دور بعض المؤشرات الحيوية المناعية في التمييز بين العدوى البكتيرية والفيروسية بين الأطفال المصابين بأمراض الحمى الحادةية

Role of Some Immunological Biomarkers in Differentiation of Bacterial and Viral Infection Among Children with Acute Febrile Illnesses

Abstract

Febrile illnesses in pediatric patients present significant diagnostic challenges due to their diverse etiologies, including bacterial, viral, and inflammatory conditions. Differentiating between these causes is crucial for guiding appropriate treatment strategies, minimizing unnecessary antibiotic use, and improving patient outcomes. Biomarkers such as Tumor Necrosis Factor-related apoptosis inducing ligand (TNFL), Neutrophil Gelatinase-Associated Lipocalin (NGAL), and Matrix Metalloproteinase-8 (MMP-8) are often studied for their roles in the body’s response to infection and inflammation. This study aims to investigate the diagnostic utility of three specific immune markers TRAIL, MMP-8, and NGAL in children presenting with febrile illnesses.
This study is a Case-control study and the samples were divided into two groups: 60 febrile cases (30 patients with bacterial infection and 30 with viral cases) and 30 healthy controls. Enrolled in Karbala Teaching Hospital for Children, Karbala, Iraq. During the period November(2023) to February (2024).The samples of blood and serum were collected and detected the level of CRP, WBCs, Neutrophils, and lymphocytes were by Swelab alfa automated haematologyanalyzers, and TNFL, MMP-8, and NGAL by ELISA technique.
The study found elevated CRP, WBCs, and Neutrophil levels in patients with bacterial infection, and lymphocytes significantly increased in patients with viral infection at (P≤0.05). As well as, the study demonstrated that TNF-related apoptosis-inducing ligand (TNFL), Matrix Metalloproteinase 8 (MMP-8), and Neutrophil Gelatinase-Associated Lipocalin (NGAL) exhibit significant(P≤0.05)potential as biomarkers to differentiate bacterial from viral infections in febrile children. TNFL, in particular, showed high specificity (0.8) for bacterial infections, while elevated levels of MMP-8 (0.683) and NGAL (0.8) were more indicative of viral infections. The results showed an increase in the concentration of NGAL in females (0.038) compared to males in the group of patients with viral infection. The results of statistical analysis showed that TNFL significantly (0.002) increase in patients with bacterial infection as compared with patients with viral infection and control subjects. NGAL and MMP-8 were significantly (0.001) and (0.000) increased in patients with bacterial and viral infections as compared with control subjects respectively.
The results of this study have shown that TNF-related apoptosis-inducing ligand (TNFL), Matrix Metalloproteinase 8 (MMP-8), and Neutrophil Gelatinase-Associated Lipocalin (NGAL) exhibit significant potential as biomarkers to differentiate bacterial from viral infections in febrile children.