CRP in various clinical settings |
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Severe infections such as septicaemia, endocarditis and osteomyelitis
Many systemic diseases involve a bacteraemic phase, for instance some cases of pneumonia,
bacterial meningitis, enteric fever and septic arthritis. The symptoms may be almost identical to
those of viral infection. Markedly elevated CRP concentrations (>100 mg/l) usually suggest
bacterial or fungal infections in the absence of other overt inflammatory conditions. Nevertheless,
some patients with serious bacterial infections may have only moderately elevated or even normal CRP
concentration. This is particularly true during the first 6-12 h after the onset of infection.
Compared with ESR, CRP is a more sensitive marker for diagnosis of infective endocarditis
especially at an early phase (>12 h) of the disease. CRP is normalised sooner than ESR after the
pathogens have been eliminated.
Serial CRP determinations are the most effective way of follow up the patient's condition if
complications occur during treatment, also accounting for the interindividual differences in
normal levels of CRP. This should be kept in mind especially in doubtful cases and with premature
infants in whom the rise in CRP concentration during septicaemia may not be as great as in adults.
The measured CRP value should always be evaluated against group-specific reference values.
Bone infection is characterised by a progressive infectious process resulting in inflammatory
destruction of bone, bone necrosis and new bone formation. CRP may rise to 100 times normal levels
in cases of osteomyelitis.
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