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      Diagnostic role of inflammatory markers in pediatric Brucella arthritis

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          Abstract

          Background

          As a multisystem infectious disease, there is an inflammation, which causes increase in acute phase reactants in brucellosis. The mean platelet volume (MPV), platelet distribution width (PDW), red cell distribution width (RDW), neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have been identified as markers of inflammation. The present study aimed to evaluate diagnostic values of these biomarkers in brucella arthritis (BA).

          Methods

          The study included 64 children with BA and 66 healthy control subjects. Demographic features, joint involvement, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and hematological variables were retrospectively recorded. In addition, results of synovial fluid and serum tube agglutination test for brucella together with treatment regimens were recorded.

          Results

          The mean age of the patients (53.1 % male) was 92.3 ± 41.2 months. The most commonly affected joint was ankle (53.1 %). Synovial fluid puncture-brucella agglutination test was positive in 22 (34.3 %) patients. Puncture culture was positive in 9 patients. Most of the patients (57.8 %) were treated with a combination of rifampicin plus sulfamethoxazole/trimethoprim and gentamicin. Significantly higher mean PDW, RDW, MPV, NLR and PLR values were found in children with BA compared to control subjects ( p < 0.05). A positive correlation was found between MPV and NLR values ( R 2 = 0.192, p < 0.001).

          Conclusion

          Our findings indicated that NLR and PLR are indirect markers of inflammation that may be observed abnormally increased in children with brucella arthritis. Further longitudinal studies are needed to investigate this topic to establish the more clear associations.

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          Most cited references23

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          Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population

          Background Preliminary evidence has suggested the role of inflammation in development and prognosis of cardiovascular diseases and cancers. Most of the prognostic studies failed to account for the effects of co-morbid conditions as these might have raised the systemic inflammation. We used neutrophil lymphocyte ratio (NLR) as a measure of systemic inflammation and investigated its association with prevalent chronic conditions. Methods Present study is a cross sectional study conducted on population of Karachi, Pakistan. A detailed questionnaire about the demographic details of all subjects was filled and an informed consent obtained for blood sampling. Multinomial regression analyses were carried out to investigate the relationship between NLR and prevalent chronic conditions. Results 1070 apparently healthy individuals participated in the study. Proportion of individuals with hypertension was higher in middle and highest tertile of NLR as compared to the lowest tertile (18.2% & 16.1% compared to 11.8%). Individuals with hypertension were 43% (RRR = 1.43, 95% CI 0.94-2.20) and 66% (RRR = 1.69, 95% CI 1.09-2.54) more likely to be in the middle and highest tertile of NLR respectively compared to the baseline group. Similarly, individuals with diabetes mellitus were 53% (RRR = 1.53, 95% CI 0.93-2.51) and 65% (RRR = 1.65, 95% CI 1.01-2.71) more likely to be in the middle or highest tertile of NLR as compared to the baseline NLR group. Conclusions Systemic inflammation measured by NLR has a significant association with prevalent chronic conditions. Future research is needed to investigate this relationship with longitudinal data to establish the temporal association between these variables.
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            Platelet size: measurement, physiology and vascular disease.

            Platelet volume is a marker of platelet function and activation. It is readily measured as mean platelet volume (MPV) by clinical haematology analysers using sodium citrate as the anticoagulant. Measurement in EDTA can be unreliable since MPV increases significantly in a time-dependent manner. MPV correlates with platelet function and activation, whether measured as aggregation, thromboxane synthesis, beta-thromboglobulin release, procoagulant function, or adhesion molecule expression. MPV is increased in certain vascular risk factor states, including hypercholesterolaemia and diabetes mellitus, but not essential hypertension. It is increased in acute myocardial infarction, acute ischaemic stroke, pre-eclampsia and renal artery stenosis. Importantly, an elevated MPV predicts a poor outcome following myocardial infarction, restenosis following coronary angioplasty, and the development of pre-eclampsia. Research into the epidemiology of MPV is now required to determine whether thrombomegaly is a risk factor for developing vascular disease. Similarly, the physiological mechanisms which regulate MPV within the megakaryocyte need to be elucidated. Whether MPV ever becomes a routinely requested test remains to be seen but changes in methodology will be required first.
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              Update on laboratory diagnosis of human brucellosis.

              The persistent worldwide prevalence of human brucellosis causes serious public health concerns and economic loss to communities. The multisystem involvement and the protean and unusual clinical presentations of the disease pose significant diagnostic challenges. The clinical features are non-specific and can overlap with a wide spectrum of other infectious and non-infectious diseases, leading to brucellosis being labelled the 'disease of mistakes'. Protracted chronicity and serious complications can result and mislead physicians onto a path of costly laboratory and radiological investigations. To reach a diagnosis clinicians must use a wide range of non-specific routine haematological and biochemical tests in addition to Brucella-specific assays. The latter are microbiological (culture), serological (e.g. slide or tube agglutination, Coombs test, immunocapture agglutination, Brucellacapt, immunochromatographic lateral flow, enzyme-linked immunosorbent assays and the indirect fluorescent antibody test) and molecular (e.g. polymerase chain reaction (PCR) and real-time PCR). Each of these tests has advantages and limitations, and thus requires careful interpretation. Since brucellosis can have several presentations and phases (acute, subacute, chronic, relapsed, active and inactive), the search for reliable, discriminatory diagnostic and prognostic markers, especially for monitoring disease evolution, are ongoing. Although much progress has been made, further challenges remain to the accurate diagnosis of this historic but still common global zoonotic disease. Copyright © 2010 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.
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                Author and article information

                Contributors
                +90 5056690064 , fesihaktar@yahoo.com
                rectek21@hotmail.com
                selcukbektas008@gmail.com
                mdagunes@hotmail.com
                muhammetkosker@gmail.com
                sertugrul68@yahoo.com
                kamilyilmaz@hotmail.com
                kamuran_karaman@hotmail.com
                drhasanbalik21@hotmail.com
                ilyasyolbas@hotmail.com
                Journal
                Ital J Pediatr
                Ital J Pediatr
                Italian Journal of Pediatrics
                BioMed Central (London )
                1824-7288
                11 January 2016
                11 January 2016
                2016
                : 42
                : 3
                Affiliations
                [ ]Department of Pediatric Infectious Disease, Dicle University School of Medicine, 21280 Diyarbakir, Turkey
                [ ]Department of Clinical Microbiology and Infectious Disease, Dicle University School of Medicine, Diyarbakir, Turkey
                [ ]Department of Pediatric, Van Research Hospital, Van, Turkey
                [ ]Department of Pediatric Infectious Disease, Diyarbakir Children’s Hospital, Diyarbakir, Turkey
                [ ]Department of Pediatric, Dicle University School of Medicine, Diyarbakir, Turkey
                [ ]Department of Pediatric, Diyarbakir Children’s Hospital, Diyarbakir, Turkey
                [ ]Department of Pediatric, Yüzüncü Yil University School of Medicine, Van, Turkey
                Article
                211
                10.1186/s13052-016-0211-5
                4709903
                26753565
                2554bb73-76dc-4eca-a43e-b2ded567bccd
                © Aktar et al. 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 14 November 2015
                : 3 January 2016
                Categories
                Research
                Custom metadata
                © The Author(s) 2016

                Pediatrics
                brucella arthritis,child,correlation,inflammatory markers,diagnostic role
                Pediatrics
                brucella arthritis, child, correlation, inflammatory markers, diagnostic role

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