Review Article of American Journal of Microbiology and Immunology
Elevated Serum Procalcitonin an Adjunct for Early detection of Infant Tuberculosis in Paediatric HIV/AIDS
Ibeh Isaiah Nnanna
Health Services Department, University of Benin, Benin city PMB 1154
In countries with a high tuberculosis (TB) burden, Mycobacterium tuberculosis is a frequent cause of acquired pneumonia (AP) amongst people living with HIV/AIDS and the differential and early diagnosis of TB from common bacterial pneumonia is difficult. The varying clinical and radiographic presentation of Acquired Pneumonia and Tuberculosis according to patient age and comorbidity and the low sensitivity of acid-fast bacillus microscopy make it even more difficult to distinguish TB from common bacterial pneumonia. Therefore, an adjunct diagnostic method that can determine early pulmonary tuberculosis in infants living with HIV/AIDS in order to differentiate it from other bacterial pathogens causing acquired pneumonia. Although a confirmatory microscopy test for Tuberculosis detection was carried out which would have a clinical role in terms of isolating patients with TB and administering appropriate anti-TB medication or antibiotic treatment at an early stage. The use of serum procalcitonin (PCT) for early detection of pulmonary tuberculosis (TB) from infants with paediatric HIV/AIDS in Adamawa state, Nigeria a country with an intermediate TB burden and one with the highest number of people living with HIV/IADS in West-Africa. A prospective study, enrolling 50 infants with paediatric HIV/AIDs with suspected Pulmonary Tuberculosis in a community-based referral hospital. A clinical assessment was performed before treatment, serum and PCT were measured. The test results were compared to the final diagnoses 50 patients, 35 had Pulmonary Tuberculosis and 15 had bacterial associated pneumonia TB. The median PCT level was 0.564 ng/mL (range, 0.01 to 27.75) with bacterial acquired pneumonia and 0.044 ng/mL (range, 0.01 to 0.87) with pulmonary TB (p<0.001). No difference was detected in the discriminative values of PCT (p=0.733).The concentrations of PCT differed significantly in patients with pulmonary TB and bacterial acquired Pneumonia. The high sensitivity and negative predictive value for early detection pulmonary TB when compared to bacterial acquired pneumonia suggest a supplementary role of PCT in the diagnostic exclusion of pulmonary TB from bacterial AP in areas with an intermediate prevalence of pulmonary TB.
Keywords: Pulmonary Tuberculosis, Paediatric, Procalcitonin, Pneumonia
How to cite this article:
Ibeh Isaiah Nnanna. Elevated Serum Procalcitonin an Adjunct for Early detection of Infant Tuberculosis in Paediatric HIV/AIDS. American Journal of Microbiology and Immunology, 2016,1:8. DOI: 10.28933/nnanna-ajmi-10-2016
1. Digiovine B, Chenoweth C, Watts C, Higgins M. The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am J Respir Crit Care Med 1999; 160:
2. Vincent JL, Bihari DJ, Suter PM, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the european prevalence of infection in intensive care (EPIC) study. EPIC International Advisory Committee. JAMA 1995; 274: 639-644.
3. Gastmeier P, Sohr D, Geffers C, Behnke M, Ruden H. Risk factors for death due to nosocomial infection in intensive care unit patients: Findings from the krankenhaus infections surveillance system. Infect Control Hosp Epidemiol 2007; 28:466-472.
4. Harbarth S, Garbino J, Pugin J, Romand JA, Lew D, Pittet D. Inappropriate initial antimicrobial therapy and its effect on survival in a clinical trial of immunomodulating therapy for severe sepsis. Am J Med 2003; 115:529-535.
5. Bergmans DC, Bonten MJ, Gaillard CA, et al. Indications for antibiotic use in ICU patients: A one-year prospective surveillance. J Antimicrob Chemother 1997; 39:527-535.
6. Christ-Crain M, Muller B. Procalcitonin in bacterial infections – hype, hope, more or less? Swiss Med Wkly 2005; 135:451-460.
7. Jensen JU, Heslet L, Jensen TH, Espersen K, Steffensen P, Tvede M. Procalcitonin increase in early identification of critically ill patients at high risk of mortality. Crit Care Med 2006; 34:2596-2602.
8. Rau B, Steinbach G, Gansauge F, Mayer JM, Grunert MA, Beger HG. The potential role of procalcitonin and interleukin 8 in the prediction of infected necrosis in acute pancreatitis. Gut 1997; 41:832-840.
9. Rau BM, Frigerio I, Buchler MW, et al. Evaluation of procalcitonin for predicting septic multiorgan failure and overall prognosis in secondary peritonitis: A prospective, international multicenter study. Arch Surg 2007; 142:134-142.
10. Müller B, Becker KL (2001) Procalcitonin: how a hormone became a marker and mediator of sepsis. Swiss Med Wkly 131: 595-602.
11. de Werra I, Jaccard C, Corradin SB, Chioléro R, Yersin B, et al. (1997) Cytokines, nitrite/nitrate, soluble tumor necrosis factor receptors, and procalcitonin concentrations: comparisons in patients with septic shock, cardiogenic shock, and bacterial pneumonia. Crit Care Med 25: 607-613.
12. Stolz D, Christ-Crain M, Bingisser R, (2007) Antibiotic treatment of exacerbations of COPD: a randomized, controlled trial comparing procalcitonin-guidance with standard therapy. Chest 131: 9-19.
13. Christ-Crain M, Stolz D, Bingisser R, Müller C, Miedinger D, et al. (2006) Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial. Am J Respir Crit Care Med 174: 84-93.
14. Polzin A, Pletz M, Erbes R, Raffenberg M, Mauch H, et al. (2003) Procalcitonin as a diagnostic tool in lower respiratory tract infections and tuberculosis. Eur Respir J 21: 939-943.
15. Lawn SD, Obeng J, Acheampong JW, Griffin GE (1998) Serum procalcitonin concentrations in patients with pulmonary tuberculosis. Trans R Soc Trop Med Hyg 92: 540-541.
16. Schleicher GK, Herbert V, Brink A, Martin S, Maraj R, et al. (2005) Procalcitonin and C-reactive protein levels in HIV-positive subjects with tuberculosis and pneumonia. Eur Respir J 25: 688-692.
17. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, et al. (1997) A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 336: 243-250.
18. World Health Organization (2007) Global Tuberculosis Control: Surveillance, Planning, Financing (WHO/HTM/TB/2007.376). WHO Report Geneva.
19. Müller B, Harbarth S, Stolz D, Bingisser R, Mueller C, et al. (2007) Diagnostic and prognostic accuracy of clinical and laboratory parameters in community-acquired pneumonia. BMC Infect Dis 7: 10.
20. Hedlund J, Hansson LO (2000) Procalcitonin and C-reactive protein levels in community-acquired pneumonia: correlation with etiology and prognosis. Infection 28: 68-73.
21. Moulin F, Raymond J, Lorrot M, Marc E, Coste J, et al. (2001) Procalcitonin in children admitted to hospital with community acquired pneumonia. Arch Dis Child 84: 332-336.
22. Pepys MB, Hirschfield GM (2003) C-reactive protein: a critical update. J Clin Invest 111: 1805-1812.
22. Lawn SD, Obeng J, Acheampong JW, Griffin GE. Serum pro- calcitonin concentrations in patients with pulmonary tuberculosis. Trans R Soc Trop Med Hyg 1998;92:540-541.
23. Schleicher GK, Herbert V, Brink A, et al. Procalcitonin and C- reactive protein levels in HIV-positive subjects with tuberculosis and pneumonia. Eur Respir J 2005;25:688-692.
24. Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997;336:243-250.
25. World Health Organization. Global Tuberculosis Control: Surveillance, Planning, Financing (WHO/HTM/TB/2007.376). WHO Report 2007. Geneva: World Health Organization, 2007.
26. van der Meer V, Neven AK, van den Broek PJ, Assendelft WJ. Diagnostic value of C reactive protein in infections of the lower respiratory tract: systematic review. BMJ 2005;331:26.
27. Muller B, Harbarth S, Stolz D, et al. Diagnostic and prognostic accuracy of clinical and laboratory parameters in community- acquired pneumonia. BMC Infect Dis 2007;7:10.
28.Moulin F, Raymond J, Lorrot M, et al. Procalcitonin in children admitted to hospital with community acquired pneumonia. Arch Dis Child 2001;84:332-336.
29. Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clin Invest 2003;111:1805-1812.
30.Dandona P, Nix D, Wilson MF, et al. Procalcitonin increase after endotoxin injection in normal subjects. J Clin Endocrinol Metab 1994;79:1605-1608.
31. Hausfater P, Garric S, Ayed SB, Rosenheim M, Bernard M, Riou B. Usefulness of procalcitonin as a marker of systemic infection in emergency department patients: a prospective study. Clin Infect Dis 2002;34:895-901.
32. Masia M, Gutierrez F, Shum C, et al. Usefulness of procalcitonin levels in community-acquired pneumonia according to the patients outcome research team pneumonia severity index. Chest
33. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007;44(Suppl 2):S27-S72.