A new study published in the International Journal of Infectious Diseases investigated causes of fever in primary levels of care in Southeast Asia and evaluated whether C-reactive protein (CRP) could distinguish bacterial from viral pathogens.

In this study, blood and nasopharyngeal swab specimens were taken from 773 children and adults with fever (> 37.5 °C) or history of fever (<1 4 days), residing in Thailand and Myanmar.

Among the patients, 29.4% were detected with a target organism. Influenza virus type A was found in 85/227 cases (37.5%); dengue virus in 30 cases (13.2%); respiratory syncytial virus in 24 cases (10.6%); and Leptospira spp. In nine cases (4%). Interestingly, clinical outcomes were similar between patients with a bacterial or a viral organism, regardless of an antibiotic prescription. However, CRP was higher among patients with bacterial organism compared with those with viral organism.

The results suggested that serious bacterial infections requiring antibiotics are an exception rather than the rule in the first line of care. CRP testing could assist in ruling out such cases in settings where diagnostic uncertainty is high and routine antibiotic prescription is common.

Source: International Journal of Infectious Diseases. 2020 May 11;96:334-342. doi: 10.1016/j.ijid.2020.05.016.