Alpha 2 HS-glycoprotein levels in children with protein-energy malnutrition and infections

Efficiency of Fetuin-A and Procalcitonin in the Diagnosis of Infection in Patients with Febrile Seizure

Fetuin-A is a negative acute phase reactant, while procalcitonin is an indicator of severe bacterial infection. Diagnosis of bacterial infection in febrile seizure (FS) is important for choosing the most suitable treatment. In this study, serum fetuin-A was estimated, for the first time, in the inpatients with FS and compared with procalcitonin and blood culture tests.

A total of 60 children (28 male and 32 female) with FS in addition to 30 sex- and age-matched children participated in the study. Patients were classified according to sex, age, PCT level (high PCT>0.5ng/mL), C-reactive protein (CRP, positive >6mg/L), and according to the results of the blood culture.

Fetuin-A level decreased and PCT level increased in FS patients in comparison to those in the control group. These changes are significantly increased (p<0.05) in the positive CRP group compared with that of the negative CRP group. Kernel density estimation showed that procalcitonin is a better indicator of the infection in FS children than fetuin-A . Procalcitonin is more sensitive and specific than fetuin-A and when used together they produce 100% sensitivity and specificity for the diagnosis of bacterial infection in FS patients.

Fetuin-A is low in FS patients and can be used with procalcitonin in the diagnosis of bacterial infection in FS.

The immune system in children with malnutrition--a systematic review

BACKGROUND

Malnourished children have increased risk of dying, with most deaths caused by infectious diseases. One mechanism behind this may be impaired immune function. However, this immune deficiency of malnutrition has not previously been systematically reviewed.

OBJECTIVES

To review the scientific literature about immune function in children with malnutrition.

METHODS

A systematic literature search was done in PubMed, and additional articles identified in reference lists and by correspondence with experts in the field. The inclusion criteria were studies investigating immune parameters in children aged 1-60 months, in relation to malnutrition, defined as wasting, underweight, stunting, or oedematous malnutrition.

RESULTS

The literature search yielded 3402 articles, of which 245 met the inclusion criteria. Most were published between 1970 and 1990, and only 33 after 2003. Malnutrition is associated with impaired gut-barrier function, reduced exocrine secretion of protective substances, and low levels of plasma complement. Lymphatic tissue, particularly the thymus, undergoes atrophy, and delayed-type hypersensitivity responses are reduced. Levels of antibodies produced after vaccination are reduced in severely malnourished children, but intact in moderate malnutrition. Cytokine patterns are skewed towards a Th2-response. Other immune parameters seem intact or elevated: leukocyte and lymphocyte counts are unaffected, and levels of immunoglobulins, particularly immunoglobulin A, are high. The acute phase response appears intact, and sometimes present in the absence of clinical infection. Limitations to the studies include their observational and often cross-sectional design and frequent confounding by infections in the children studied.

CONCLUSION

The immunological alterations associated with malnutrition in children may contribute to increased mortality. However, the underlying mechanisms are still inadequately understood, as well as why different types of malnutrition are associated with different immunological alterations. Better designed prospective studies are needed, based on current understanding of immunology and with state-of-the-art methods.

The physiologic development of fetuin-a serum concentrations in children

Fetuin-A prevents tissue calcification by forming soluble complexes with calcium and phosphate. A pathological depletion of serum fetuin-A has been observed in children on dialysis or after renal transplantation but knowledge on physiologic age-related changes in serum fetuin-A is limited. We prospectively evaluated serum fetuin-A in 133 infants and children, ranging from very low birth weight infants to adolescents. Highest serum fetuin-A levels were present between 23 and 30 wk of gestation (1 +/- 0.33 mg/mL). Thereafter, the values decreased. This decrease was linked to biological rather than chronological age. At 32 to 36 and 37 to 40 wk of gestation, the serum fetuin-A concentration was 0.63 +/- 0.26 and 0.63 +/- 0.21 mg/mL, respectively. Thereafter, the concentrations remained stable until adolescence at 0.58 +/- 0.12 mg/mL. Intercurrent infections were associated with a transient decrease of serum fetuin-A levels. The high serum fetuin-A concentrations in preterm children suggest that fetuin-A is of high physiologic impact for the fetal and the preterm-born organism, showing extensive tissue formation. This might point to a new mechanism contributing to organ damage in these patients, comparable with children on dialysis.