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Serum Procalcitonin Levels in Newly Diagnosed Hodgkin Lymphoma: Correlation with Other Inflammatory Biomarkers. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101331. [PMID: 36295492 PMCID: PMC9609271 DOI: 10.3390/medicina58101331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/06/2022] [Accepted: 09/15/2022] [Indexed: 11/20/2022]
Abstract
Background and Objectives: Procalcitonin (PCT) is a useful biomarker for the diagnosis of sepsis. Inflammatory markers are elevated in patients with Hodgkin lymphoma (HL), and yet ongoing infection rarely coexists at diagnosis. PCT levels might be helpful in differentiating bacterial from disease-related inflammation. Materials and Methods: We evaluated serum PCT levels and other inflammation markers in newly diagnosed HL patients. Values < 0.50 ng/mL were considered normal (0.10−0.50 ng/mL: detectable, <0.10 ng/mL: undetectable), while values ≥ 0.50 ng/L were considered elevated. Results: Among 137 patients, 55 had B symptoms (40%), 77/130 (59%) had elevated Erythrocyte Sedimentation Rate (ESR) and 116 (85%) had elevated C-Reactive Protein (CRP) (median 38.1 mg/L (range; 2.97−328)). PCT levels were normal in most patients (undetectable 94/137 (68.5%) and detectable 41/137(30%)) with median value < 0.10 ng/mL (range; <0.10−15.90). Elevated PCT was recorded in only two patients (1.5%). Patients with PCT < 0.10 ng/mL had significantly lower median CRP (25.75; range (2.97−203.0)) compared to patients with PCT ≥ 0.1 ng/mL (median CRP 92.50 mg/L; range (3.34−328.0)). Almost all patients (40/41, 97.6%) with detectable PCT had elevated CRP. Conclusions: This is the first study showing that the inflammation characterizing HL is not associated with PCT elevations, although CRP levels are elevated in 85% of the patients. Normal PCT levels may rule out the possibility of occult infection, thus preventing extensive evaluation, which may delay treatment initiation.
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Elgormus Y. Biomarkers and their Clinical Applications in Pediatrics. Biomark Med 2022. [DOI: 10.2174/9789815040463122010019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Biomarker studies are becoming increasingly interesting for many fields of
medicine. The use of biomarkers in medicine is involved in detecting diseases and
supporting diagnosis and treatment decisions. New research and new discoveries on the
molecular basis of the disease show that there may be a number of promising new
biomarkers for use in daily clinical practice. Clinical trials in children lag behind adult
research both in quality and quantity. The number of biomarkers validated to optimize
pediatric patient management is limited. In the pathogenesis of many diseases, it should
not be extrapolated to the pediatric clinical setting, taking into account that biomarkers
that are effective in adults are clearly different in children and that ontogeny directly
affects disease development and therapeutic response in children. The search for ideal
biomarkers or markers that can make an early and definitive diagnosis in neonatal
sepsis is still ongoing. The ideal biomarker for pediatric diseases should be costeffective,
noninvasive, applicable to pediatric specific diseases, and its results should
correspond to age-related physiological changes. Lactate, troponin and B-type
natriuretic peptide are valuable biomarkers in the evaluation and management of
critically ill children with cardiac disease. Tumor markers in children are biochemical
substances used in the clinical treatment of pediatric tumors and to detect the presence
of cancer (regression or progression). In this chapter, current and brief information
about biomarkers and their clinical applications used in the diagnosis and monitoring of
pediatric diseases is presented.;
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Affiliation(s)
- Yusuf Elgormus
- Medicine Hospital,Department of Pediatric Health and Diseases,Department of Pediatric Health and Diseases, Medicine Hospital, Istanbul, Turkey,Istanbul,Turkey
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3
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Ojuawo O, Ojuawo A, Aladesanmi A, Adio M, Iroh Tam PY. Childhood pneumonia diagnostics: a narrative review. Expert Rev Respir Med 2022; 16:775-785. [DOI: 10.1080/17476348.2022.2099842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Olutobi Ojuawo
- Global Health Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Ayotade Ojuawo
- General Practice Specialty, St Helens and Knowsley Teaching Hospitals NHS Trust (Lead Employer), United Kingdom
| | | | - Mosunmoluwa Adio
- Acute Medical Unit, North Cumbria Integrated Care NHS Foundation Trust, United Kingdom
| | - Pui-Ying Iroh Tam
- Paediatrics and Child Health Research Group, Malawi – Liverpool Wellcome Programme, Blantyre, Malawi
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Wang W, Zhu Y, Yin L, Deng Y, Chu G, Liu S. Utilization of serum procalcitonin as a biomarker in the diagnosis and treatment of children with bacterial hospital-acquired pneumonia. Mol Cell Biochem 2020; 476:261-267. [PMID: 32990893 PMCID: PMC7522182 DOI: 10.1007/s11010-020-03902-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/02/2020] [Indexed: 01/09/2023]
Abstract
Hospital-acquired pneumonia (HAP) is one of the common infections in hospitalized patients. Early and prompt diagnosis of HAP is important because it aids in the appropriate selection of antibiotics and decreases the mortality and morbidity of patients. The investigation on serum procalcitonin (PCT) levels in pediatric patients is limited. Herein we aimed to evaluate the role of PCT in the early diagnosis of children with bacterial HAP. The study enrolled 264 children (< 14 years old) who were radiographically detected by pulmonary condensation chest X-rays. The HAP patients were stratified by patterns of microbiological detection of pathogens. Baseline white blood cell (WBC) count, neutrophil proportion, PCT, and C-reactive protein (CRP) were measured on admission. The laboratory findings and microbiological findings were analyzed and compared among groups. The median PCT concentration of patients with typical bacterial pathogens (3.95 ± 3.75 ng/mL) was significantly higher than the one of the patients with other pathogen types (median lower than 1.20 ng/mL). Correlation analysis indicated a significant correlation between PCT concentrations and the main inflammation makers including WBC count, neutrophil proportion, and CRP. PCT level was significantly decreased to 0.86 ± 1.46 ng/mL in post-treatment patients (p < 0.001). This cohort study with 264 pediatric HAP patients demonstrated the reliability of PCT level as a biomarker in patients with typical bacterial pathogens. Specifically, PCT cutoffs of 2 ng/mL accurately identified HAP children with typical bacterial pathogens. This finding suggested that PCT may serve as a reliable biomarker for the early diagnosis and treatment indicator of children with HAP.
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Affiliation(s)
- Wenlong Wang
- Department of Clinical Laboratory, Cangzhou Central Hospital, No.16 Xinhua West Road, Cangzhou, 061001, Hebei, China.
| | - Yitang Zhu
- Department of Clinical Laboratory, Cangzhou Central Hospital, No.16 Xinhua West Road, Cangzhou, 061001, Hebei, China
| | - Linlin Yin
- Department of Clinical Laboratory, Cangzhou Central Hospital, No.16 Xinhua West Road, Cangzhou, 061001, Hebei, China
| | - Yaoyao Deng
- Clinical Laboratory, Mengcun Hui Autonomous County Hospital, Chaoyang Dajie, Mengcun Hui Autonomous County, Cangzhou, 061400, Hebei, China
| | - Guoxian Chu
- Clinical Laboratory, People's Hospital of Qingxian, Nanhuanxi Road, Qingxian, Cangzhou, 062650, Hebei, China
| | - Supin Liu
- Department of Blood Collection Center, Cangzhou Central Hospital, No.16 Xinhua West Road, Cangzhou, 061001, Hebei, China
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5
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Bobillo-Perez S, Rodríguez-Fanjul J, Jordan Garcia I. Is Procalcitonin Useful in Pediatric Critical Care Patients? Biomark Insights 2018; 13:1177271918792244. [PMID: 30093797 PMCID: PMC6081751 DOI: 10.1177/1177271918792244] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 07/11/2018] [Indexed: 12/11/2022] Open
Abstract
This review examines the use of procalcitonin in different clinical situations in the pediatric patient, with special emphasis on those requiring intensive care. We review the latest articles on its potency as a biomarker in both infectious processes at diagnosis and on the response to treatment.
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Affiliation(s)
- Sara Bobillo-Perez
- Pediatric Intensive Care Unit Service, Research Group of the Pediatric Critical Patient, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
| | - Javier Rodríguez-Fanjul
- Neonatal Intensive Care Unit Service, Hospital de Sant Joan de Déu Maternal, Fetal and Neonatology Center Barcelona (BCNatal), University of Barcelona, Barcelona, Spain
| | - Iolanda Jordan Garcia
- Pediatric Intensive Care Unit, Paediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, CIBERESP, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
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van Houten CB, de Groot JAH, Klein A, Srugo I, Chistyakov I, de Waal W, Meijssen CB, Avis W, Wolfs TFW, Shachor-Meyouhas Y, Stein M, Sanders EAM, Bont LJ. A host-protein based assay to differentiate between bacterial and viral infections in preschool children (OPPORTUNITY): a double-blind, multicentre, validation study. THE LANCET. INFECTIOUS DISEASES 2017; 17:431-440. [DOI: 10.1016/s1473-3099(16)30519-9] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/11/2016] [Accepted: 10/28/2016] [Indexed: 12/22/2022]
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Biomarkers in Pediatric Community-Acquired Pneumonia. Int J Mol Sci 2017; 18:ijms18020447. [PMID: 28218726 PMCID: PMC5343981 DOI: 10.3390/ijms18020447] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 02/07/2017] [Accepted: 02/13/2017] [Indexed: 01/05/2023] Open
Abstract
Community-acquired pneumonia (CAP) is an infectious disease caused by bacteria, viruses, or a combination of these infectious agents. The severity of the clinical manifestations of CAP varies significantly. Consequently, both the differentiation of viral from bacterial CAP cases and the accurate assessment and prediction of disease severity are critical for effectively managing individuals with CAP. To solve questionable cases, several biomarkers indicating the etiology and severity of CAP have been studied. Unfortunately, only a few studies have examined the roles of these biomarkers in pediatric practice. The main aim of this paper is to detail current knowledge regarding the use of biomarkers to diagnose and treat CAP in children, analyzing the most recently published relevant studies. Despite several attempts, the etiologic diagnosis of pediatric CAP and the estimation of the potential outcome remain unsolved problems in most cases. Among traditional biomarkers, procalcitonin (PCT) appears to be the most effective for both selecting bacterial cases and evaluating the severity. However, a precise cut-off separating bacterial from viral and mild from severe cases has not been defined. The three-host protein assay based on C-reactive protein (CRP), tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), plasma interferon-γ protein-10 (IP-10), and micro-array-based whole genome expression arrays might offer more advantages in comparison with former biomarkers. However, further studies are needed before the routine use of those presently in development can be recommended.
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Abstract
PURPOSE OF REVIEW This review covers the outpatient management of pediatric community-acquired pneumonia (CAP), discussing the changing microbiology of CAP since the introduction of the 13-valent pneumococcal conjugate vaccine in 2010, and providing an overview of national guideline recommendations for diagnostic evaluation and treatment. RECENT FINDINGS Rates of invasive pneumococcal disease and pneumococcal antibiotic resistance have plummeted since widespread 13-valent pneumococcal conjugate vaccine immunization. Viruses remain the most common cause of CAP in young children; children over age 5 years have increased rates of Mycoplasma pneumoniae. A recent national guideline offers recommendations for office-based diagnostic evaluation and treatment of pediatric CAP. SUMMARY This review offers a discussion of the above findings with practical recommendations for the office-based practitioner in the evaluation and treatment of an infant (>3 months) or child with suspected CAP.
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Esposito S, Di Gangi M, Cardinale F, Baraldi E, Corsini I, Da Dalt L, Tovo PA, Correra A, Villani A, Sacco O, Tenero L, Dones P, Gambino M, Zampiero A, Principi N. Sensitivity and Specificity of Soluble Triggering Receptor Expressed on Myeloid Cells-1, Midregional Proatrial Natriuretic Peptide and Midregional Proadrenomedullin for Distinguishing Etiology and to Assess Severity in Community-Acquired Pneumonia. PLoS One 2016; 11:e0163262. [PMID: 27846213 PMCID: PMC5113019 DOI: 10.1371/journal.pone.0163262] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 09/05/2016] [Indexed: 02/03/2023] Open
Abstract
Study Design This study aimed to evaluate the diagnostic accuracy of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), midregional proatrial natriuretic peptide (MR-proANP) and midregional proadrenomedullin (MR-proADM) to distinguish bacterial from viral community-acquired pneumonia (CAP) and to identify severe cases in children hospitalized for radiologically confirmed CAP. Index test results were compared with those derived from routine diagnostic tests, i.e., white blood cell (WBC) counts, neutrophil percentages, and serum C-reactive protein (CRP) and procalcitonin (PCT) levels. Methods This prospective, multicenter study was carried out in the most important children’s hospitals (n = 11) in Italy and 433 otherwise healthy children hospitalized for radiologically confirmed CAP were enrolled. Among cases for whom etiology could be determined, CAP was ascribed to bacteria in 235 (54.3%) children and to one or more viruses in 111 (25.6%) children. A total of 312 (72.2%) children had severe disease. Results CRP and PCT had the best performances for both bacterial and viral CAP identification. The cut-off values with the highest combined sensitivity and specificity for the identification of bacterial and viral infections using CRP were ≥7.98 mg/L and ≤7.5 mg/L, respectively. When PCT was considered, the cut-off values with the highest combined sensitivity and specificity were ≥0.188 ng/mL for bacterial CAP and ≤0.07 ng/mL for viral CAP. For the identification of severe cases, the best results were obtained with evaluations of PCT and MR-proANP. However, in both cases, the biomarker cut-off with the highest combined sensitivity and specificity (≥0.093 ng/mL for PCT and ≥33.8 pmol/L for proANP) had a relatively good sensitivity (higher than 70%) but a limited specificity (of approximately 55%). Conclusions This study indicates that in children with CAP, sTREM-1, MR-proANP, and MR-proADM blood levels have poor abilities to differentiate bacterial from viral diseases or to identify severe cases, highlighting that PCT maintains the main role at this regard.
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Affiliation(s)
- Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- * E-mail:
| | - Maria Di Gangi
- Pediatric Infectious Diseases Unit, G. Cristina Hospital, Palermo, Italy
| | | | - Eugenio Baraldi
- Pediatric Pulmonology Unit, Children’s Hospital, University of Padua, Padua, Italy
| | - Ilaria Corsini
- Pediatric Emergency Unit, Policlinico Sant’Orsola, University of Bologna, Bologna, Italy
| | - Liviana Da Dalt
- Pediatric Unit, Treviso Hospital, University of Padua, Padua, Italy
| | - Pier Angelo Tovo
- Pediatric Clinic, Regina Margherita Hospital, University of Turin, Turin, Italy
| | | | - Alberto Villani
- General Pediatrics and Infectious Diseases, IRCCS Bambino Gesù Hospital, Rome, Italy
| | - Oliviero Sacco
- Pulmonology Unit, IRCCS Giannina Gaslini Hospital, Genoa, Italy
| | - Laura Tenero
- Pediatric Clinic, University of Verona, Verona, Italy
| | - Piera Dones
- Pediatric Infectious Diseases Unit, G. Cristina Hospital, Palermo, Italy
| | - Monia Gambino
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Zampiero
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Principi
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Barrett C, Ben-Shimol S, Greenberg D. Differences Between Radiologically Confirmed Pneumonia With and Without Pleural Fluid in Hospitalized Children Younger Than 5 Years in Southern Israel. Clin Pediatr (Phila) 2016; 55:897-903. [PMID: 26578358 DOI: 10.1177/0009922815616246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
We compared demographic and clinical characteristics of pneumonia with and without pleural fluid (PF and Pn, respectively) in hospitalized children younger than 5 years in southern Israel, between 2002 and 2011. Overall, 108 PF and 5811 Pn episodes were recorded. Children with PF were older. Prematurity (6.6% vs 14.0%) and asthma (9.9% vs 23.5%) were less common in PF. Mean temperature and saturation were higher in PF while hemoglobin and sodium levels were lower in PF compared with Pn. Nasal washes were obtained in 30.6% and 39.9% of PF and Pn episodes, respectively, with respiratory syncytial virus identified more commonly in Pn (24.2% vs 42.3%). Streptococcus pneumoniae was identified in 5.2% and 0.9% of blood cultures in PF and Pn, respectively. In conclusion, PF differed from Pn in demographic and clinical characteristics, possibly due to differences in etiology. Although both diseases are considered bacterial, a high proportion of viral etiology was found in both, especially in Pn.
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Affiliation(s)
- Chiya Barrett
- Soroka University Medical Center, Ben-Gurion University, Beer-Sheva, Israel
| | - Shalom Ben-Shimol
- Soroka University Medical Center, Ben-Gurion University, Beer-Sheva, Israel
| | - David Greenberg
- Soroka University Medical Center, Ben-Gurion University, Beer-Sheva, Israel
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An SJ, Bae SP, Park JS, Choi YJ, Lim HH, Lee JH. Antibiotic therapy decision and clinical outcome comparison based on serum procalcitonin in children with pneumonia. ALLERGY ASTHMA & RESPIRATORY DISEASE 2016. [DOI: 10.4168/aard.2016.4.1.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Se Jin An
- Department of Pediatrics, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sung Phil Bae
- Department of Pediatrics, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Joon Soo Park
- Department of Pediatrics, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Young Jin Choi
- Department of Laboratory Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Han Hyuk Lim
- Department of Pediatrics, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jae Ho Lee
- Department of Pediatrics, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
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Giulia B, Luisa A, Concetta S, Bruna LS, Chiara B, Marcello C. Procalcitonin and community-acquired pneumonia (CAP) in children. Clin Chim Acta 2015; 451:215-8. [PMID: 26434548 DOI: 10.1016/j.cca.2015.09.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 09/25/2015] [Accepted: 09/30/2015] [Indexed: 02/04/2023]
Abstract
The role of procalcitonin (PCT) as a biomarker for sepsis in adults is well documented, while its role in infections affecting neonatal children remains controversial. Among these infections, Community-Acquired pneumonia (CAP) has been studied extensively, because it's the second cause of death in children in developing countries, and one of the most frequent causes of hospitalization in industrialized countries. The PubMed database and the Cochrane Library were used to search for the following keywords: CAP, procalcitonin, and children. Thirteen articles were studied to determine the role of PCT in CAP management, specifically its usefulness for distinguishing pneumococcal infections from viral and unknown infections, for predicting severity and the correct antibiotic treatment. This paper focuses on the studies performed to identify the best inflammatory biomarker for CAP management. Although there is an increase in studies confirming the usefulness of PCT in CAP management in children, further studies are needed to have better understanding of its role for pediatric CAP management.
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Affiliation(s)
- Bivona Giulia
- Sezione Biochimica Clinica e Medicina Molecolare, Dipartimento di Biopatologia e Biotecnologie Mediche, Università degli studi di Palermo, Italy
| | - Agnello Luisa
- Sezione Biochimica Clinica e Medicina Molecolare, Dipartimento di Biopatologia e Biotecnologie Mediche, Università degli studi di Palermo, Italy
| | - Scazzone Concetta
- Sezione Biochimica Clinica e Medicina Molecolare, Dipartimento di Biopatologia e Biotecnologie Mediche, Università degli studi di Palermo, Italy
| | - Lo Sasso Bruna
- Sezione Biochimica Clinica e Medicina Molecolare, Dipartimento di Biopatologia e Biotecnologie Mediche, Università degli studi di Palermo, Italy
| | - Bellia Chiara
- Sezione Biochimica Clinica e Medicina Molecolare, Dipartimento di Biopatologia e Biotecnologie Mediche, Università degli studi di Palermo, Italy
| | - Ciaccio Marcello
- Sezione Biochimica Clinica e Medicina Molecolare, Dipartimento di Biopatologia e Biotecnologie Mediche, Università degli studi di Palermo, Italy; UOC Medicina di Laboratorio-CoreLab, AOUP Policlinico P. Giaccone, Palermo, Italy.
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Abstract
Community-acquired pneumonia is one of the most common reasons for emergency department (ED) visits in children and adults. Despite its prevalence, there are many challenges to proper diagnosis and management of pneumonia. There is no accurate and timely etiologic gold standard to differentiate bacterial from viral disease, and there are limitations with precise risk stratification of patients to ensure appropriate site-of-care decisions. Clinical factors obtained by history and physical examination have limited the ability to diagnose pneumonia etiology and severity. Biomarkers offer information about the host response to infection and pathogen activity within the host that can serve to augment clinical features in decision-making. As science and technology progress, novel biomarkers offer great potential in aiding critical decisions for patients with pneumonia. This review summarizes existing knowledge about biomarkers of host response and pathogen activity, in addition to briefly reviewing emerging biomarkers using novel technologies.
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Wróblewski T, Marcisz C. Procalcitonin as a biomarker of acute lower respiratory tract infections. ACTA ACUST UNITED AC 2013; 3:67-79. [PMID: 23495964 DOI: 10.1517/17530050802623859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Procalcitonin (PCT) has emerged as a promising 'acute phase' biomarker used for diagnosis of acute bacterial infections of the respiratory tract. The introduction of new sensitive PCT assays has facilitated implementation of a new clinical approach to reduce antibiotic use in acute lower respiratory tract infections (LRTIs), without compromising patient safety. OBJECTIVE Current state of knowledge on the clinical usefulness of serum PCT measurements for the evaluation of acute LRTIs is presented herein, together with basic information on available rapid diagnostic tests for PCT measurement. METHODS During the literature search the emphasis was on PCT use as a diagnostic, monitoring and prognostic tool for acute LRTIs. The acute LRTIs have been defined as acute bronchitis, acute exacerbations of chronic obstructive pulmonary disease or asthma, and pneumonia. Original studies involving patients with these conditions have been considered, and recent articles documenting interventional trials on PCT use for guidance of antimicrobial treatment in LRTIs have been reviewed in particular. RESULTS/CONCLUSION When measured with sensitive and rapid assays, PCT has proved to be a good biomarker for acute bacterial LRTIs, which enables an early diagnosis, facilitates therapeutic decisions, and can inform clinicians about the course of disease and prognosis. PCT can become a particularly suitable tool for implementation in an emergency and acute medical care setting.
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Affiliation(s)
- Tomasz Wróblewski
- Oddział Nefrologii i Chorób Wewnetrznych, Szpital Powiatowy w Chrzanowie, ul. Topolowa 16, PL 32-500 Chrzanów, Poland +48 32 624 7326, +48 32 624 7777 ; +48 32 623 9428 ;
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Williams DJ, Shah SS. Community-Acquired Pneumonia in the Conjugate Vaccine Era. J Pediatric Infect Dis Soc 2012; 1:314-28. [PMID: 26619424 PMCID: PMC7107441 DOI: 10.1093/jpids/pis101] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 10/05/2012] [Indexed: 12/27/2022]
Abstract
Community-acquired pneumonia (CAP) remains one of the most common serious infections encountered among children worldwide. In this review, we highlight important literature and recent scientific discoveries that have contributed to our current understanding of pediatric CAP. We review the current epidemiology of childhood CAP in the developed world, appraise the state of diagnostic testing for etiology and prognosis, and discuss disease management and areas for future research in the context of recent national guidelines.
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Affiliation(s)
- Derek J. Williams
- Division of Hospital Medicine, The Monroe Carell Jr Children's Hospital at Vanderbilt, and,Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee; Divisions of,Corresponding Author: Derek J. Williams, MD, MPH, 1161 21st Ave. South, CCC 5311 Medical Center North, Nashville, TN 37232. E-mail: derek.
| | - Samir S. Shah
- Infectious Diseases and,Hospital Medicine, Cincinnati Children's Hospital Medical Center,Department of Pediatrics, University of Cincinnati College of Medicine, Ohio
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Antibiotic therapy for pediatric community-acquired pneumonia: do we know when, what and for how long to treat? Pediatr Infect Dis J 2012; 31:e78-85. [PMID: 22466326 DOI: 10.1097/inf.0b013e318255dc5b] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Community-acquired pneumonia (CAP) is a common cause of morbidity among children in developed countries and accounts for an incidence of 10-40 cases per 1000 children in the first 5 years of life. Given the clinical, social and economic importance of CAP, there is general agreement that prompt and adequate therapy is essential to reduce the impact of the disease. The aim of this discussion paper is to consider critically the available data concerning the treatment of uncomplicated pediatric CAP and to consider when, how and for how long it should be treated. This review has identified the various reasons that make it difficult to establish a rational approach to the treatment of pediatric CAP, including the definition of CAP, the absence of a pediatric CAP severity score, the difficulty of identifying the etiology, limited pharmacokinetic (PK)/pharmacodynamic (PD) studies, the high resistance of the most frequent respiratory pathogens to the most widely used anti-infectious agents and the lack of information concerning the changes in CAP epidemiology following the introduction of new vaccines against respiratory pathogens. More research is clearly required in various areas, such as the etiology of CAP and the reasons for its complications, the better definition of first- and second-line antibiotic therapies (including the doses and duration of parenteral and oral antibiotic treatment), the role of antiviral treatment and on how to follow-up patients with CAP. Finally, further efforts are needed to increase vaccination coverage against respiratory pathogens and to conduct prospective studies of their impact.
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The Role of Procalcitonin in Respiratory Infections. Curr Infect Dis Rep 2012; 14:308-16. [DOI: 10.1007/s11908-012-0249-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C, Kaplan SL, Mace SE, McCracken GH, Moore MR, St Peter SD, Stockwell JA, Swanson JT. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis 2011; 53:e25-76. [PMID: 21880587 PMCID: PMC7107838 DOI: 10.1093/cid/cir531] [Citation(s) in RCA: 972] [Impact Index Per Article: 74.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 07/08/2011] [Indexed: 02/07/2023] Open
Abstract
Evidenced-based guidelines for management of infants and children with community-acquired pneumonia (CAP) were prepared by an expert panel comprising clinicians and investigators representing community pediatrics, public health, and the pediatric specialties of critical care, emergency medicine, hospital medicine, infectious diseases, pulmonology, and surgery. These guidelines are intended for use by primary care and subspecialty providers responsible for the management of otherwise healthy infants and children with CAP in both outpatient and inpatient settings. Site-of-care management, diagnosis, antimicrobial and adjunctive surgical therapy, and prevention are discussed. Areas that warrant future investigations are also highlighted.
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Affiliation(s)
- John S Bradley
- Department of Pediatrics, University of California San Diego School of Medicine and Rady Children's Hospital of San Diego, San Diego, California, USA.
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Esposito S, Tagliabue C, Picciolli I, Semino M, Sabatini C, Consolo S, Bosis S, Pinzani R, Principi N. Procalcitonin measurements for guiding antibiotic treatment in pediatric pneumonia. Respir Med 2011; 105:1939-45. [PMID: 21959024 DOI: 10.1016/j.rmed.2011.09.003] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 09/05/2011] [Accepted: 09/12/2011] [Indexed: 11/15/2022]
Abstract
In order to evaluate the use of an algorithm based on a procalcitonin (PCT) cut-off value as a means of guiding antibiotic therapy, 319 hospitalised children with uncomplicated community-acquired pneumonia (CAP) were randomised 1:1 to be treated on the basis of the algorithm or in accordance with standard guidelines. The children in the PCT group did not receive antibiotics if their PCT level upon admission was <0.25 ng/mL, and those receiving antibiotics from the time of admission were treated until their PCT level was ≥ 0.25 ng/mL. The final analysis was based on 155 patients in the PCT group and 155 in the control group. In comparison with the controls, the PCT group received significantly fewer antibiotic prescriptions (85.8% vs 100%; p < 0.05), were exposed to antibiotics for a shorter time (5.37 vs 10.96 days; p < 0.05), and experienced fewer antibiotic-related adverse events (3.9% vs 25.2%; p < 0.05), regardless of CAP severity. There was no significant between-group difference in recurrence of respiratory symptoms and new antibiotic prescription in the month following enrollment. The results of this first prospective study using a PCT cut-off value to guide antibiotic therapy for pediatric CAP showed that this approach can significantly reduce antibiotic use and antibiotic-related adverse events in children with uncomplicated disease. However, because the study included mainly children with mild to moderate CAP and the risk of the use of the algorithm-based approach was not validated in a relevant number of severe cases, further studies are needed before it can be used in routine clinical practice.
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Affiliation(s)
- Susanna Esposito
- Department of Maternal and Pediatric Sciences, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy, Via Commenda 9, 20122 Milano, Italy
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Brouard J, Vabret A, Nimal-Cuvillon D, Bach N, Bessière A, Arion A, Freymuth F. Bronconeumopatías agudas del niño. EMC. PEDIATRIA 2011; 44:1-16. [PMID: 32308523 PMCID: PMC7158968 DOI: 10.1016/s1245-1789(09)70209-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Las infecciones infantiles afectan con frecuencia al aparato respiratorio inferior. Las clasificaciones convencionales, basadas en el tipo de afección anatómica, radiológica y etiopatogénica, permiten definir entidades clínicas (bronquitis, bronquiolitis, neumopatía); sin embargo, la evaluación de la gravedad del proceso es lo más útil para decidir el tipo y la rapidez del tratamiento. Aunque la etiología viral es la más frecuente, la estrategia fundamental para reducir la morbilidad e incluso la mortalidad de las infecciones respiratorias bajas se basa en el tratamiento adecuado de las neumonías bacterianas. Ante la ausencia de especificidad, es indispensable, cuando esté indicado, recurrir a una antibioticoterapia inicial probabilística que incluya el neumococo. En el niño, las muestras no suelen proceder del parénquima pulmonar y, además, la recogida de las secreciones bronquiales durante los primeros años de vida no es de buena calidad. Al contrario de lo que ocurre con los virus, el examen bacteriológico de las secreciones de las vías respiratorias altas es poco útil, porque los niños suelen ser portadores de gérmenes que pueden causar neumopatías. Los datos clínicos y radiológicos sólo pueden sugerir el diagnóstico. El desarrollo de técnicas que detectan antígenos microbianos o la búsqueda de material genético por biología molecular han permitido mejorar de manera significativa la identificación del patógeno responsable y la elección del tratamiento adecuado. Algunos grupos particulares de pacientes pueden padecer una afección respiratoria por agentes infecciosos inusuales o, incluso, oportunistas. Una proporción importante de la afectación respiratoria del adulto puede atribuirse a las agresiones pulmonares sufridas durante su infancia. La aplicación de vacunas, en especial, la antigripal y la antineumocócica, es fundamental para la prevención de estas afecciones respiratorias.
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Affiliation(s)
- J. Brouard
- Service de pédiatrie, Centre hospitalier universitaire de Caen, avenue Clemenceau, BP 95182, 14033 Caen cedex 5, France
| | - A. Vabret
- Laboratoire de virologie, Centre hospitalier universitaire de Caen, avenue Clemenceau, BP 95182, 14033 Caen cedex 5, France
| | - D. Nimal-Cuvillon
- Service de pédiatrie, Centre hospitalier universitaire de Caen, avenue Clemenceau, BP 95182, 14033 Caen cedex 5, France
| | - N. Bach
- Service de pédiatrie, Centre hospitalier universitaire de Caen, avenue Clemenceau, BP 95182, 14033 Caen cedex 5, France
| | - A. Bessière
- Service de pédiatrie, Centre hospitalier universitaire de Caen, avenue Clemenceau, BP 95182, 14033 Caen cedex 5, France
| | - A. Arion
- Service de pédiatrie, Centre hospitalier universitaire de Caen, avenue Clemenceau, BP 95182, 14033 Caen cedex 5, France
| | - F. Freymuth
- Laboratoire de virologie, Centre hospitalier universitaire de Caen, avenue Clemenceau, BP 95182, 14033 Caen cedex 5, France
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Abstract
Community-acquired pneumonia (CAP) still remains a significant cause for childhood morbidity worldwide. Streptococcus pneumoniae is the most important causative agent at all ages. Respiratory syncytial virus is common in young children, and Mycoplasma pneumoniae in schoolchildren. Paediatric CAP is universally treated with antibiotics; amoxicillin is the drug of choice for presumably pneumococcal and a macrolide for presumably atypical bacterial cases. Because of globally increased resistances, macrolides are not safety for pneumococcal CAP. At present, available prospective research data on the epidemiology of paediatric CAP in western countries are from 1970s to 1980s; correspondingly, data on bacterial aetiology are mainly from 1980s to 1990s. Current concepts on pneumococcal aetiology are mostly based on poorly validated antibody assays. Most data on clinical characteristics in children's CAP, as well as on antibiotic treatment come from developing countries, thus not being directly applicable in western communities. Recent viral studies have revealed the role of rhinoviruses, metapneumovirus and bocavirus in the aetiology of paediatric CAP. This review critically summarizes the available data on epidemiology, aetiology, clinical presentation, treatment and outcome of CAP in children, with special focus on the newest microbial findings, the age and applicability of the data and the need of new studies.
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Affiliation(s)
- Massimiliano Don
- Pediatric Department, School of Medicine, DPMSC, University of Udine, Udine, Italy.
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Lee JY, Hwang SJ, Shim JW, Jung HL, Park MS, Woo HY, Shim JY. Clinical Significance of Serum Procalcitonin in Patients with Community-acquired Lobar Pneumonia. Ann Lab Med 2010; 30:406-13. [DOI: 10.3343/kjlm.2010.30.4.406] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Jin Yong Lee
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Su Jin Hwang
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Won Shim
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Lim Jung
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Moon Soo Park
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Yeon Woo
- Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Yeon Shim
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Procalcitonin as a marker of severe bacterial infection in children in the emergency department. Pediatr Emerg Care 2010; 26:51-60; quiz 61-3. [PMID: 20065834 DOI: 10.1097/pec.0b013e3181c399df] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Procalcitonin, the prohormone of calcitonin, is a relatively new and innovative marker of bacterial infection that has multiple potential applications in the pediatric emergency department. In healthy individuals, circulating levels of procalcitonin are generally very low (<0.05 ng/mL), but in the setting of severe bacterial infection and sepsis, levels can increase by hundreds to thousands of fold within 4 to 6 hours. Although the exact physiologic function of procalcitonin has not been determined, the consistent response and rapid rise of this protein in the setting of severe bacterial infection make procalcitonin a very useful biomarker for invasive bacterial disease. In Europe, serum procalcitonin measurements are frequently used in the diagnosis and the management of patients in a variety of clinical settings. To date, the use of procalcitonin has been limited in the United States, but this valuable biomarker has many potential applications in both the pediatric emergency department and the intensive care unit. The intent of this article is to review the history of procalcitonin, describe the kinetics of the molecule in response to bacterial infection, describe the laboratory methods available for measuring procalcitonin, examine the main causes of procalcitonin elevation, and evaluate the potential applications of procalcitonin measurements in pediatric patients.
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24
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Don M, Valent F, Korppi M, Falleti E, De Candia A, Fasoli L, Tenore A, Canciani M. Efficacy of serum procalcitonin in evaluating severity of community-acquired pneumonia in childhood. ACTA ACUST UNITED AC 2009; 39:129-37. [PMID: 17366029 DOI: 10.1080/00365540600951283] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Microbe-specific diagnosis of community-acquired pneumonia (CAP) in childhood is difficult in clinical practice. Chest radiographs and non-specific inflammatory markers have been used to separate presumably bacterial from viral infection but the results have been inconsistent. The aim of the present study was to evaluate the usefulness of procalcitonin (PCT) in assessing the severity as well as the bacterial or viral aetiology of CAP. Serum PCT was measured by an immunoluminometric assay in 100 patients with CAP; 26 were treated as inpatients and 74 as outpatients. The pulmonary infiltrate was considered to be alveolar in 62 and interstitial in 38 cases, according to the radiological diagnosis. The bacterial and viral aetiology of pneumonia was studied by an extensive serological test panel. No differences were found in PCT concentrations between the 4 aetiological (pneumococcal, atypical bacterial, viral, unknown) and the 3 age (< 2, 2-4 and > or = 5 y) groups. Serum PCT was >0.5 ng/ml in 69%, >1.0 ng/ml in 54% and >2.0 ng/ml in 47% of all patients. PCT was higher in patients that were admitted than as outpatients (medians 17.81 vs 0.72 ng/ml, respectively, p<0.01) and higher in alveolar than in interstitial pneumonia (medians 9.43 vs 0.53 ng/ml, respectively, p<0.01). In conclusion, serum PCT values were found to be related to the severity of CAP in children even though they were not capable, at any level of serum concentration, to differentiate between bacterial and viral aetiology.
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Affiliation(s)
- Massimiliano Don
- Department of Paediatrics, School of Medicine, DPMSC, University of Udine, Udine, Italy.
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25
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Don M, Valent F, Korppi M, Canciani M. Differentiation of bacterial and viral community-acquired pneumonia in children. Pediatr Int 2009; 51:91-6. [PMID: 19371285 DOI: 10.1111/j.1442-200x.2008.02678.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Microbe-specific diagnosis of pediatric community-acquired pneumonia (CAP) and the distinction between typical-bacterial, atypical-bacterial and viral cases are difficult. The aim of the present study was to evaluate the role of four serum non-specific inflammatory markers and their combinations, supplemented by chest radiological findings, in the screening of bacterial etiology of pediatric CAP. METHODS Serum procalcitonin (PCT), serum C-reactive protein (CRP), blood erythrocyte sedimentation rate (ESR) and white blood cell (WBC) counts were determined in 101 children with CAP, all confirmed on chest radiograph. Evidence of etiology was achieved in 68 patients (67%) mainly using a serologic test panel including 15 pathogens. RESULTS For the combination of CRP > 100 mg/L, WBC count > 15 x 10(9)/L, PCT > 1.0 ng/mL and ESR > 65 mm/h, the likelihood ratio for a positive test result (LR+) was 2.7 in the distinction between pneumococcal and viral CAP and 3.9 between atypical and viral CAP. If there was a higher value in one of these four parameters (CRP > 200 mg/L, WBC count > 22 x 10(9)/L, PCT > 18 ng/mL or ESR > 90 mm/h) LR+ changed to >or=3.4, which means a significant increase from pre-test to post-test disease probability. An alveolar radiological infiltration was associated with higher values in non-specific inflammatory markers when compared with interstitial infiltrates, but there were no significant associations between radiological and etiological findings. CONCLUSIONS CRP, WBC count, PCT and ESR or their combinations have a limited role in screening between bacterial and viral pediatric CAP. If all or most of these markers are elevated, bacterial etiology is highly probable, but low values do not rule out bacterial etiology.
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Affiliation(s)
- Massimiliano Don
- Department of Pediatrics, School of Medicine, DPMSC, University of Udine, Italy.
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26
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Abstract
Procalcitonin measurement has been claimed as a helpful marker in bacterial infection and sepsis. It has obtained FDA approval and is now widely marketed in the United States and Europe. This review summarises the current assays available, the evidence for its use and possible future applications of the assay.
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Affiliation(s)
- Hans-Gerhard Schneider
- Clinical Biochemistry Unit, Alfred Pathology Service, The Alfred Hospital, Monash University, Melbourne, Australia.
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27
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C-Reactive Protein and Procalcitonin as Markers of Infection, Inflammatory Response, and Sepsis. ACTA ACUST UNITED AC 2007. [DOI: 10.1097/cpm.0b013e3180555bbe] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Community-acquired bronchopneumonia is very common in children and responsible for a great morbidity. It can be revealed by bronchiolitis, due to viral infection, bronchitis (80% due to viruses), and pneumonia potentially much more severe due to bacteria (60%), viruses (40%) or both causes (20%). Being unable to exclude a bacterial origin in pneumonia leads physicians to prescribe systematically antibiotics.
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Affiliation(s)
- V Marchac
- Service de pneumologie et allergologie pédiatriques, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France.
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29
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Balfour-Lynn IM, Abrahamson E, Cohen G, Hartley J, King S, Parikh D, Spencer D, Thomson AH, Urquhart D. BTS guidelines for the management of pleural infection in children. Thorax 2005; 60 Suppl 1:i1-21. [PMID: 15681514 PMCID: PMC1766040 DOI: 10.1136/thx.2004.030676] [Citation(s) in RCA: 232] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- I M Balfour-Lynn
- Consultant in Paediatric Respiratory Medicine, Royal Brompton Hospital, Syndey St, SW3 6NP London, UK.
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30
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Madhi SA, Heera JR, Kuwanda L, Klugman KP. Use of procalcitonin and C-reactive protein to evaluate vaccine efficacy against pneumonia. PLoS Med 2005; 2:e38. [PMID: 15736995 PMCID: PMC549587 DOI: 10.1371/journal.pmed.0020038] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2004] [Accepted: 12/17/2004] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pneumonia remains the leading cause of death in young children. The poor specificity of chest radiographs (CXRs) to diagnose pneumococcal pneumonia may underestimate the efficacy of pneumococcal conjugate vaccine in preventing pneumococcal pneumonia. METHODS AND FINDINGS The efficacy of nine-valent pneumococcal conjugate vaccine among children not infected with HIV (21%; 95% confidence interval, 1%-37%) increased when CXR-confirmed pneumonia was associated with serum C-reactive protein of 120 mg/l (12 mg/dl) or more and procalcitonin of 5.0 ng/ml or more (64%; 95% confidence interval, 23%-83%). Similar results were observed in children infected with HIV. CONCLUSION C-reactive protein and procalcitonin improve the specificity of CXR to diagnose pneumococcal pneumonia and may be useful for the future evaluation of the effectiveness of pneumococcal conjugate vaccine in preventing pneumococcal pneumonia.
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Affiliation(s)
- Shabir A Madhi
- National Health Laboratory Service, University of The Witwatersrand, Johannesburg, South Africa.
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31
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Korppi M. Non-specific host response markers in the differentiation between pneumococcal and viral pneumonia: what is the most accurate combination? Pediatr Int 2004; 46:545-50. [PMID: 15491381 DOI: 10.1111/j.1442-200x.2004.01947.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Serum C-reactive protein (CRP), blood white cell count (WBC), serum procalcitonin (PCT) and erythrocyte sedimentation rate (ESR) were measured in 132 children hospitalized for community-acquired pneumonia. Serological evidence for viral infection was found in 38 cases and for pneumococcal infection in 41 cases, and the infiltrate was alveolar in 46 cases and interstitial in 86 cases. The aim of the present paper was to determine if there is a combination of these four host response markers and chest radiograph findings suitable for differentiating pneumococcal from viral etiology of pneumonia. METHODS The 50th, 75th and 90th percentiles of CRP, WBC, ESR and PCT in the total group of 132 patients were calculated. By using these cut-off limits, the likelihood ratios of a positive test result were calculated for the possible combinations of CRP, WBC, ESR and PCT, and the likelihood ratio was 1.50 or more for six combinations. RESULTS The highest likelihood ratio (1.74) was achieved with the combination CRP > 90th (80 mg/L) or WBC > 75th (17.0 x 10(9)/L) or PCT > 75th (0.84 microg/L) or ESR > 90th (63 mm/h) percentile. For this combination, the sensitivity was 61% and the specificity 65%. When the 90th percentile cut-off limit was applied also for WBC (>22 x 10(9)/L) and PCT (>1.8 microg/L), the specificity increased to 76%, but the sensitivity decreased to 37%. When the presence of an alveolar infiltration was included in the combination, the likelihood ratio was 1.89; the specificity was as high as 82% and the sensitivity as low as 34%. CONCLUSIONS CRP, PCT, WBC and ESR have only limited value in differentiating pneumococcal or other bacterial pneumonia from viral pneumonia. If there was a high value in at least one of the markers (CRP > 80 mg/L, PCT > 1.8 microg/L, WBC > 22 x 10(9)/L or ESR > 60 mm/h), viral infections were rare. There was no combination of these markers which was sufficiently sensitive and specific to be used in clinical pediatric practice.
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Affiliation(s)
- Matti Korppi
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland.
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van Rossum AMC, Wulkan RW, Oudesluys-Murphy AM. Procalcitonin as an early marker of infection in neonates and children. THE LANCET. INFECTIOUS DISEASES 2004; 4:620-30. [PMID: 15451490 DOI: 10.1016/s1473-3099(04)01146-6] [Citation(s) in RCA: 180] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A child or neonate presenting with fever is a common medical problem. To differentiate between those with a severe bacterial infection and those with a localised bacterial or a viral infection can be a challenge. This review provides an overview of neonatal and paediatric studies that assess the use of procalcitonin as an early marker of bacterial infection. Procalcitonin is an excellent marker for severe, invasive bacterial infection in children. However, the use of procalcitonin in the diagnosis of neonatal bacterial infection is complicated, but if correctly used procalcitonin results in a higher specificity than C-reactive protein. In addition, procalcitonin has been shown to correlate with severity of disease (urinary tract infections and sepsis), and can therefore be used as a prognostic marker. Procalcitonin is therefore a useful additional tool for the diagnosis of bacterial disease in neonates and children.
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Abstract
The treatment of community-acquired pneumonia (CAP) in children is empirical, being based on the knowledge of the etiology of CAP at different ages. As a result of currently available methods in everyday clinical practice, a microbe-specific diagnosis is not realistic in the majority of patients. Even the differentiation between viral, 'atypical' bacterial (Mycoplasma pneumoniae or Chlamydia pneumoniae) and 'typical' bacterial (Streptococcus pneumoniae) CAP is often not possible. Moreover, up to one-third of CAP cases seem to be mixed viral-bacterial or dual bacterial infections. Recent serologic studies have confirmed that S. pneumoniae is an important causative agent of CAP at all ages. M. pneumoniae is common from the age of 5 years onwards, and C. pneumoniae is common from the age of 10 years onwards. In addition to age, the etiology and treatment of CAP are dependent on the severity of the disease. Pneumococcal infections are predominant in children treated in hospital, and mycoplasmal infections are predominant in children treated at home.In ambulatory patients with CAP, amoxicillin (or penicillin V [phenoxymethylpenicillin]) is the drug of choice from the age of 4 months to 4 years, and at all ages if S. pneumoniae is the presumptive causative organism. Macrolides, preferably clarithromycin or azithromycin, are the first-line drugs from the age of 5 years onwards. In hospitalized patients who need parenteral therapy for CAP, cefuroxime (or penicillin G [benzylpenicillin]) is the drug of choice. Macrolides should be administered concomitantly if M. pneumoniae or C. pneumoniae infection is suspected. Radiologic findings and C-reactive protein (CRP) levels offer limited help for the selection of antibacterials; alveolar infiltrations and high CRP levels indicate pneumococcal pneumonia, but the lack of these findings does not rule out bacterial CAP. Most guidelines recommend antibacterials for 7-10 days (except azithromycin, which has a recommended treatment duration of 5 days). If no improvement takes place within 2 days, therapy must be reviewed.
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Affiliation(s)
- Matti Korppi
- Department of Paediatrics, Kuopio University and University Hospital, Kuopio, Finland.
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34
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Prat C, Domínguez J, Rodrigo C, Giménez M, Azuara M, Jiménez O, Galí N, Ausina V. Procalcitonin, C-reactive protein and leukocyte count in children with lower respiratory tract infection. Pediatr Infect Dis J 2003; 22:963-8. [PMID: 14614368 DOI: 10.1097/01.inf.0000095197.72976.4f] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lower respiratory tract infection is the most common infection leading to unnecessary antibiotic treatment in children. Etiologic diagnosis is not immediately achieved, and the pathogen remains unidentified in a large number of cases. Neither clinical nor laboratory factors allow for a rapid distinction between bacterial and viral etiology. The aim of our study was to evaluate the reliability of procalcitonin (PCT), C-reactive protein (CRP) and leukocyte count in distinguishing pneumococcal, atypical and viral lower respiratory tract infection. METHODS PCT, CRP and leukocyte count were measured in children with microbiologically documented diagnoses of lower respiratory tract infection. The results were compared of children with pneumococcal, atypical and viral etiologies. RESULTS PCT and CRP showed significant correlation with a bacterial etiology of lower respiratory tract infection. No significance was found for leukocyte count. Using a cutoff point of 2 ng/ml for PCT and 65 mg/l for CRP, the sensitivities and specificities for distinguishing bacterial from viral lower respiratory tract infections were 68.6 and 79.4% for PCT and 79.1 and 67.1% for CRP. The sensitivities and specificities for distinguishing pneumococcal from other etiologies were 90.3 and 74.1% for PCT and 90.3 and 60% for CRP, respectively. CONCLUSIONS High PCT and CRP values show a significant correlation with the bacterial etiology of lower respiratory tract infection. PCT and CRP show good sensitivity for distinguishing pneumococcal from other etiologies. PCT shows higher specificity than CRP. PCT and CRP can help make decisions about antibiotic therapy in children with lower respiratory tract infections.
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Affiliation(s)
- Cristina Prat
- Servei de Microbiologia, Hospital Universitari Germans Trias i Pujol, C/Canyet s/n, 08916 Badalona, Spain.
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Korppi M, Remes S, Heiskanen-Kosma T. Serum procalcitonin concentrations in bacterial pneumonia in children: a negative result in primary healthcare settings. Pediatr Pulmonol 2003; 35:56-61. [PMID: 12461740 DOI: 10.1002/ppul.10201] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A microbe-specific diagnosis in community-acquired pneumonia (CAP) is difficult in children, and studies on nonspecific chest radiographic and host response markers have been inconsistent. Serum procalcitonin (PCT) is a newly recognized, promising marker for differentiating between bacterial and viral infections. Serum PCT was measured by a luminometric assay in 190 children with CAP diagnosed in the primary healthcare setting during a population-based study in a geographically defined population. The pneumococcal, mycoplasma, chlamydia, and viral etiology of infections was studied by an extensive serologic test panel. The median PCT concentrations were 0.47, 0.46, and 0.35 ng/mL in children aged <5 years, 5-9 years, and >/=10 years (P = 0.004). An elevated PCT >1.0 ng/mL was seen in 12.1% and >2.0 ng/mL in only 2.1% of the children. No association was seen between severity (inpatient vs. outpatient care) and etiology of CAP (evidence for pneumococcal, mycoplasma, or chlamydia, vs. viral infection). We conclude that serum PCT measurements have no role in the diagnosis of bacterial CAP in children in primary healthcare settings.
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Affiliation(s)
- Matti Korppi
- Department of Paediatrics, Kuopio University Hospital, Kuopio University, Kuopio, Finland.
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Esposito S, Principi N. Emerging resistance to antibiotics against respiratory bacteria: impact on therapy of community-acquired pneumonia in children. Drug Resist Updat 2002; 5:73-87. [PMID: 12135583 DOI: 10.1016/s1368-7646(02)00018-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Perhaps because of its etiologic complexity, community-acquired pneumonia (CAP) in infants and children remains a significant problem worldwide. Over the last few years, difficulties related to CAP treatment in children have greatly increased because of the emergence of resistance to the most widely used antibiotics against some of the bacterial pathogens involved in the development of the disease. There are few data describing the impact of antibiotic resistance on clinical outcomes in CAP, but many experts believe that the clinical impact is limited. We here discuss the prevalence of different etiologic agents in CAP of children, the diagnostic criteria, problems related to antibiotic resistance, therapeutic strategies, and future implications.
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Affiliation(s)
- Susanna Esposito
- Pediatric Department I, University of Milan, Via Commenda 9, 20122 Milan, Italy.
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