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Serum procalcitonin distinguishes CAP due to bacteria, Mycobacterium tuberculosis and PJP

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SETTING: Procalcitonin (PCT), a propeptide of the hormone calcitonin, is a novel marker of the inflammatory response to infection. It has been used to discriminate between infectious and non-infectious causes of inflammation, and as a marker of severe sepsis in the intensive care unit.

OBJECTIVE: To evaluate the utility of PCT in distinguishing community-acquired pneumonia (CAP) due to common bacteria, Mycobacterium tuberculosis and Pneumocystis jirovecii in a high human immunodeficiency virus (HIV) prevalence setting.

METHODS: Two hundred and sixty-six patients admitted with a diagnosis of CAP were investigated. Serum samples for PCT were collected on admission. PCT levels were measured using a commercial immunoluminometric assay.

RESULTS: A microbiological diagnosis was obtained in 169/266 patients: 44 pulmonary tuberculosis (PTB), 31 P. jirovecii pneumonia (PJP), and 35 bacterial pneumonia. The PCT levels were PTB 4.16 ng/ml (SEM 1.197; 95%CI 1.749–6.579); PJP 1.138 ng/ml (SEM 0.2911; 95%CI 0.543–1.734); and bacterial pneumonia 19.48 ng/ml (SEM 5.64; 95%CI 8.021–30.938, P < 0.0004). Thirty-six had co-infections.

CONCLUSION: PCT levels differ significantly in patients with CAP due to TB, PJP and bacteria. PCT may be important in distinguishing M. tuberculosis and PJP in a high HIV prevalence setting where atypical presentations often confound the empirical clinical diagnosis.

Keywords: community-acquired pneumonia; diagnosis; procalcitonin

Document Type: Regular Paper

Affiliations: Department of Medicine, Nelson R Mandela School of Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

Publication date: May 1, 2006

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  • The International Journal of Tuberculosis and Lung Disease (IJTLD) is for clinical research and epidemiological studies on lung health, including articles on TB, TB-HIV and respiratory diseases such as COVID-19, asthma, COPD, child lung health and the hazards of tobacco and air pollution. Individuals and institutes can subscribe to the IJTLD online or in print – simply email us at [email protected] for details.

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