C-reactive Protein, Interleukin-6 and Procalcitonin as parameters of infection in pediatric patients with oncologic diseases.

Due to anti-neoplastic therapy, there is a high incidence of infections and fever in pediatric patients with malignant disease. We have searched for p arameters that may be of value in the early diagnosis of infection, in disc riminating between bacterial and non-bacterial causes and for monitoring th e response to antimicrobiotic therapy. Patients: 46 febrile episodes in 33 children with malignant diseases under anti-neoplastic therapy, aged 0.5 to 17 years, were included. Each patient was supplied with a central venous c atheter (Hickman catheter). Methods: Blood was taken for the evaluation of C-reactive-protein (CRP), Interleukin-6 (IL-6) and Procalcitonin (PCT). Lab oratory data included WBC, blood cultures, as well as microbiologic and ser ologic tests for important infectious agents. Patients were grouped as foll ows: 1. Patients with febrile diseases and positive blood cultures, 2. Pati ents with localized bacterial or mycotic infections and negative blood cult ures, 3. Patients with fever of unknown origin, 4. Patients with viral infe ctions, 5. Control group. Results: CRP and 1L-6 were more sensitive than PC T in detecting bacterial and mycotic diseases in leukopenic children, becau se of low PCT-levels in patients with localized infections. IL-6 values wer e high shortly after onset of fever and decreased under sufficient antimicr obiotic therapy until day three. Conclusions: Because of the quick response , IL-6 may be helpful in monitoring antimicrobiotic therapy. Using Procalci tonin-levels, we were not able to distinguish between localized bacterial a nd viral infection in leukocytopenic patients.