Calprotectin, a new biomarker for diagnosis of acute respiratory infections

Aleksandra Havelka,Kristina Sejersen,Karlis Pauksens,Per Venge,Anders Larsson

doi:10.1038/s41598-020-61094-z

Aleksandra Havelka, Kristina Sejersen + Show 3 more

Open Access

https://doi.org/10.1038/s41598-020-61094-z

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Abstract

Respiratory tract infections require early diagnosis and adequate treatment. With the antibiotic overuse and increment in antibiotic resistance there is an increased need to accurately distinguish between bacterial and viral infections. We investigated the diagnostic performance of calprotectin in respiratory tract infections and compared it with the performance of heparin binding protein (HBP) and procalcitonin (PCT). Biomarkers were analyzed in patients with viral respiratory infections and patients with bacterial pneumonia, mycoplasma pneumonia and streptococcal tonsillitis (n = 135). Results were compared with values obtained from 144 healthy controls. All biomarkers were elevated in bacterial and viral infections compared to healthy controls. Calprotectin was significantly increased in patients with bacterial infections; bacterial pneumonia, mycoplasma pneumonia and streptococcal tonsillitis compared with viral infections. PCT was significantly elevated in patients with bacterial pneumonia compared to viral infections but not in streptococcal tonsillitis or mycoplasma caused infections. HBP was not able to distinguish between bacterial and viral causes of infections. The overall clinical performance of calprotectin in the distinction between bacterial and viral respiratory infections, including mycoplasma was greater than performance of PCT and HBP. Rapid determination of calprotectin may improve the management of respiratory tract infections and allow more precise diagnosis and selective use of antibiotics.

Highlights

Respiratory tract infections require early diagnosis and adequate treatment
The aim of the current study was to evaluate the performance of calprotectin, a neutrophil activation marker for the diagnosis of acute respiratory infection and the differentiation between bacterial and viral infections
Performance of calprotectin was compared to performance of heparin binding protein (HBP) which is produced in neutrophils but stored in the azurophil granules within the cells and procalcitonin (PCT) which is widely used as a marker for bacterial infections

Summary

Introduction

Respiratory tract infections require early diagnosis and adequate treatment. With the antibiotic overuse and increment in antibiotic resistance there is an increased need to accurately distinguish between bacterial and viral infections. PCT was significantly elevated in patients with bacterial pneumonia compared to viral infections but not in streptococcal tonsillitis or mycoplasma caused infections. Since isolation of the disease-causing microorganism is usually too time consuming to be useful for early diagnosis, other biomarkers are used clinically to distinguish viral infections not requiring antibiotic treatment from bacterial infections in early phases of the infection. Such biomarkers usually include a combination of white blood cell count, neutrophil count, C-reactive protein, and less frequently procalcitonin (PCT), heparin binding protein (HBP) or calprotectin[6,7]. Type of infection Viral Bacterial pneumonia Mycoplasma pneumonia Streptococcal tonsillitis is released upon activation and turnover of neutrophils and is recognized as an important marker for neutrophil mediated inflammation[13]

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