Procalcitonin measurement using antibody-conjugated fluorescent microspheres distinguishes atypical bacterial meningitis from viral encephalitis in children

Progress in Procalcitonin Detection Based on Immunoassay

Procalcitonin (PCT) serves as a crucial biomarker utilized in diverse clinical contexts, including sepsis diagnosis and emergency departments. Its applications extend to identifying pathogens, assessing infection severity, guiding drug administration, and implementing theranostic strategies. However, current clinical deployed methods cannot meet the needs for accurate or real-time quantitative monitoring of PCT. This review aims to introduce these emerging PCT immunoassay technologies, focusing on analyzing their advantages in improving detection performances, such as easy operation and high precision. The fundamental principles and characteristics of state-of-the-art methods are first introduced, including chemiluminescence, immunofluorescence, latex-enhanced turbidity, enzyme-linked immunosorbent, colloidal gold immunochromatography, and radioimmunoassay. Then, improved methods using new materials and new technologies are briefly described, for instance, the combination with responsive nanomaterials, Raman spectroscopy, and digital microfluidics. Finally, the detection performance parameters of these methods and the clinical importance of PCT detection are also discussed.

Diagnostic Accuracy of Procalcitonin in Bacterial Infections of the CNS: An Updated Systematic Review, Meta-Analysis, and Meta-Regression

OBJECTIVES

To evaluate diagnostic accuracy of serum and cerebrospinal fluid (CSF) procalcitonin for diagnosing CNS bacterial infections.

DATA SOURCES

We searched MEDLINE, Cochrane Central Register of Controlled Trials, and International Web of Science databases from January 1, 2016, to September 30, 2022.

STUDY SELECTION

Randomized controlled trials and observational studies, either prospective or retrospective, focusing on procalcitonin as a biomarker for CNS infections.

DATA EXTRACTION

We screened and extracted studies independently and in duplicate. We assessed risk of bias using the revised Quality Assessment for Studies of Diagnostic Accuracy tool. Data for diagnostic sensitivity and specificity were pooled using the bivariate or hierarchical model, as appropriate.

DATA SYNTHESIS

Of 5,347 citations identified, 23 studies were included. Overall, CSF procalcitonin showed slightly higher pooled sensitivity, specificity, and positive likelihood ratio compared with serum procalcitonin. In adults, pooled sensitivity of CSF procalcitonin was 0.89 (95% CI, 0.71-0.96), specificity 0.81 (95% CI, 0.66-0.91); pooled sensitivity of serum procalcitonin was 0.82 (95% CI, 0.58-0.94), specificity 0.77 (95% CI, 0.60-0.89). In children, pooled sensitivity of CSF procalcitonin was 0.96 (95% CI, 0.88-0.99), specificity 0.91 (95% CI, 0.72-0.97); pooled sensitivity of serum procalcitonin was 0.90 (95% CI, 0.75-0.97), specificity 0.83 (95% CI, 0.67-0.92). In post-neurosurgical patients, pooled sensitivity of CSF procalcitonin was 0.82 (95% CI, 0.53-0.95), specificity 0.81 (95% CI, 0.63-0.91); pooled sensitivity of serum procalcitonin was 0.65 (95% CI, 0.33-0.88), specificity 0.61 (95% CI, 0.41-0.78). Logistic regression revealed between-study heterogeneity higher for serum than CSF procalcitonin. For the latter, threshold variability was found as source of heterogeneity.

CONCLUSIONS

In children and critical post-neurosurgical patients, CSF procalcitonin gains superior sensitivity and specificity compared with serum procalcitonin. Overall, CSF procalcitonin appears to have a higher pooled positive likelihood ratio compared with serum procalcitonin.

A highly sensitive immunosensor based on nanochannel-confined nano-gold enhanced electrochemiluminescence for procalcitonin detection

Sensitive detection of procalcitonin (PCT) in serum is crucial for the timely diagnosis and treatment of rheumatoid arthritis. In this work, an electrochemiluminescence (ECL) detection platform is developed based on in-situ growth of Au nanoparticles (AuNPs) in nanochannels and an analyte-gated detection signal, which can realize ECL determination of PCT with high sensitivity. Vertically ordered mesoporous silica films with amine groups and uniform nanochannel array (NH2-VMSF) is easily grown on the supporting indium tin oxide (ITO) electrode through electrochemical assisted self-assembly method (EASA). Anchored by the amino groups, AuNPs were grown in-situ within the nanochannels to catalyze the generation of reactive oxygen species (ROS) and amplify the ECL signal of luminol. An immuno-recognitive interface is constructed on the outer surface of NH2-VMSF, through covalent immobilization of PCT antibodies. In the presence of PCT, the immunocomplex will hinder the diffusion of luminol and co-reactants, leading to a gating effect and decreased ECL signals. Based on this principle, the immunosensor can detect PCT in the range from 10 pg/mL to 100 ng mL-1 with a limit of detection (LOD) of 7 pg mL-1. The constructed immunosensor can also be used for detecting PCT in serum. The constructed sensor has advantages of simple fabrication and sensitive detection, demonstrating great potential in real sample analysis.

Progress in etiological diagnosis of viral meningitis

In recent years, with the rapid development of molecular biology techniques such as polymerase chain reaction and molecular biochip, the etiological diagnosis of viral encephalitis has a very big step forward. At present, the etiological examination of viral meningitis mainly includes virus isolation, serological detection and molecular biological nucleic acid detection. This article reviews the progress in etiological diagnosis of viral meningitis.

Advantages of aggregation-induced luminescence microspheres compared with fluorescent microspheres in immunochromatography assay with sandwich format

Organic fluorescein dye-embedded fluorescent microspheres (FMs) are currently the most established commercially fluorescent markers, and they have been widely used to improve the sensitivity of immunochromatography assay (ICA). However, these FMs have natural defects, such as the aggregation-caused quenching effect and small Stokes shift, which are not conducive to improving the detection performance of ICA. Herein, two green emitted FMs, namely aggregation-induced emission FMs (AIEFMs) and fluorescein isothiocyanate FMs (FITCFMs), were prepared by swelling the AIE luminogens and FITC dyes into the carboxyl group-modified polystyrene microspheres. The average diameters of AIEFMs and FITCFMs were 350 and 450 nm, respectively. Compared with FITCFMs, the AIEFMs exhibited stronger fluorescence intensity and a larger Stokes shift. These two FMs were used as the labeling markers of ICA for procalcitonin (PCT) detection with the sandwich format. Among them, AIEFM-ICA showed dynamic linear detection of PCT from 7.6 pg mL^-1 to 125 ng mL^-1 with the limit of detection (LOD) at 3.8 pg mL^-1. These values were remarkably superior to those of FITCFM-ICA (linear range from 61 pg mL^-1 to 62.5 ng mL^-1 and LOD value at 60 pg mL^-1). Furthermore, the average recoveries of the intra- and inter-assays of AIEFM-ICA ranged from 86% to 112%, with coefficients of variation ranging from 1.2% to 8.8%, indicating accuracy and precision for PCT quantitative detection. Additionally, the reliability of the developed AIEFM-ICA was further assessed by analyzing 30 real serum samples from systemic inflammatory response by infectious diseases, and the results showed good agreement with the chemiluminescence immunoassay. In conclusion, compared with traditional FITCFMs, green emitted AIEFMs as a novel fluorescent label, exhibits greater potential to enhance the detection performance of the ICA platform.