Serum Procalcitonin is a sensitive and specific marker in the diagnosis of septic arthritis and acute osteomyelitis.

Karthikeyan Maharajan,Murali Poduval,Sreenivas Thimmaiah,Jagdish Menon,Dilip Kumar Patro,Ananthanarayanan Palghat Hariharan,Sabhash Chandra Parija

doi:10.1186/1749-799x-8-19

Abstract

BackgroundEarly diagnosis of Acute Osteomyelitis (OM) and Septic Arthritis (SA) is of vital importance to avoid devastating complications. There is no single laboratory marker which is sensitive and specific in diagnosing these infections accurately. Total Count, ESR and CRP are not specific as they can also be elevated in non pyogenic causes of inflammation. Pus Culture and sensitivity is not a true gold standard due to its varied positivity rates (40 – 70%). Serum Procalcitonin (PCT), at 0.5 ng/ml is found to be an accurate marker for pyogenic infections. The objectives of this study were to show that PCT is an accurate marker in differentiating Acute Osteomyelitis and Septic Arthritis from viral and non infective inflammatory bone and joint conditions.MethodsPatients of all age groups (n = 82) with suspected Acute Osteomyelitis and Septic Arthritis were prospectively included in this study. All patients were subjected to TC, CRP, PCT, IgM Dengue, IgM Chikungunya, pus and blood culture and sensitivity. At the end of the study, patients were classified into 3 groups: Group 1 = Confirmed Pyogenic (n = 27); Group 2 = Presumed Pyogenic (n = 21); Group 3 = Non – infective inflammatory (n = 34).ResultsGroup 1 has higher mean PCT levels than Group 2 and 3 (p < 0.05). PCT, at 0.4 ng/ml, was 85.2% sensitive and 87.3% specific in diagnosing Septic Arthritis and Acute Osteomyelitis. In comparison, PCT at conventional cut – off of 0.5 ng/ml is 66.7% sensitive and 91% specific.ConclusionSerum Procalcitonin, at a cut – off of 0.4 ng/ml, is a sensitive and specific marker in the diagnosis of Septic Arthritis and Acute Osteomyelitis.

Highlights

Diagnosis of Acute Osteomyelitis (OM) and Septic Arthritis (SA) is of vital importance to avoid devastating complications
24 patients were excluded from the study as 11 patients gave a history of antibiotic administration before presentation and 13 patients had other foci of infection
Septic Arthritis and Acute Osteomyelitis are relatively common entities in day to day orthopedic practice and in a tertiary referral centre like ours, it is more common. The diagnosis of these infections faces the following problems: inadvertent use of antibiotics by the physician who first sees the patient before the proper diagnosis is made; pus culture and sensitivity which is often considered the gold standard is not a useful gold standard because of its low positivity rates; absence of a single laboratory parameter with high specificity and sensitivity; dubious presentations of these infections in the very young and the old; the search for a realistic laboratory marker is essential

Summary

Introduction

Diagnosis of Acute Osteomyelitis (OM) and Septic Arthritis (SA) is of vital importance to avoid devastating complications. The objectives of this study were to show that PCT is an accurate marker in differentiating Acute Osteomyelitis and Septic Arthritis from viral and non infective inflammatory bone and joint conditions. Total Count (TC), Erythrocyte Sedimentation Rate (ESR) and C – Reactive Protein (CRP) are routinely used in the diagnosis of these infections but no specific laboratory test exists infection is slowly being withdrawn because of emerging issues with antimicrobial resistance. In this regard, there is a need for a biochemical marker which shows high sensitivity and specificity in diagnosing infection and as a guide for starting antibiotics. Owing to its high specificity, Procalcitonin can be used as a guide for starting antibiotics and monitoring treatment [19,20]

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