Normal Procalcitonin Research Articles

Association of procalcitonin levels with the progression and prognosis of hospitalized patients with COVID-19.

Rationale: Coronavirus disease 2019 (COVID-19) was first announced in Wuhan, and has rapidly evolved into a pandemic. However, the risk factors associated with the severity and mortality of COVID-19 are yet to be described in detail.Methods: We retrospectively reviewed the information of 1525 cases from the Leishenshan Hospital in Wuhan. Univariate and multivariate Cox regression analyses were generated to explore the relationship between procalcitonin (PCT) level and the progression and prognosis of COVID-19. Univariate and multivariate logistic regression analyses were performed to explore the relationship between disease severity in hospitalized patients and their PCT levels. Survival curves and the cumulative hazard function for COVID-19 progression were conducted in the two groups. To further detect the relationship between the computed tomography score and survival days, curve-fitting analyses were performed.Results: Patients in the elevated PCT group had a higher incidence of severe and critical severity conditions (P < 0.001), death, and higher computed tomography (CT) scores. There was an association between elevated PCT levels and mortality in the univariate ((hazard ratio [1], 3.377; 95% confidence interval [2], 1.012-10.344; P = 0.033) and multivariate Cox regression analysis (HR, 4.933; 95% CI, 1.170-20.788; P = 0.030). Similarly, patients with elevated PCT were more likely to have critically severe disease conditions in the univariate (odds ratio [2], 7.247; 95% CI, 3.559-14.757; P < 0.001) and multivariate logistic regression analysis (OR, 10.679; 95% CI, 4.562-25.000; P < 0.001). Kaplan-Meier curves showed poorer prognosis for patients with elevated PCT (P = 0.024). The CT score 1 for patients with elevated PCT peaked at day 40 following the onset of symptoms then decreased gradually, while their total CT score was relatively stable.Conclusion: PCT level was shown as an independent risk factor of in-hospital mortality among COVID-19 patients. Compared with inpatients with normal PCT levels, inpatients with elevated PCT levels had a higher risk for overall mortality and critically severe disease. These findings may provide guidance for improving the prognosis of patients with critically severe COVID-19.

Elevated serum procalcitonin levels and their association with the prognosis of patients with liver cirrhosis.

Bacterial infection is a major complication in patients with liver cirrhosis. Procalcitonin is an early diagnostic marker of bacterial infection. This study aimed to investigate the association between the serum procalcitonin levels and the prognosis of patients with liver cirrhosis. We retrospectively analyzed the serum procalcitonin levels in 236 hospitalized patients with liver cirrhosis. The impact of the serum procalcitonin level on their prognoses was evaluated using multivariate Cox proportional hazards analyses and the Kaplan-Meier method. The serum procalcitonin level was higher (≥0.05 ng/mL) in 151 (64%) patients, and it was significantly higher in the patients with Child-Turcotte-Pugh class C than in those with Child-Turcotte-Pugh classes A/B. Patients with refractory ascites, hepatic encephalopathy, gastrointestinal bleeding, and bacterial infections had elevated serum procalcitonin levels. The multivariate analyses showed a serum procalcitonin level ≥0.05 ng/mL was an independent prognostic factor for liver cirrhosis (hazard ratio = 1.64; 95% confidence interval = 1.07-2.53; P = 0.024). During a median follow-up interval of 2.1 years, the three-year cumulative survival rates for the patients with normal and elevated serum procalcitonin levels were 72.9 and 56.0%, respectively (P < 0.001). The subgroup analyses that stratified the patients according to age, the Child-Turcotte-Pugh classification, and the presence of liver cancer showed the serum procalcitonin level was significantly associated with their prognoses. The patients with liver cirrhosis had higher serum procalcitonin levels, regardless of local bacterial infections, and higher procalcitonin levels were associated with poor prognoses.

2005 Dieulafoy’s Lesion and Granulomatosis With Polyangitis

INTRODUCTION: Commonly located in the proximal stomach, Dieulafoy’s lesions are a result of small vessel dilation that can result in GI hemorrhages. Granulomatosis with polyangiitis, a systemic small-vessel vasculitis, usually involves the respiratory tract, kidneys, skin, and joints. Although GI symptoms are uncommon, previous cases have shown an association between Dieulafoy’s lesions and other systemic vasculitides, including Buerger’s disease and HSP. This case suggests a possible link between Dieulafoy’s lesion and granulomatosis with polyangiitis. CASE DESCRIPTION/METHODS: A 69-year-old white female with history of nasal vestibulitis, sinusitis, and otitis media presented with generalized weakness and sharp, bilateral chest pain with associated shortness of breath and tachycardia. CTA was negative for pulmonary embolism. Labs revealed normal procalcitonin and lactic acid but elevated ESR, CRP, D-dimer, and WBC. Due to her high oxygen requirement, patient underwent a bronchoscopy that revealed multiple lung nodules. Biopsies revealed caseating granulomatous inflammation. Further workup confirmed the diagnosis of granulomatosis with polyangiitis, and she was started on Rituxan and solumedrol. Her condition was improving until she had acute onset of hematemesis, dropping her hemoglobin by 5 g/dL. She underwent an EGD that revealed hiatal hernia with erosions, a Dieulafoy vessel in the gastric body of the lesser curvature, and a large clot that obscured nearly two-thirds of the stomach. Once hemodynamically stable, EGD was repeated and revealed several small satellite ulcers around a large 1 cm ulcer with visible vessel in the greater curvature that was then cauterized and clipped. Hemoglobin remained stable for the remainder of the hospital course. Biopsies were negative for H. pylori. She was discharged to inpatient rehab, where she continued to receive Protonix, Rituxan, prednisone, Xopenex, and Pulmicort. DISCUSSION: Several case reports linking Dieulafoy’s lesions with vasculitides have been reported in recent times. In the case above, this abnormal lesion was found in a patient with active granulomatosis with polyangitis, a diagnosis primarily known to affect the respiratory and renal system. The presence of a Dieulafoy’s lesion can be life-threatening, as in this case. EGD is an important tool for diagnosis and treatment of these lesions in the upper GI tract. Awareness of this potential association can help physicians anticipate and prevent fatal outcomes while inducing remission of this disease.

Procalcitonin levels among patients with fever secondary to severe intracerebral infection. A cross-sectional study.

Making the differential diagnosis between central fever and infectious fever is critically important among intracerebral hemorrhage patients followed up in intensive care units (ICUs). Serum procalcitonin (PCT) has been found to be a promising biomarker for the initial diagnosis of infection, even before culturing results. To investigate the relationship between PCT and both fever etiologies and C-reactive protein (CRP) levels among critically ill patients with suspected intracerebral hemorrhage. Cross-sectional study in a public university hospital in Elazig, Turkey. ICU patients diagnosed with intracerebral hemorrhage and normal procalcitonin levels were included in this study. From clinical assessments and cultures, they were classified as presenting either infectious or central fever. The sensitivity and specificity of PCT and CRP for predicting infection were calculated using a receiver operating characteristic (ROC) curve. There were 98 ICU patients with diagnoses of intracerebral hemorrhage. The median (interquartile range) PCT levels of patients with infectious and central fever were 4 (0.9-11) and 0.1 (0.1-0.4) ng/ml, respectively, with a statistically significant intergroup difference (P < 0.001). The areas under the ROC curve for predicting infectious or central fever PCT and CRP were 0.958 (P < 0.001) and 0.816 (P < 0.001), respectively. A statistically significant positive correlation was detected between PCT and CRP levels in patients with infectious fever (rho: 0.461; P = 0.003), but not in patients with central fever. PCT can possibly be used as a biomarker to differentiate between infectious and central fever among ICU patients.

Differences of viral panel positive versus negative by real-time PCR in COPD exacerbated patients.

Exacerbations of chronic obstructive pulmonary disease (COPD) are often caused by respiratory tract infections. The aim of this study was to investigate the clinical, laboratory and computed tomography features of patients with hospitalized COPD exacerbations in which respiratory viruses were detected using a real-time polymerase chain reaction (PCR) technique. This retrospectively planned study included patients hospitalized in the chest diseases clinic due to exacerbation of COPD between November 2018-February 2019. The study included patients who had virus-specific real-time PCR, and computed tomography scans of the chest. A total of 110 patients were included in the study. Respiratory viruses were identified in the nasopharyngeal swabs of 50 patients (45.5%) using the real-time PCR method, with rhinovirus (25%), influenza A (13.1%) and coronavirus (11.8%) being the most commonly isolated agents. The mean age of the patients was 68.28 ± 9.59 years in the virus-positive group and 68.20 ± 8.27 years in the virus-negative group (p= 0.963). Gender distribution, rate of smokers, exposure to biofuels, blood leukocyte count, neutrophil percentage, C-reactive protein (CRP) level, FEV1/FVC ratio did not significantly differ between the two groups (p> 0.05). Procalcitonin (PCT) and FEV1 values were significantly lower (p= 0.001 and p= 0.028, respectively) and the number of exacerbations was significantly higher in the virus-positive group (p= 0.001). The length of hospital stay was longer in the virus-positive group than in the virus-negative group (p= 0.012). Among the findings of computed tomography (CT) of the chest, bronchial wall thickening, cystic bronchiectasis, and emphysema did not differ significantly (p> 0.05). The rate of infiltrative lesions (tree-in-bud opacity, ground-glass opacity, atypical pneumonia) was significantly higher in the virus-positive group (p= 0.020). Viral respiratory tract infections should be considered in hospitalized patients with an exacerbation of COPD who have a history of frequent exacerbations, normal PCT value, and the absence of consolidation in CT scan of the chest. The use of broadspectrum antibiotic therapy should be avoided in patients with these features.

What is the role of Ewingella americana in humans? A case report in a healthy 4-year-old girl

BackgroundEwingella americana (Ea) is a Gram-negative, lactose-fermenting, oxidase-negative and catalase-positive bacterium that was first described in 1983 as a new genus and species in the family Enterobacteriaceae. It is not known whether Ea is a true pathogen or simply an opportunistic infectious agent, as most of the cases have been described in patients at risk.Case presentationA 4-year-old girl described here was hospitalized due to a productive cough over the previous 3 weeks and a fever > 38 °C associated with tachypnea over the previous 2 days. Her familial and personal medical histories were negative for relevant diseases, including respiratory infections. At admission, she was febrile (axillary temperature 39.2 °C) and had dyspnea with retractions, grunting and nasal flaring. A chest examination revealed fine crackling rales in the left upper field associated with bilateral wheezing. A chest X-ray revealed segmental consolidation of the lingula of the left lung. Laboratory tests revealed leukocytosis (15.,800 white blood cells/mm3 with 50.3% neutrophils), a slight increase in serum C-reactive protein (11.9 mg/L) and normal procalcitonin values (< 0.12 ng/mL). A nasopharyngeal swab culture did not reveal viral or bacterial respiratory pathogens, including atypical bacteria. A blood culture revealed the presence of a Gram-negative, lactose-fermenting rod that was oxidase negative and catalase positive. The isolate was identified by means of the VITEK®2 identification system (bioMérieux, Firenze, Italy) as Ea. This identification was confirmed by sequencing the 16 s ribosomal deoxyribonucleic acid (rDNA). The pathogen was sensitive to aminoglycoside, fluoroquinolones, carbapenems, cefotaxime, and ceftazidime but was intermediate against sulfametoxazole/trimethoprim and resistant to amoxicillin-clavulanic acid, fosfomycin, and oxacillin. The child was immediately treated orally with amoxicillin-clavulanic acid and erythromycin. Based on the results of a blood culture and sensitivity tests, the amoxicillin-clavulanic acid medication was stopped after 3 days. Erythromycin was continued for a total of 10 days, and the child was discharged after 3 days in the hospital. Follow-up visit 1 month later did not reveal any respiratory problems.ConclusionThis case shows that Ea infections in healthy subjects are mild even in pediatric age, and the need for antibiotic therapy is debated. Cases occurring in subjects with underlying chronic disease can be significantly more complicated and require appropriate antibiotic therapy.

Cerebrospinal lactate dehydrogenase and serum procalcitonin in the diagnosis of meningitis

Background Meningitis is inflammation of the membranes that cover the brain, spinal cord, and the intervening cerebrospinal fluid..Aim The aim of this paper was to assess the diagnostic role of cerebrospinal lactate dehydrogenase (LDH) and serum procalcitonin (PCT) in meningitis and to differentiate septic from aseptic meningitis.Patients and methods The cases were divided into septic meningitis (group I), aseptic meningitis (group II), and meningism (group III) and 100 control cases of complaints other than central nervous system (CNS) infection. All patients were evaluated by full clinical examination, laboratory investigation (complete blood count, erythrocyte sedimentation rate, C-reactive protein, and random blood sugar, liver and renal function tests, and blood culture), lumbar puncture for cerebrospinal fluid examination, cerebrospinal LDH by spectrophotometer, serum PCT in selected patients, computed tomography, and MRI in complicated cases.Results Cerebrospinal LDH 100% of 139 cases in septic meningitis and 98% of 104 cases in aseptic meningitis were elevated above normal range. All cases of meningism show normal range. Furthermore, serum PCT testing was positive in all patients with septic meningitis, while serum PCT testing is positive in 35 (34%) patients with aseptic meningitis and negative in 69 (66%) patients and serum PCT-Q testing was negative in all patients with meningism. Controls were assessed for normal serum PCT level.Conclusion Cerebrospinal LDH can be used only as a preliminary screening test, whereas PCT-Q was a good diagnostic marker for distinguishing septic from aseptic meningitis.

A Gram-Negative False-Negative: Normal Procalcitonin Level in a Patient with Multiple Klebsiella Pneumoniae Intra-Abdominal Abscesses: A Case Report and Literature Review

A Gram-Negative False-Negative: Normal Procalcitonin Level in a Patient with Multiple Klebsiella Pneumoniae Intra-Abdominal Abscesses: A Case Report and Literature Review

Procalcitonin and C-Reactive Protein during Transplant-Related Adverse Events after Allogeneic Hematopoietic Stem Cell Transplantation in Pediatric Patients

BackgroundEarly diagnosis and treatment interventions of transplant-related adverse events (TRAE) such as sepsis, fungal, bacterial and viral infection, graft-versus-host disease (GvHD), veno-occlusive disease (VOD), and graft rejection is crucial for the patient outcome. The predictive value of a multitude of serum biomarkers their specific patterns in occurring TRAE have been widely investigated. Procalcitonin (PCT) is a precursor molecule of the hormone calcitonin that regulates calcium homeostasis and is elevated for example during systemic infection, thermal injury or septic shock. A discriminative value of PCT during adverse events after HSCT has been described for adult patients. There is currently no data available concerning PCT in the context of TRAE in children.Material and MethodsIn this single-center retrospective analysis, serum PCT and CRP levels of pediatric patients who underwent allogeneic HSCT for the treatment of hemato-oncological malignancies and non-malignancies were analyzed and correlated to TRAE (graft rejection, VOD, GvHD, sepsis, and viral or fungal infection). Primary objective of this work was to evaluate a predictive and discriminative value of serum PCT and CRP in the early identification of transplant-related complications in these patients. The observation period included the time of measurement directly before start of conditioning, until the day of clinical discharge. Serum PCT and CRP values were analyzed daily during the occurrence of fever or at least 3 times per week.ResultsThe patient group consisted of 124 male and 87 female pediatric patients (n=211) with a median age of 9.0 years (range 0.5-17.8 years) undergoing HSCT for hemato-oncological malignancies and inborn errors of metabolism. Patients received grafts from mismatched unrelated donors (n=66), matched unrelated donors (n=118) or matched family donors (n=27). The patients underwent HSCT for the treatment of acute leukemia (AML, ALL, AML relapse and ALL relapse; 50.7% of the patients), myelodysplastic syndromes (5.2%), anemia (severe aplastic anemia, beta thalassemia, sickle cell anemia; 16.1%), or solid tumors (28.0%). The median observation period was 76 days (range 31-245 days). Graft rejection occurred in 9 patients (4.3%), VOD in 4 patients (1.9%), acute skin GvHD grade II-IV in 31 patients (14.7%), acute intestinal GvHD grade II-IV in 10 patients (4.7%), sepsis in 24 patients (11.4%), viremia in 22 patients (10.4%), and fungemia in 7 patients (3.3%).PCT values were significantly and relevantly elevated (>0.5 ng/mL) during graft rejection (median 1.43 ng/mL, range 1.04-5.46 ng/mL), skin GvHD (median 0.90 ng/mL, range 0.02-4.34 ng/mL), intestinal GvHD (median 1.01 ng/mL, range 0.30-3.05 ng/mL), and sepsis (median 3.09 ng/mL, range 0.57-37.32 ng/mL). CRP values were significantly and relevantly elevated (>0.5 mg/dL) during graft rejection (median 10.34 mg/dL, range 5.45-30.19 mg/dL), skin GvHD (median 1.85 mg/dL, range 0.04-21.63 mg/dL), intestinal GvHD (median 8.73 mg/dL, range 1.05-24.2 mg/dL), sepsis (median 10.26 mg/dL, range 2.67-49.47 mg/dL), viremia (median 1.80 mg/dL, range 0.06-14.04 mg/dL), and fungemia (median 5.10 mg/dL, range 2.30-11.60 mg/dL). A simultaneous significant and relevant elevation of both PCT and CRP values was observed during graft rejection, skin and intestinal GvHD, and sepsis (Fig. 1).ConclusionsEspecially during acute skin and intestinal GvHD, PCT and CRP values strongly and significantly increased beyond the upper normal limits. Simultaneous elevations of PCT and CRP occurred during graft rejection, skin and intestinal GvHD, and sepsis. Taken together, laboratory-chemical analyses of serum PCT in combination with CRP could be a useful discriminative biomarker in the detection of TRAE. Larger, prospective trials are needed, to evaluate these findings.FigureFig. 1. PCT and CRP serum concentrations during acute GvHD, graft rejection, VOD, sepsis, viremia and fungemia. Dotted horizontal lines indicate normal PCT and CRP values (PCT: 0.5 ng/mL | CRP: 0.5 mg/dL). Symbols indicate *: p<0.05; **:p<0.01; ***: p<0.001; ****: p<0.0001; tested by Wilcoxon matched-pairs signed rank test.AcknowledgmentsThis work was supported by the Stefan-Morsch-Stiftung, Birkenfeld, Germany and the Bettina-Bräu-Stiftung, Fürstenfeldbruck, Germany. [Display omitted] DisclosuresLang:Miltenyi Biotec: Patents & Royalties, Research Funding. Handgretinger:Miltenyi Biotec: Patents & Royalties: Co-patent holder of TcR alpha/beta depletion technologies, Research Funding.

Procalcitonin As a Potential Biomarker for Differentiating Bacterial Infectious Fevers from Cytokine Release Syndrome

Procalcitonin As a Potential Biomarker for Differentiating Bacterial Infectious Fevers from Cytokine Release Syndrome

Prospective, comparative clinical study between high-dose colistin monotherapy and colistin-meropenem combination therapy for treatment of hospital-acquired pneumonia and ventilator-associated pneumonia caused by multidrug-resistant Klebsiella pneumoniae.

In clinical practice, colistin is used as combination therapy to improve its antibacterial activity, despite the consequent increase in toxicity. This prospective, comparative study evaluated the effectiveness and adverse effects of using colistin alone at a loading dose of 9 million international units (MIU) followed by 3 MIU every 8h (q8h) versus colistin+meropenem 1g q8h in treating multidrug-resistant (MDR) Klebsiella pneumoniae-induced hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP). The primary outcome measure was in-hospital mortality. The secondary measure was the occurrence of colistin toxicity. A total of 60 patients were divided into two groups (30 patients each); the first group received intravenous colistin at a mean daily dose of 8.304 MIU and the second group received colistin 8.58 MIU combined with meropenem (mean daily dose of 2.88g for 15 days). The colistin-meropenem combination group showed a significant decrease in mortality versus colistin alone [16.7% (5/30) vs. 43.3% (13/30); P=0.047]. The improved clinical response mediated by combination therapy was not associated with any significant nephrotoxicity, hepatotoxicity or neurotoxicity. Moreover, the 42 surviving patients showed normal procalcitonin values associated with a decrease in SOFA score, whilst 12 of them showed significantly elevated C-reactive protein (CRP) (P=0.0002). This study revealed the superiority of colistin-meropenem combination therapy over colistin monotherapy in the treatment of MDR K. pneumoniae-induced HAP or VAP and highlights the advantage of procalcitonin over CRP as a marker for eradication of sepsis and suspension of therapy.

ACUTE BLASTOMYCOSIS PNEUMONIA CAUSING ARDS REQUIRING OPEN LUNG BIOPSY FOR IDENTIFICATION

SESSION TITLE: Chest Infections 2 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Blastomycosis is a systemic pyogranulomatous fungal infection usually affecting the lungs. Presenting symptoms are similar to other forms of acute pneumonia making disease identification difficult. CASE PRESENTATION: A 49-year-old male was hospitalized after 3 weeks of worsening dyspnea, fever, and non-productive cough despite two courses of antibiotics for suspected pneumonia. Within days, he decompensated requiring mechanical ventilation. His past medical history was negative for tobacco use and he denied immunocompromising illnesses. On physical exam, he was afebrile and normotensive. There was no jugular venous distention or peripheral edema. Auscultation revealed decreased breath sounds and diffuse crackles bilaterally. On mechanical ventilation, the patient had an oxygen saturation of 90% and PaO2 78 mmHg on FiO2 0.8 and PEEP 14. Workup revealed WBC 14 (x10ˆ3/uL) and normal procalcitonin. Bacterial, fungal and acid fast bacilli cultures of the blood were negative as well as respiratory viral panel and HIV. His chest X-ray showed diffuse bilateral alveolar and interstitial opacities and CT chest displayed bilateral ground-glass infiltrates. ANCA, ANA, and anti-GBM tests were negative. Echocardiogram and brain natriuretic peptide were normal. Bronchoscopy with transbronchial biopsy and bronchoalveolar lavage (BAL) was performed. BAL cytology had alveolar macrophages without malignant cells and a normal eosinophil count. BAL fluid had negative fungal, viral and bacterial cultures, along with negative fungal antigen and serology testing. Given that the transbronchial biopsy was unrevealing, an open lung biopsy was performed. The sample showed organizing diffuse alveolar damage, alveolar macrophages and broad-based budding yeast, all of which are consistent with Blastomyces infection. Amphotericin and high-dose corticosteroids were started with subsequent rapid improvement. He was discharged home with itraconazole and prednisone. DISCUSSION: Blastomycosis is endemic to the Mississippi and Ohio River basins, and Midwest states [1]. Infection depends on soil exposure in endemic areas; outbreaks with waterways and major highway projects [2]. Definitive diagnosis requires positive cultures. Sputum and BAL cultures result in diagnosis in 86% and 92% of patients, respectively; [1,2] while antigen testing yields 93% sensitivity and 79% specificity [3]. Blastomycosis pneumonia rarely causes acute respiratory distress syndrome (ARDS); however, when it does mortality rates are estimated at over 50%. Steroids may have benefit in fulminant cases, but study results have been mixed. Given the efficacy of culture and antigen testing, this is a rare case that required an open lung biopsy for diagnosis. CONCLUSIONS: This case of biopsy-proven acute blastomycosis organizing pneumonia with negative serum and BAL serology, antigen and culture resulting in ARDS demonstrates the risks of delayed identification. Reference #1: Azar, M. M., Assi, R., Relich, R. F., Schmitt, B. H., Norris, S., Wheat, L. J., & Hage, C. A. (2015). Blastomycosis in Indiana: Clinical and Epidemiologic Patterns of Disease Gleaned from a Multicenter Retrospective Study. Chest, 148(5), 1276–1284. https://doi.org/10.1378/chest.15-0289 Reference #2: Carlos, W. G., Rose, A. S., Wheat, L. J., Norris, S., Sarosi, G. A., Knox, K. S., & Hage, C. A. (2010). Blastomycosis in indiana: digging up more cases. Chest, 138(6), 1377–1382. https://doi.org/10.1378/chest.10-0627 Reference #3: Durkin, M., Witt, J., Lemonte, A., Wheat, B., & Connolly, P. (2004). Antigen assay with the potential to aid in diagnosis of blastomycosis. Journal of Clinical Microbiology, 42(10), 4873–4875. https://doi.org/10.1128/JCM.42.10.4873-4875.2004 DISCLOSURES: No relevant relationships by William Carlos, source=Web Response no disclosure on file for Rajat Kapoor; No relevant relationships by Jonathan Prest, source=Web Response

Use of procalcitonin in the diagnosis of tuberculosis in infants and preschool children.

In our study, PCT was not a useful diagnostic test for TB in young children. In a low-burden TB setting, PCT may be of some value in distinguishing pulmonary TB from pneumococcal pneumonia. What is Known: • Diagnosis of pediatric tuberculosis on clinical evidence is difficult, particularly in infants and small children. • Studies in adults with tuberculosis have mostly reported normal procalcitonin levels at diagnosis. What is New: • In pre-scholars with tuberculosis, erythrocyte sedimentation rate and white blood cell counts were higher than in healthy controls, but procalcitonin was not. • Procalcitonin may be useful in the differential diagnosis of intrathoracic tuberculosis and pneumococcal pneumonia.

Clinical Evaluation of Urosepsis in Tane General Hospital ; Clinical Utility of Measurement of Procalcitonin

We clinicaliye valuated 355 patients with urinarytract infections (UTI), suspected of having urosepsis at Tane General Hospital, and determined the usefulness of the biomarker procalcitonin (PCT) as an aid in predicting urosepsis. Clinical and microbiological data were collected. The logistic regression analysis was used to determine the risk factors of urosepsis. Of 355 patients, 169 patients (47.6%) were diagnosed with urosepsis. C-reactive protein (CRP) (OR 2. 633, p＜0. 001), PCT (OR 2. 153, p＝0. 003) and clinical diagnosis (calculous pyelonephritis OR 1. 886, p＝0. 019, acute prostatitis OR 3. 614, p＜0. 001) were established as the independent risk factors of urosepsis. Of 169 patients with urosepsis, 43 patients (25.4%) were diagnosed with severe urosepsis. In the severe urosepsis group, 2 patients with a PCT value ＜2.0 ng/ml were included. The mortalityrate in patients with severe urosepsis was 4.65% (2/43) in this study. We concluded that the PCT level could be a reliable marker suggestive of urosepsis. However, patients very early in the onset of infection mayhave a normal PCT value. It is essential to use all available clinical information when interpreting the results of a PCT measurement.

The role of elevated serum procalcitonin in neuroendocrine neoplasms of digestive system

IntroductionElevated serum procalcitonin (PCT) was reported in patients with certain type of neuroendocrine neoplasms (NENs). ObjectiveThe aim of this study was to assess the role of elevated serum PCT in NENs from digestive system. Patients and methodsSerum PCT and serum CgA level were measured in 155 patients with NENs from digestive system. ResultsElevated serum PCT was found in 63 patients (40.6%). Grade 3 disease was a significant factor associated with elevated serum PCT (OR, 9.24; 95%CI, 3.04–28.08; P<0.001). Serum PCT level was significantly decreased after treatment both in patients with stable disease (P=0.003) and patients with partial remission (P=0.001). In these patients, serum PCT level significantly increased again at the time of progression disease (P=0.001). Elevated serum PCT was a significant factor of worse survival (HR, 2.86; 95%CI, 1.36–6.03; P=0.006). Compared with patients with normal serum PCT and CgA level, patients with either PCT or CgA elevated and patients with both PCT and CgA elevated had progressively worse survival. Additionally, PCT expression in tumor cells was found in 24.0% of patients but did not correlate with other clinicopathological factors, including serum PCT. ConclusionsSerum PCT is elevated in part of patients with NENs of digestive system, especially in patients with grade 3 disease. Serum PCT level can help evaluate treatment response and its elevation indicates poor prognosis. Combination of serum PCT and CgA can improve outcome prediction.

Cutaneous necrotizing vasculitis as a first manifestation of antiphospholipid syndrome with catastrophic development

We describe a case of anti-phospholipid syndrome, with catastrophic development and unusual brain involvement, in which the first manifestation was necrotizing cutaneous vasculitis. A 58-year-old woman presented with fever, gangrene of her lower limbs and ischemic lesions of her arms and hands. Laboratory results showed normal white cell count and normal procalcitonin value. The vascular ultrasound study of the lower limbs did not show any thrombosis or stenosis. A chest-abdomen computed tomography scan showed inflammatory thickening of the lung. A month after admission she developed confusion, weakness and aphasia. Magnetic resonance imaging of the brain showed hyperintense bilateral symmetrical lesions in the frontal and cerebellar regions. Anti-cardiolipin antibodies and lupus anticoagulant were negative, whereas anti-β 2 glycoprotein 1 were in high titer. She was started on steroids, and subsequently warfarin, acetylsalicylic acid and hydroxychloroquine, with progressive improvement of her clinical status.

Accidental Cymoxanil (TANOS) Pesticide Poisoning (Case Report)

Background: Pesticides are a group of chemicals used in agriculture in order to achieve higher and better-quality crops. The vast majority of these are synthetic substances whose effect on the human organism is unfavorable, even toxic. Methods: We provide a brief overview of available Slovak and world literature on these issues. In the next section, we deal with the case of a patient, whose leading symptoms were headache and behavioral changes. After excluding organic lesions, we made a diagnosis „per exclusionem“ and diagnosed cymoxanil poisoning. Conclusions: We consider the relatively low number of recorded poisonings to be a result of strict regulation of pesticide use. Original Articles 28 Clinical Social Work and Health Intervention Clinical Social Work and Health Intervention Vol. 7 No. 3 2016 Introduction Pesticides are chemicals used to protect vegetables against animal pests, fungi and weeds. These are organic or inorganic substances. They are applied as a spray, powder, granules or mordant. The most important pesticides are insecticide substances used for destroying insects; fungicides substances used to destroy harmful parasitic fungi; herbicide substances used for weed control; rodenticides substances used for destroying rodents1. (1) If one uses pesticides it is important to work with extreme caution. How to use them and health at work are regulated by provisions having the force of law2,3.(2-3) TANOS 50WG is a combined two-component fungicide to protect potatoes against potato blight and potato Alternaria leaf spot, tomatoes against potato blight; cucumbers and zucchini against cucumber Peronospora; vines against Peronospora. Active substance: cymoxanil 250g/kg + famoxadone 250g/kg. Formulated as: dispersible granule Mechanism of action: systemic and contact. Antracol Combi WP 76 is a combined two-component fungicide intended for plant care, with a spectrum of activity similar to the product TANOS 50WG. Active substance: propineb 70% + cymoxanil 6%. Formulated as: dispersible powder4. Characterization of cymoxanil: Chemical characterization: N-ethylaminocarbonyl-2-cyano-2-methoxyiminoacetamide. The substance belongs to the class of acylureas. It acts primarily in systemic, but partly also in contact, fashion on plants. The effects of cymoxanil in plants include inhibition of nucleic acid synthesis, reduction in the permeability of cell membranes, limiting respiration and disruption of serine, glycine and cysteine synthesis. This results in inhibition of mycelial growth, reduction of sporulation and spores germination5. Symptoms of cymoxanil poisoning are presented in Table 1. Case description A 50-year-old, otherwise healthy man was brought into the internal medicine emergency room with a headache lasting 4 days and body temperature up to 38 °C. Beside the headache he complained about dry mucous membranes of the mouth, loss of appetite, fatigue, increased sweating, also at night. Targeted questions specified that four days before admission, i.e. before symptoms started, he sprayed vegetables against fungi. He could not specify the product name. During the spraying he was exposed to direct sunlight and despite knowledge of safety he did not use any respirator. The symptoms started the next morning and persisted during the consultation with a doctor. Objective finding reads that the patient was obese (BMI 33), skin was sweaty, body temperature 36.5 °C, isocoric pupils in middle position, bulbs without nystagmus, injected conjunctiva. Overall, psychomotor restlessness was present. The patient was restless & fussed to find a relief position. Neither neurological focality nor laterality were observed. Signs of meningeal irritation were indicated. The laboratory tests showed neutrophilic leukocytosis, adequate coagulation parameters, a high level of C-reactive protein, a normal procalcitonin, slightly increased GMT activity (Table 2). CT scan of the brain + skull trauma program were indicated. The finding was negative. The condition was evaluated as susp. Meningitis. We indicated parenteral antibiotic therapy. We examined the eye-ground with age-appropriate findings. The patient was IV hydrated and orally hydrated at the same time. During hospitalization the body temperature repeatedly exceeded 38 °C, we took a blood culture but it was completed with negative results. 29 Original Articles Clinical Social Work and Health Intervention Vol. 7 No. 3 2016 Family members delivered packaging of the spraying used. It was a TANOS preparation (active substances: cymoxanil + famoxadone). From the available literature we found that symptoms may indicate a cymoxanil poisoning. Tests for focal infection were conducted. Echokg, dental and ENT findings were normal. The eyeground finding was negative. Hydration, antibiotic, anti-edematous (mannitol) and analgesic treatment continued. The patient‘s condition gradually improved. On the fifth day he was in good condition released to outpatient care.

Calcific degeneration and rupture of the aortic valve and ascending aorta: from cardiac auscultation to multimodality imaging.

Calcific degeneration and rupture of the aortic valve and ascending aorta: from cardiac auscultation to multimodality imaging.

O3-12-6 - Prognostic Significance of Procalcitonin in Small Cell Lung Cancer

Background: Procalcitonin (PCT) has been established as a sensitive and specific marker of sepsis and systemic bacterial infection. The increase of PCT in patients with neuroendocrine tumors has also been reported. In this study, we evaluated the diagnostic and prognostic value of PCT in small cell lung cancer (SCLC).Methods: We analyzed PCT levels in 23 patients with SCLC and 26 patients with advanced non-small cell lung cancer (NSCLC) before first-line chemotherapy.Results: The serum levels of PCT in SCLC patients were significantly higher than those in NSCLC patients (P < 0.0001). We use the serum PCT level of 0.05 ng/ml as the cut off value. Fourteen patients (61%) with SCLC had higher level of PCT than the cut off value. By contrast, only 2 patients (8%) with advanced NSCLC showed elevated levels of PCT. The sensitivity, specificity, efficiency, predictive value of positive results and predictive value of negative results to discriminate SCLC from NSCLC are 61%, 92%, 78%, 88% and 27%, respectively. No sign of infection was observed in SCLC patients with elevated level of PCT. There was no significant difference in PCT level between patients with limited disease-SCLC and those with extended disease-SCLC. In SCLC patients with elevated PCT, overall survival was significantly shorter than that in SCLC patients with normal PCT (11.1 months vs. 72.7 months, P = 0.0046). The CR rate in SCLC patients with elevated PCT was significantly lower than that in patients with normal PCT (17% vs. 63%, P = 0.0353).Conclusions: Our findings indicate that PCT is a prognostic biomarker in SCLC patients.

Serum procalcitonin and C-reactive protein levels as markers of bacterial infection in patients with liver cirrhosis: a systematic review and meta-analysis

The diagnostic value of procalcitonin (PCT) for patients with liver cirrhosis is unclear. We searched the PubMed, EMBASE, and Cochrane databases for studies published through December 2013 that evaluated the diagnostic performance of PCT for patients with acute or chronic liver disease with suspected systemic infection. We summarized the test performance characteristics by using forest plots, hierarchical summary receiver operating characteristic curves, and bivariate random effects models. Our search identified 230 citations, of which 10 diagnostic studies that evaluated 1144 patients and 435 bacterial infection episodes (32.1%) were ultimately included for analysis. The bivariate pooled sensitivity estimates were 79% (95% confidence interval [CI]: 64%–89%) for PCT tests and 77% (95% CI: 69%–84%) for C-reactive protein (CRP) tests. Pooled specificity estimates were higher for both PCT and CRP tests (PCT, 89% [95% CI: 82%–94%]; CRP, 85% [95% CI: 76%–90%]). The positive likelihood ratio for PCT (LR+, 7.38, 95% CI: 4.70–11.58) was sufficiently high to qualify PCT as a rule-in diagnostic tool, and the negative likelihood ratio for CRP was sufficiently low to qualify CRP as an acceptable rule-out diagnostic tool (LR− 0.23, 95% CI: 0.13–0.41) in patients with no signs of infection. Available clinical evidence showed that PCT has comparable accuracy to CRP for the diagnosis of systemic infection in patients with liver cirrhosis. Compared with patients with normal liver function, both PCT and CRP tests have acceptable accuracy for diagnosing bacterial infection among patients with liver cirrhosis.