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Patient no 5

This article discusses the use of biochemical markers, such as procalcitonin and lipopolysaccharide-binding protein, to differentiate bacterial from viral infections. It also explores a clinical condition related to alpha-1 antitrypsin deficiency.

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Patient no 5

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  1. Patient no 5 A 24 days old precious boy has been brought to a paediatrician with 4 days history of vomiting fever and face skin lesion. His lab investigations revealed: • WBC Count: 10 x 109/L • Serum CRP level: 26.0 mg/dl (<0.2 mg/dl) • Serum ALT: 46 U/l Physician wants to know whether this infection is bacterial or viral before start of antibiotic. • Name one important biochemical marker which can be very helpful in differentiating bacterial from viral infection in this patient • Name another biochemical marker which be helpful in differentiating gram negative from gram positive infection in this patient. Procalcitonin Lipopolysaccharide Binding Protein Ref No 5 A comparison of high-mobility group-box 1 protein, lipopolysaccharide-binding protein and procalcitonin in severe community-acquired infections and bacteraemia: a prospective Study. Critical Care 2007, 11:R76 (doi:10.1186/cc5967)

  2. Lipopolysaccharide Binding Protein (LPBP) and Pro-calcitonin (PCN) • Both are markers of bacterial septicaemia. • LPBP has been claimed to be a differentiating marker for gram negative bacteria • But recent studies have shown doubts as its role in differentiating gram positive from gram negative septicaemia. • PCN has been shown to be a differentiating marker.

  3. Patient no 5 A 20 years old female was unwell and having generalized weakness for the last three years. She also complained of chronic cough for the same duration. Her serum protein electrophoresis showed the following pattern: • Albumin = 39 g/L (35-50) • α1 globulin = 0.01 g/L (1- 4) • α2 globulin = 6 g/L (3- 8) • β globulin = 10 g/L (6-11) • γ globulin = 14 g/L (5-17) • Name the clinical condition patient is suffering from • Name other two important clinical conditions which can present with same electrophoretic pattern • Alpha-1 antitrypsin deficiency leading to emphysema lung • (1) Hepatic cirrhosis/hepatocellular carcinoma • (2) Lung cancer Ref No 5 Clinical manifestations, diagnosis, and natural history of alpha-1 antitrypsin deficiency www.UpToDate.com

  4. Alpha-1 Antitrypsin (AAT) Deficiency • Emphysema of lung is the most common manifestation of AAT deficiency which results due to uninhibited action of elastase in the lung. • Being member of the Serine Protease Inhibitors (SERPIN) family, it can also present with other manifestations • Direct measurement of AAT can be done by techniques like immunodiffusion and nephelometry in addition to serum protein separation by Capillary Electrophoresis

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