Clinical and laboratory observation

C-reactive protein in respiratory virus infections+

Neonatal sepsis is one of the most critical causes of infant mortality. Alteration in phosphorous levels is known to be associated with sepsis. The aim of this study is to evaluate the level of blood phosphorus in neonates admitted to ICU and its relation with different factors and prognosis of patients.

In this cross-sectional study, all neonates admitted to the intensive care unit diagnosed with neonatal sepsis were included. Serum phosphorus levels were evaluated along with c-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and urine and blood culture. Demographic data along with clinical findings were collected in a research questionnaire for all the patients.

Of 211 neonates, 98 (46.4%) were female and 113 (53.6%) were male, and the mean age of the patients was 10.51 days. The mean phosphorus level was 4.39 ± 0.67 mg/dL. The mean phosphorus levels among girls and boys was significantly different, p = 0.001 (4.23 ± 0.62 vs 4.53 ± 0.69 mg/dL). The mean phosphorus among positive and negative blood culture patients was also significant, p < 0.001 (4.74 ± 0.67 vs 4.29 ± 0.64 mg/dL). However, type of feeding, ESR, urine culture and CRP status was not associated with phosphorus levels, p > 0.05.

The alterations in phosphorous levels among neonatal sepsis patient is likely to be correlated with gender and blood culture status. Other prognostic markers might not have an effect on phosphorous levels in these patients.

Glioblastoma (GBM) is the most common malignant adult primary brain tumor. We profiled 724 cancer-associated proteins in sera of healthy individuals (n = 27) and GBM (n = 28) using antibody microarray. While 69 proteins exhibited differential abundance in GBM sera, a three-marker panel (LYAM1, BHE40 and CRP) could discriminate GBM sera from that of healthy donors with an accuracy of 89.7% and p < 0.0001. The high abundance of C-reactive protein (CRP) in GBM sera was confirmed in 264 independent samples. High levels of CRP protein was seen in GBM but without a change in transcript levels suggesting a non-tumoral origin. Glioma-secreted Interleukin 6 (IL6) was found to induce hepatocytes to secrete CRP, involving JAK-STAT pathway. The culture supernatant from CRP-treated microglial cells induced endothelial cell survival under nutrient-deprivation condition involving CRP-FcγRIII signaling cascade. Transcript profiling of CRP-treated microglial cells identified Interleukin 1β (IL1β) present in the microglial secretome as the key mediator of CRP-induced endothelial cell survival. IL1β neutralization by antibody-binding or siRNA-mediated silencing in microglial cells reduced the ability of the supernatant from CRP-treated microglial cells to induce endothelial cell survival. Thus our study identifies a serum based three-marker panel for GBM diagnosis and provides leads for developing targeted therapies.

Biological significance

A complex antibody microarray based serum marker profiling identified a three-marker panel — LYAM1, BHE40 and CRP as an accurate discriminator of glioblastoma sera from that of healthy individuals. CRP protein is seen in high levels without a concomitant increase of CRP transcripts in glioblastoma. Glioma-secreted IL6 induced hepatocytes to produce CRP in a JAK-STAT signaling dependent manner. CRP induced microglial cells to release IL1β which in turn promoted endothelial cell survival. This study, besides defining a serum panel for glioblastoma discrimination, identified IL1β as a potential candidate for developing targeted therapy.

to characterize and compare clinical, epidemiological, and laboratory aspects of infants with acute lower respiratory infection (ALRI) associated with the detection of adenovirus (ADV) or respiratory syncytial virus (RSV).

a preliminary respiratory infection surveillance study collected samples of nasopharyngeal aspirate (NPA) for viral research, linked to the completion of a standard protocol, from children younger than two years admitted to a university hospital with ALRI, between March of 2008 and August of 2011. Polymerase chain reaction (PCR) was used for eight viruses: ADV, RSV, metapneumovirus, Parainfluenza 1, 2, and 3, and Influenza A and B. Cases with NPA collected during the first 24 hours of admission, negative results of blood culture, and exclusive detection of ADV (Gadv group) or RSV (Grsv group) were selected for comparisons.

the preliminary study included collection of 1,121 samples of NPA, 813 collected in the first 24 hours of admission, of which 50.3% were positive for at least one virus; RSV was identified in 27.3% of cases surveyed, and ADV was identified in 15.8%. Among the aspects analyzed in the Gadv (n = 58) and Grsv (n = 134) groups, the following are noteworthy: the higher mean age, more frequent prescription of antibiotics, and the highest median of total white blood cell count and C-reactive protein values in Gadv.

PCR can detect persistent/latent forms of ADV, an aspect to be considered when interpreting results. Additional studies with quantitative diagnostic techniques could elucidate the importance of the high frequency observed.

caracterizar e comparar aspectos clínicos, epidemiológicos e laboratoriais de lactentes com evidências de infecção aguda do trato respiratório inferior (IATRI) associada à detecção do adenovírus (ADV) ou do vírus sincicial respiratório (VSR).

um estudo preliminar de vigilância de infecções respiratórias desenvolveu coleta de aspirado nasofaríngeo (ANF) para pesquisa viral, vinculada ao preenchimento de protocolo padrão, de menores de dois anos internados com quadro de IATRI em hospital universitário, entre março de 2008 e agosto de 2011. Utilizou-se técnica da reação em cadeia da polimerase (PCR) para oito vírus: ADV, VSR, metapneumovírus, parainfluenza 1, 2 e 3 e influenza A e B. Foram selecionados para comparações os casos com ANF coletado nas primeiras 24horas da admissão, resultado de hemocultura negativo e detecção exclusiva de ADV (grupo Gadv) ou VSR (grupo Gvsr).

o estudo preliminar incluiu coleta de 1.121 amostras de ANF, sendo 813 coletadas nas primeiras 24 h da admissão, das quais 50,3% foram positivas para ao menos um dos vírus, com VSR em primeiro lugar, em 27,3%, e ADV em segundo, em 15,8% dos casos pesquisados. Dentre os aspectos analisados nos grupos Gadv (n=58) e Gvsr (n=134), destacaram-se a média da idade mais elevada, maior frequência da prescrição de antibióticos e medianas mais elevadas para contagem total de leucócitos e valores da proteína C-reativa no Gadv.

a PCR utilizada pode detectar formas persistentes/latentes de ADV, aspecto a ser considerado ao interpretar os resultados. Estudos complementares com técnicas diagnósticas quantitativas, por exemplo, poderiam evidenciar a importância da elevada frequência verificada.