Substantially elevated C-reactive protein (CRP), together with low levels of procalcitonin (PCT), contributes to diagnosis of fungal infection in immunocompromised patients
Language English Country Germany Media print-electronic
Document type Journal Article, Research Support, Non-U.S. Gov't
- MeSH
- Bacterial Infections blood immunology MeSH
- C-Reactive Protein metabolism MeSH
- Adult MeSH
- Hematologic Neoplasms blood immunology microbiology MeSH
- Fever blood immunology microbiology MeSH
- Immunocompromised Host MeSH
- Calcitonin blood MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Mycoses blood immunology MeSH
- Graft vs Host Disease blood immunology microbiology MeSH
- Calcitonin Gene-Related Peptide MeSH
- Predictive Value of Tests MeSH
- Protein Precursors blood MeSH
- ROC Curve MeSH
- Aged MeSH
- Hematopoietic Stem Cell Transplantation MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Names of Substances
- C-Reactive Protein MeSH
- CALCA protein, human MeSH Browser
- Calcitonin MeSH
- Calcitonin Gene-Related Peptide MeSH
- Protein Precursors MeSH
PURPOSE: Serum procalcitonin (PCT) has become a routinely utilized parameter with a high prediction value of the severity of bacterial infectious complications and their immediate outcomes. Whereas the utility of PCT in differentiating between bacterial and viral infection is generally accepted, its significance in fungal infections has yet to be determined. The aim of the study was to determine the role of PCT testing in patients at high risk for invasive fungal infections. METHODS: Immunocompromised hematological patients undergoing cyclic chemotherapy treatment or allogeneic hemopoietic stem cell transplantation with infectious complications in which the infectious agents were identified during the disease course were evaluated. In patients with bacterial infection, positive hemocultures were documented, and in patients with fungal infection, the presence of either proven or probable disease was confirmed according to Ascioglu criteria. C-reactive protein (CRP) and PCT were prospectively assessed from the day following fever onset, for four consecutive days. RESULTS: Overall, 34 patients were evaluated, 21 with bacterial and 13 with fungal infections. Significant elevations of CRP concentrations (i.e., above the upper normal limit) were observed in all patients, with a tendency toward higher levels in bacterial (both gram-positive [Gr+] and Gr-negative [Gr-]) than in fungal infections. PCT levels were significantly elevated in patients with bacterial infections (e.g., predominantly in Gr- compared to Gr+), whereas in patients with fungal infections, we identified minimal or no PCT elevations, p < 0.01. For the fungal infections, according to constructed receiver operating characteristic curves, a combination of PCT <0.5 μg/L and CRP 100-300 mg/L offers the best specificity, sensitivity and positive and negative predictive values (81, 85, 73, and 89 %, respectively). CONCLUSION: Altogether, our data suggest that the finding of substantially elevated CRP combined with low PCT in immunocompromised patients may indicate systemic fungal infection. The use of this combination might simplify the diagnostic process, which otherwise can often be lengthy and arduous.
See more in PubMed
Infection. 2009 Dec;37(6):497-507 PubMed
J Prev Med Hyg. 2011 Mar;52(1):38-9 PubMed
Lancet. 1993 Feb 27;341(8844):515-8 PubMed
J Infect Dis. 2004 Aug 1;190(3):641-9 PubMed
Eur J Clin Microbiol Infect Dis. 2005 Apr;24(4):272-5 PubMed
J Clin Microbiol. 2000 Apr;38(4):1434-8 PubMed
Clin Infect Dis. 2002 Jan 1;34(1):7-14 PubMed
Eur J Intern Med. 2002 Dec;13(8):493-495 PubMed
Med Mycol. 2011 Apr;49 Suppl 1:S90-5 PubMed
Br J Haematol. 2004 Aug;126(3):372-6 PubMed
Crit Care Med. 2008 Mar;36(3):941-52 PubMed
Intensive Care Med. 2006 Oct;32(10):1577-83 PubMed
Clin Diagn Lab Immunol. 2000 Nov;7(6):889-92 PubMed
Clin Infect Dis. 2011 May;52(9):1123-9 PubMed
J Endotoxin Res. 2003;9(6):367-74 PubMed
JAMA. 2009 Sep 9;302(10):1059-66 PubMed
Med Intensiva. 2012 Apr;36(3):177-84 PubMed
Crit Care Clin. 2011 Apr;27(2):253-63 PubMed
Cancer. 2009 Jan 15;115(2):355-62 PubMed
J Infect Dis. 2007 Feb 1;195(3):455-66 PubMed
Haematologica. 2002 Jun;87(6):643-51 PubMed
Crit Care Clin. 2011 Apr;27(2):241-51 PubMed
Crit Care. 2009;13(2):R38 PubMed
Infection. 1995 Sep-Oct;23(5):310-1 PubMed
Med Mycol. 2005 May;43 Suppl 1:S139-45 PubMed
Crit Care Med. 2002 Sep;30(9):2091-5 PubMed
J Infect. 2010 Jun;60(6):425-30 PubMed
Inflamm Res. 2011 Feb;60(2):203-7 PubMed
Infection. 1998 May-Jun;26(3):168-9 PubMed
Clin Infect Dis. 2004 Jul 15;39(2):206-17 PubMed
Support Care Cancer. 2005 May;13(5):343-6 PubMed
Drug Resist Updat. 2011 Jun;14(3):164-76 PubMed
Curr Opin Crit Care. 2007 Oct;13(5):578-85 PubMed
Br J Anaesth. 2008 May;100(5):612-21 PubMed
BMC Infect Dis. 2008 May 29;8:73 PubMed
