Correlation of C-reactive protein and neutrophil counts as early indicators of severe dengue in children

Sandhya Rani Atukuri, Praveen Nayak


Background: Dengue has broad clinical presentation with unpredictable clinical evolution and outcome while most patients recover following a self-limiting non-severe clinical course, a small proportion progress to severe disease. As early diagnosis of dengue infection remains a challenge around the world in areas of limited resources, laboratory parameters like CRP, Neutrophil counts may serve as predictive markers to promote early diagnosis. The objectives of this study were to stratify the levels of C-reactive protein and Neutrophil counts in children with dengue fever and to determine the correlation of C-reactive protein and Neutrophil counts with the severity of dengue

Methods: This was an Observational chart based descriptive study done in all pediatric dengue children (aged 1-15 years) admitted at Father Muller medical college hospital, Mangalore during the period of June 2014 to 2016. Total sample size was 100. Data collection was done by using purposive sampling based on inclusion and exclusion criteria from case records. Controls (n = 20), children with diagnosis of viral fever were considered in the study.

Results: Out of the 100 children studied, 16% were <5 years ,33% between 6-10 years and 51% above 10 years of age. Mean CRP levels in NS1, IgM and both are 6.2, 6.9, 6.3. CRP values >5 were considered as positive. Mean CRP values in dengue fever with warning signs (DF1), without warning signs (DF2) and Severe Dengue (DF3) were 6.3, 6.2, 11.4 respectively. Absolute Neutropenia was observed in 52% of the study population of dengue (DF1) of which severe neutropenia was observed in 19% and 15% OF DF2 (with no warning signs) also showed neutropenia. CRP values are significant in the study when compared to controls and absolute neutropenia was observed in 52% of dengue with warning signs. Hence CRP and neutropenia may be helpful as early predictors of severe dengue.

Conclusions: Our study was an attempt to correlate CRP and neutropenia for early prediction of severe dengue. Mean CRP values in the population were significant statically but not as markedly elevated in other bacterial illness as the study population have no enrolled cases of severe dengue. But neutropenia (<1,500/cmm) and positive CRP (>5) may serve as predictive markers in a resource limited setting. 


C-Reactive protein, Neutrophil count, Severe dengue

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Simmons CP, Farrar JJ, van Vinh Chau N, Wills B. Dengue. New Eng J Med. 2012;366(15):1423-2.

Halstead SB. Pathogenesis of dengue: challenges to molecular biology. Sci. 1988;239:476-81.

National vector borne disease control programme. Director General Health Services. Ministry of Health and Family Welfare. Dengue; 2016.

Potts JA, Gibbons RV, Rothman AL. Prediction of dengue disease severity among pediatric thai patients using early clinical laboratory indicators. PLoS Neglected Trop Dis. 2010;4(8):e769.

Hemungkorn M, Thisyakorn U, Thisyakorn C. Dengue infection: a growing global health threat. Biosci. Trend. 2007;1:90-6.

Wright WF, Pritt BS. Update: the diagnosis and management of dengue virus infection in North America. Diagn Microbiol Iinfect Dis. 2012;73:215-20.

Kalayanarooj S, Vaughn DW, Nimmannitya S, Green S, Suntayakorn S, Kunentrasai N, et al. Early clinical and laboratory indicators of acute dengue illness. J Infect Dis. 1997;176(2):313-21.

Dietz VJ, Gubler DJ, Rigau-Perez JG, Pinheiro F, Schatzmayr HG, Bailey R, et al. Epidemic dengue 1 in Brazil, 1986: evaluation of a clinically based dengue surveillance system. Am J Epidemiol. 1990;131(4):693-701.

Jaye DL, Waites KB. Clinical applications of C-reactive protein in paediatrics. Pediatr Infect Dis J. 1997;16(8):735-47.

Potts JA, Rothman AL. Clinical and laboratory features that distinguish dengue from other febrile illnesses in endemic populations. Trop Med Int Health. 2008;13:1328-40.

Dengue. Guidelines for diagnosis, treatment prevention and control, Geneva, World Health Organization, 2009, WHO/HTM/NTD/DEN; 2009.

Engorn B, Flerlage J. The Harriet Lane. 19th ed. United States of America: Elseiver; 2012:313-314.

Chadwick D, Arch B, Wilder-Smith A, Paton N. Distinguishing dengue fever from other infections on the basis of simple clinical and laboratory features: Application of logistic regression analysis. J Clin Virol. 2006;35(2):147-53.

Chen CC, Lee IK, Liu JW, Huang SY, Wang L. Utility of C-Reactive Protein Levels for Early Prediction of Dengue, Severity in Adults. Bio Med Res Internat. 2015:Article ID 936062:6 pages.

Kutsuna S, Hayakawa K, Kato Y, Fujiya Y, Mawatari M, Takeshita N, et al. The usefulness of serum C-reactive protein and total bilirubin levels for distinguishing between dengue fever and malaria in returned travelers. Am J Trop Med Hyg. 2014;90(3):444-8.

Ho TS, Wang SM, Lin YS, Liu CC. Clinical and laboratory predictive markers for acute dengue infection. J Biomed Sci. 2013;20(1):75.