p < 0.01. The m ean difference between the non-infected and the control subjects was n ot significant. Using a diagnostic level of 20.00 mg/l of CRP gave a s ensitivity of 85.0% and a specificity of 80.0%. This CRP level is a us eful index of bacterial infections in severe PEM. C3 complement protei n was low in the non-infected malnourished group, but rose significant ly in the presence of infection to values similar to that of the healt hy controls. C3 protein thus behaves as an acute phase reactant in the presence of infection in severe PEM, and does not appear to be consum ed, probably due to a deficiency in the early components of the comple ment cascade. This suggests a role for C3 measurement in the monitorin g of bacterial infections in severe PEM.