Serum Procalcitonin Levels in Patients with Acute Central Nervous System Infections

Yordan Kalchev; Tsetsa  Petkova; Ralitsa Raycheva; Bothwell  Kabayira; Tanya  Deneva; Marianna  Murdjeva

doi:10.3889/oamjms.2020.5497

Authors

Yordan Kalchev Department of Microbiology and Immunology, Faculty of Pharmacy, Medical University, Plovdiv, Bulgaria; Laboratory of Microbiology, St. George University Hospital, Plovdiv, Bulgaria
Tsetsa Petkova Laboratory of Virology, St. George University Hospital, Plovdiv, Bulgaria
Ralitsa Raycheva Department of Social Medicine and Public Health, Faculty of Public Health, Medical University, Plovdiv, Bulgaria
Bothwell Kabayira Medical student, Faculty of Medicine, Medical University, Plovdiv, Bulgaria
Tanya Deneva Clinical Laboratory Department, Faculty of Medicine, Medical University, Plovdiv, Bulgaria; Clinical Laboratory, St. George University Hospital, Plovdiv, Bulgaria
Marianna Murdjeva Department of Microbiology and Immunology, Faculty of Pharmacy, Medical University, Plovdiv, Bulgaria; Laboratory of Microbiology, St. George University Hospital, Plovdiv, Bulgaria; Laboratory of Virology, St. George University Hospital, Plovdiv, Bulgaria; Research Institute, Medical University, Plovdiv, Bulgaria

DOI:

https://doi.org/10.3889/oamjms.2020.5497

Keywords:

Procalcitonin, Neuroinfection, Meningitis

Abstract

BACKGROUND: Bacterial infections of the brain are associated with high mortality and neurological sequelae, whereas viral diseases are usually self-limiting. A fast and easy-to-perform biomarker is needed to improve management in these patients.

AIM: Procalcitonin (PCT) testing has already been implemented in many laboratories for evaluating septic patients and it is an easily accessible biomarker, so we aimed to examine its role specifically in discriminating acute bacterial from viral infections of the central nervous system (CNS).

MATERIALS AND METHODS: This prospective study included 80 patients with both clinical symptoms and laboratory findings suggesting acute CNS infection. The microbiological analysis included direct microscopy, culturing, latex-agglutination test, and multiplex polymerase chain reaction. PCT levels were measured by enzyme-linked fluorescent assay technology.

RESULTS: Following the results of the microbiological analysis, the cases were divided into three groups – bacterial 26.3% (n = 21), viral 17.5% (n = 14), and unidentified neuroinfections – 56.2% (n = 45). A statistically significant difference in the median serum PCT was observed between the bacterial and viral neuroinfections (p = 0.004) as well as between bacterial and unidentified infections of the brain (p = 0.000). No significant difference was found (p = 1.000) when comparing viral and unidentified neuroinfection. The area under the receiver operating characteristic curve for serum PCT was 0.823 but could be increased to 0.929 when combining serum PCT and C-reactive protein (CRP).

CONCLUSION: Serum PCT levels are significantly higher in patients with acute bacterial infections of the brain. As a stand-alone biomarker, its discriminatory power is not superior to the classical laboratory parameters in the cerebrospinal fluid and serum CRP. However, when combined with serum CRP, excellent discriminatory power is observed.

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