To investigate the role of serum C-reactive protein (CRP) in the diagnosis of typhoid fever, we studied 227 febrile Malaysian children hospitalized during a 12-month period. The children were: culture-positive for Salmonella typhi (Group 1; n = 108); culture-negative but with typical clinical features of typhoid fever (Group 2; n = 60); or had non-typhoidal illness (Group 3; n = 59). Group 1 children had the highest serum CRP concentrations (geometric mean [SD range]; 43 [12-150] mg/l vs. 26 [8-85] mg/l in Group 2 and 21 [4-110] mg/l in Group 3; p < 0.001). In regression analysis, age, patient group and fever duration were independently associated with serum CRP (p < 0.05) but gender was not. In Group 1 patients, there was a significant positive association between serum CRP and Widal O and H agglutinin titres. In receiver-operator characteristic (ROC) analysis of serum CRP for Groups 1 and 2 combined, compared with Group 3, the area under the curve (AUC) was 0.65. These data show that the serum CRP is highest in culture-positive children with enteric fever and reflects the immune response to the infection in this group. Nevertheless, serum CRP had relatively low sensitivity and specificity for confirmed or clinically diagnosed typhoid fever (68 and 58 per cent, respectively at 'cut-off' concentration 30.0 mg/l), and an AUC value only moderately above that associated with no predictive power (0.5). Although of limited use as a primary diagnostic test, a raised serum CRP may still have a place as one of a range of features that facilitate assessment of a febrile child in a typhoid-endemic area.
This article presents findings from three separate data sets on food consumption in apparently healthy Malaysian adult males and females aged 22-60 years, and secondary data extracted from the Malaysian Adult Nutrition Survey (MANS) 2003. Assessment of food intake by 24-hour recall or the food diary method and use of the nutrient calculator- DietPLUS- to quantify intake of macronutrients and dietary fibre (DF) in the primary data, revealed low mean DF intakes of 10.7±1.0 g/day (Course participants, n=52), 15.6 ±1.2 (University sample, n=103), and 16.1±6.1 (Research Institute staff, n=25). An alarmingly high proportion of subjects (75 to 95%) in these three data sets did not meet the national population intake goal of 20-30 g DF/day. A list of 39 food items which contain fibre, extracted from the MANS 2003 report as being average amounts consumed daily by each Malaysian adult, provided 19.2 g DF which meant that >50% of Malaysian adults consumed less than the recommended DF intake of 20-30 g/day. This large deficit of actual intake versus recommended intakes is not new and is also observed in developed western nations. What is of great concern is that the preliminary findings presented in this article indicate that the national population goal of 20-30 g DF/day may be beyond the habitual diets of the majority of Malaysians. Appropriately, the authors propose the inclusion of a daily minimum requirement for DF intake in the Malaysian Dietary Guidelines, which would somewhat mimic the Malaysian Dietary Guidelines 1999 for dietary fat, as well as the stand taken by the Scientific Advisory Committee on Nutrition (SACN) of the United Kingdom. This minimum requirement, if agreed to, should not be higher than the 16 g DF or so provided by the hypothetical 'high-fibre' healthy diet exemplified in this article.
Study name: Malaysian Adult Nutrition Survey (MANS-2003)