Русский
Optimization of differential diagnosis of viral and bacterial acute intestinal infections
DOI: https://dx.doi.org/10.18565/epidem.2025.15.1.56-60
Gorodin V.N., Moysova D.L., Surkova A.D.
1) Kuban State Medical University, Krasnodar, Russia; 2) Infectious Diseases Hospital №. 2, Krasnodar Territory Department of Health, Sochi, Russia
Materials and methods. Determination of the fecal calprotectin (FCP) level by ELISA was performed in 105 hospitalized patients with AII aged from 1 year to 40 years. Statistical analysis was performed by Statistica 12.0 (Stat Soft, USA). Multivariate ANOVA with the Kruskal-Wallis test was performed, and the Spearman direct linear correlation coefficient (r) was determined. The relative risk of an event (RR (CI)) was calculated using four-field tables.
Results. The relative risk of bacterial AII in adults was 3 times higher than in children. The presence of leukocytosis, neutrophilia, and left shift, changes in the coprogram, and the maximum level of increase in body temperature did not allow for a differential diagnosis between viral and bacterial AII. The CRP level was significantly (p < 0.05) higher in bacterial AII (15.9 [12.2–39.96] mg/l) than in viral AII (7.04 [1.9–14.17] mg/l). At the CRP level > 12 mg/l, bacterial AII were recorded more often than viral ones (RR = 4.34 (95% CI 1.03–18.17)). In the case of viral AII, the FCP level was 477.7 [355.9–600] μg/g, and in the case of bacterial ones – 1472.0 [584.0–1571.0] μg/g (p < 0.05). At the FCP level > 600 μg/g, the probability of bacterial AII was 45 times higher than viral one (RR = 45.0 (6.19–326.9)), sensitivity 90%, specificity 92%. At the FCP level > 600 μg/g, hemorrhagic gastropathy, liver dysfunction, and later admission to hospital were recorded more often (p < 0.05). A strong direct correlation was established between the CRP and FCP values (r = 0.7).
Conclusion. FCP is a useful non-invasive, easily and quickly measured laboratory test for differentiating bacterial and viral AII and can become an objective criterion for prescribing antibacterial therapy for AII.
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About the Autors
Рrofessor Vladimir N. Gorodin, MD, Head, Department of Infectious Diseases and Epidemiology, Kuban State Medical University, Ministry of Health of the Russia; Chief Physician, Infectious Diseases Hospital № 2, Krasnodar Territory Department of Health, Sochi, Ministry of Health of the Krasnodar Territory, Russia; vgorodin@mail.ru; https://orcid.org/0000-0003-3062-7595
Diana L. Moysova, MD, Professor, Department of Infectious Diseases and Epidemiologу, Kuban State Medical University, Ministry of Health of the Russia, Krasnodar, Russia; moisova.di@yandex.ru; https://orcid.org/0000-0003-3920-5997
Anastasiуa D. Surkova, 2nd year Resident, Department of Infectious Diseases and Epidemiology, Kuban State Medical University, Ministry of Health of the Russia, Krasnodar, Russia: nastya@surkoff. ru; https://orcid.org/0009-0000-8438-7115
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