Serum procalcitonin does not differentiate between infection and disease flare in patients with systemic lupus erythematosus

Systemic erythematosus lupus (SLE) is a common autoimmune disease. Disease flares may mimic infection with fever, inflammatory syndrome and chills, sometimes resulting in a difficult differential diagnosis. Elevated serum procalcitonin (PCT) levels have been reported to be predictive of bacterial infections, but with conflicting results. The value of serum procalcitonin has not been assessed in large series of SLE. We aimed to describe the distribution of PCT levels in SLE patients with and without flares, to assess the factors associated with increased PCT levels, and to determine the positive and negative predictive values of increased PCT for bacterial infection in SLE patients. Hospitalized SLE patients were included in a retrospective study. Serum PCT had been assayed, or a serum sample had been frozen on admission, before treatment modification. Serum PCT, measured by an automated immunofluorometric assay, and SLEDAI were assessed at the same time. Some 53 women (median age: 33.7?years, range 16-76) and seven men (median age: 52.5?years?±?19) were included. The median SLEDAI for patients with flare (n?=?16, 28%) was 2 (range: 0-29). Five patients (8%) had systemic infection. Only one patient had increased PCT levels. Men had significantly higher PCT levels than women (0.196?±?0.23 versus 0.066?±?0.03, p?相似文献   

Diagnostic value of procalcitonin measurement in febrile patients with systemic autoimmune diseases

OBJECTIVE: To determine the usefulness of plasma procalcitonin (PCT) measurement to suspect infectious etiology in febrile patients with systemic autoimmune disease. METHODS: PCT, C-Reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white blood cell count (WBC) were measured in 44 consecutive inpatients with a diagnosis of systemic autoimmune disease and fever >38 masculine C. After careful microbiologic screening no obvious infection was demonstrated in 24 patients (Group A) while an infectious bacterial complication was diagnosed in 20 cases (Group B). RESULTS: Median PCT levels were significantly higher in the group B (1.11 vs 0.24 ng/ml; p = 0.0007), whereas the differences for CRP, WBC and ESR did not reach statistical significance. PCT also exhibited a good sensitivity and specificity (75%) in differentiating patients with infection from those with disease flare. With respect to positive and negative predictive values (71.4% and 78.2%), PCT markedly exceeded the other variables. By analyzing PCT values by disease we identified a false positive subgroup of patients suffering from adult onset Still's disease (AOSD), showing markedly elevated PCT levels in absence of infection. By excluding these patients, PCT showed a very good sensitivity and specificity (73.6% and 89.4%) and the area under receiver operating characteristics (ROC) curve rose from 0.801 to 0.904. CONCLUSION: Our data indicate that elevated PCT concentrations offer good sensitivity and specificity for the diagnosis of systemic bacterial infection in febrile patients with systemic autoimmune diseases. However, in fever associated with AOSD PCT may be elevated even in the absence of infectious complication.     

Diagnostic accuracy of serum procalcitonin concentrations for detecting systemic bacterial infection in patients with systemic autoimmune diseases

OBJECTIVE: To examine whether serum procalcitonin (PCT) concentrations are useful for distinguishing bacterial infections from disease flares in patients with systemic autoimmune diseases. METHODS: Patients with systemic autoimmune diseases who were admitted to our hospitals due to either a suspected deterioration of their primary diseases or an infectious disease were enrolled. Serum PCT levels were measured in 99 serum samples of 98 patients who had elevated serum C-reactive protein (CRP) levels; 29 samples were obtained from patients with bacterial infections, and 70 samples were obtained from patients with disease deterioration without a detectable infection. The diagnostic accuracy, sensitivity, and specificity for identifying a bacterial infection were estimated using the receiver-operating characteristic curve. Multiple logistic regression analysis was also done with PCT level, age, sex, steroid dose, and use of immunosuppressive agents. RESULTS: Serum PCT levels were higher in the bacterial infection group than in the disease flare group (mean +/- SD, 4.539 +/- 9.677 vs 0.116 +/- 0.127; p < 0.0001). The diagnostic accuracy of PCT for bacterial infection was 0.797, sensitivity 53.3%, and specificity 97.1%. On multivariate analysis, the odds ratio of a PCT > or = 0.5 ng/ml was significant (OR 59.085, 95% CI 7.705 453.088, p < 0.0001) for identifying bacterial infection. CONCLUSION: Elevated serum PCT levels have a good specificity for diagnosing bacterial infection in patients with systemic autoimmune diseases regardless of their dosage of oral corticosteroids and immunosuppressive agents.     

Extrahepatic manifestations of infection with hepatitis C virus.

Chronic hepatitis C is associated with, and may trigger or exacerbate, an extraordinary variety of extrahepatic manifestations. Most of these manifestations affect the skin, the most frequent and important of which are the leukocytoclastic vasculitis of MC type II and PCT. The former is an example of an autoimmune disorder triggered by HCV infection, whereas PCT is a skin disease caused by hepatic overproduction of uro- and 7-carboxyl porphyrins caused by increased oxidative stress in hepatocytes. Currently available effective therapies of CHC (IFN, ribavirin) may also trigger or exacerbate extrahepatic manifestations, especially including autoimmune thyroiditis, skin rashes, and hemolytic anemia.     

Hepatitis C virus infection and non-Hodgkin's lymphoma: a review and case report of nine patient

The role of hepatitis C virus (HCV) is well established in the development of chronic hepatitis, cirrhosis and hepatic carcinoma, as well as in mixed type II cryoglobulinemia, membranoproliferative glomerulonephritis(MPGN) and porphyria cutanea tarda (PCT). Increasing evidence has been reported of a close association of HCV infection with autoimmune and hematological processes, mainly cytopenias and lymphoproliferative disorders such as B cell non-Hodgkin's lymphoma. We describe the demographic, clinical and histopathological findings of nine patients from the Mexican population with non-Hodgkin's lymphoma and HCV infection.     

Serum procalcitonin concentration in patients with Kawasaki disease

BACKGROUND: Procalcitonin (PCT) is a new parameter of inflammation, the clinical usefulness of which is currently being evaluated. MATERIALS AND METHODS: We determined simultaneously the serum concentrations of PCT and C-reactive protein (CRP) as well as the white blood cell (WBC) count in 25 patients with Kawasaki disease (KD), 17 with bacterial infections, 10 with systemic autoimmune diseases, 17 with viral infections and 18 healthy children. The optimal cut-off value of each parameter for predicting coronary aneurysms was determined using receiver operating characteristic curves. RESULTS: Significantly higher serum concentrations of PCT were observed in patients with KD (2.3 +/- 3.0 ng/ml) and bacterial infections (2.2 +/- 2.9 ng/ml) than in patients with autoimmune diseases (0.4 +/- 0.4 ng/ml) or viral infections (0.4 +/- 0.3 ng/ml), or in healthy children (0.2 +/- 0.1 ng/ml). The serum PCT but not the WBC count or CRP, differentiated the KD patients from the patients with autoimmune diseases. The optimal cut-off value of 3.0 ng/ml of PCT increased the prediction rate of coronary aneurysms that subsequently occurred in 4 (16%) patients with KD. CONCLUSIONS: The serum PCT may be clinically useful for determining the severity of KD and for narrowing the differential diagnosis of patients with inflammatory diseases.     

Usefulness of procalcitonin for differentiation between activity of systemic autoimmune disease (systemic lupus erythematosus/systemic antineutrophil cytoplasmic antibody-associated vasculitis) and invasive bacterial infection

Objective. To investigate whether the determination of serum procalcitonin (PCT) in systemic autoimmune disease will help to discriminate invasive infection from highly active underlying disease. Methods. Three hundred ninety-seven serum samples, from 18 patients with systemic lupus erythematosus (SLE) and 35 patients with systemic antineutrophil cytoplasmic antibody-associated vasculitis (AAV), were analyzed. Clinical disease activity was assessed by the Systemic Lupus Activity Measure in SLE patients and by the Birmingham Vasculitis Activity Score in AAV patients. Procalcitonin concentrations were determined in parallel with concentrations of neopterin, interleukin-6 (IL-6), and C-reactive protein (CRP). Additionally, serum creatinine values were obtained. Results. In 321 of the 324 samples from the 42 patients with autoimmune disease but without systemic infection, serum PCT levels were within the normal range (i.e., <0.5 ng/ml), whereas the values for neopterin, IL-6, and CRP were elevated in patients with active underlying disease. All 16 systemic infections occurred in 11 patients with AAV, and were associated with PCT levels that were markedly elevated, to a mean ± SD of 1.93 ± 1.19 ng/ml. No correlation between the degree of renal impairment and PCT concentrations was seen. Conclusion. PCT may serve as a useful marker for the detection of systemic bacterial infection in patients with systemic autoimmune disease.     

Iron overload in porphyria cutanea tarda

BACKGROUND AND OBJECTIVE: Porphyria cutanea tarda (PCT) is a disorder of porphyrin metabolism associated with decreased activity of uroporphyrinogen decarboxylase (URO-D) in the liver. The relevance of iron in the pathogenesis of PCT is well established: iron overload is one of the factors that trigger the clinical manifestations of the disease and iron depletion remains the cornerstone of therapy for PCT. A role for genetic hemochromatosis in the pathogenesis of iron overload in PCT has been hypothesized in the past but only after the recent identification of the genetic defect causing hemochromatosis has the nature of this association been partially elucidated. This review will outline current concepts of the pathophysiology of iron overload in PCT as well as recent contributions to the molecular epidemiology of hemochromatosis defects in PCT. EVIDENCE AND INFORMATION SOURCES: The authors of the present review have a long-standing interest in the pathogenesis, etiology and epidemiology of iron overload syndromes. Evidence from journal articles covered by the Science Citation Index(R) and Medline(R) has been reviewed and collated with personal data and experience. STATE OF THE ART AND PERPECTIVES: Mild to moderate iron overload plays a key role in the pathogenesis of PCT. The recent identification of genetic mutations of the hemochromatosis gene (HFE) in the majority of patients with PCT confirms previous hypotheses on the association between PCT and hemochromatosis, allows a step forward in the understanding of the pathophysiology of the disturbance of iron metabolism in the liver of PCT patients, and provides an easily detectable genetic marker which could have a useful clinical application. Besides the epidemiological relevance of the association between PCT and hemochromatosis, however, it remains to be fully understood how iron overload, and in particular the cellular modifications of the iron status secondary to hemochromatosis mutations, affect the activity of URO-D, and how the altered iron metabolism interacts with the other two common triggers for PCT and etiological agents for the associated liver disease: alcohol and hepatitis viruses. The availability of a genetic marker for hemochromatosis will allow some of these issues to be addressed by studying aspects of porphyrins and iron metabolism in liver samples obtained from patients with PCT, liver disease of different etiology and different HFE genotypes, and by in vitro studies on genotyped cells and tissues.     

Clinical manifestations of hepatitis C

Hepatitis C is a common cause of viral hepatitis that progresses to chronic infection in the majority of patients. Clinically, the infection is generally asymptomatic, but it may present with a wide variety of symptoms. Cirrhosis, hepatocellular carcinoma, cryoglobulinemia, auto-antibodies, and glomerulonephritis have been strongly associated with HCV. There is a probable association with autoimmune disease and NHL. More information is needed to determine whether lichen planus, PCT, and other disorders are part of the growing clinical spectrum or just coincidental associations with chronic liver disease.     

Human herpesvirus‐6 as an inducer of porphyria cutanea tarda: implications from a case

T. Weber, S. Theurich, M. Christopeit, T. Klapperstueck, G. Behre. Human herpesvirus‐6 as an inducer of porphyria cutanea tarda: implications from a case.
Transpl Infect Dis 2010: 12: 432–436. All rights reserved Abstract: Here we describe a case that might deliver a link between sporadic porphyria cutanea tarda (PCT) and human‐herpesvirus‐6 (HHV6) hepatitis. Sporadic PCT is a rare disease of the heme synthesis pathway. The pathogenesis has not been fully determined but iron overload and viral infections – e.g., hepatitis C virus – are thought to play an important role. We present the case of a patient suffering from myelo‐monocytic leukemia. He developed symptomatic sporadic PCT concomitant with HHV6‐associated subclinical hepatitis after allogeneic stem cell transplantation (SCT). Although HHV6 often reactivates after SCT and HHV6‐induced hepatitis can occur in immunocompromised patients, it has not been described that HHV6 might trigger PCT. A contribution of HHV6 to the pathogenesis of sporadic PCT could have dramatic implications on our current therapeutic approach.     

Could procalcitonin be a predictive biological marker in systemic fungal infections?. Study of 14 cases

BACKGROUND: Procalcitonin (PCT) is a recently described inflammatory marker that has been shown to increase significantly in patients with severe systemic bacterial infections or sepsis. Reports on the diagnostic and predictive value of PCT in systemic fungal infections are limited. METHODS: In order to evaluate the role of PCT in systemic mycosis, 14 patients (mean age 40 years) with proven or probable systemic fungal infections were investigated. Blood samples were collected on days 1, 3, 5, and 10 after the onset of signs and symptoms of systemic fungal infection (clinical and/or laboratory diagnosis and/or radiographic evidence). PCT measurements were performed using an immunoluminometric assay. RESULTS: In five patients with severe fungal infection and an unfavorable course (patient group 2), PCT levels were moderately elevated on day 3 (0.5-1.0 ng/ml), whereas they were normal in the patients who recovered (patient group 1). High PCT levels (>/=1.11 ng/ml) were detected on the 10th day of the course of the illness in patient group 2. A normal or moderate elevation of PCT on day 10 was observed in patient group 1. The difference in mean PCT levels in patient groups 1 and 2 on days 3 and 10 were statistically significant. CONCLUSIONS: PCT levels seem to correlate with the severity and outcome of systemic fungal infection. If this finding can be confirmed in a larger number of patients, it could serve as a prognostic indicator.     

Serum procalcitonin in uncomplicated falciparum malaria: a preliminary study

BACKGROUND: Procalcitonin (PCT) has been found elevated in complicated forms of Plasmodium falciparum malaria. Its usefulness has almost never been assessed in uncomplicated falciparum malaria. METHOD: We assessed diagnostic and prognostic value of PCT in a prospective series of 25 adults with uncomplicated P. falciparum malaria. Patients originated mainly from western Africa and were infected during a stay back in their native country (19 semi-immune and 6 non-immune subjects; 11 had not received any chemoprophylaxis). RESULTS: Parasitaemia ranged from 0.01 to 3%. Eighteen patients had their first PCT determined at admission or within 24h thereafter (mean +/- SD: 3.0 +/- 4.6 ng/ml; range: 0.1-19.7). PCT was higher than 0.5 ng/ml in 14 patients (78%), higher than 2 ng/ml in 7 (39%). PCT correlated with parasitaemia (r = 0.53; p = 0.027), not with C-reactive protein (CRP). Delay between first symptoms and diagnosis was much longer among patients with PCT higher than 2 ng/ml than among those with a lower PCT. CONCLUSION: PCT was often elevated in uncomplicated malaria, especially when delay between first symptoms and diagnosis was long or parasitaemia was high (prognostic marker).     

Procalcitonin (PCT) and C-reactive Protein (CRP) as severe systemic infection markers in febrile neutropenic adults

Background  

Procalcitonin (PCT) is an inflammatory marker that has been used as indicator of severe bacterial infection. We evaluated the concentrations of PCT as a marker for systemic infection compared to C-reactive protein (CRP) in patients neutropenic febrile.     

The Role of Procalcitonin in Febrile Neutropenic Patients: Review of the Literature

Background  Procalcitonin (PCT) has been increasingly used as an inflammatory marker to identify patients with systemic infection. Moreover, PCT guidance allowed significant reduction of antibiotic therapy in patients with respiratory disease. The aim of this qualitative review was, therefore, to evaluate the role of PCT measurements in febrile neutropenic patients in differentiating between various causes of fever and to investigate the value of PCT levels in terms of diagnosing infection or predicting outcome in these patients. Patients and Methods  A MEDLINE search was performed using the keyword ‘procalcitonin’ crossed with ‘febrile neutropenia’, ‘neutropenia’, ‘fever’, ‘bone marrow transplantation’, and ‘stem cell transplantation’, and limited to human studies published between January 1990 and October 2006. Bibliographies of identified articles were also searched. Predefined variables were collected from the articles, including year of publication, study design, number of patients included, age group, disease group, markers other than PCT, and study results. Results  From the 30 articles included, PCT seems to be able to discriminate fever due to systemic forms of infection from non-infectious etiologies. Patients with fungal infection may have a delayed increase in PCT levels. PCT has a minimal role, if any, in discriminating Gram-negative from Gram-positive infections. PCT may be useful in outcome prediction in patients with febrile neutropenia but is not superior to interleukin-6 or C-reactive protein concentrations for this purpose. Conclusions  Despite lack of standard definitions, heterogeneity of study populations, and small numbers of patients included in some studies, our review provides important insight into the value of PCT as a diagnostic and prognostic tool in patients with febrile neutropenia.     

Porphyria cutanea tarda and HIV: two cases associated with hepatitis C

Hepatitis C virus (HCV) is a probable etiologic factor for the development of porphyria cutanea tarda (PCT), a photosensitive skin disease causing blistering, skin fragility, milia, and scarring. In a review of the literature, the hepatitis C status of patients coinfected with HIV and PCT was not known. Two patients with PCT who were seropositive for HIV and HCV are discussed herein. The appropriateness of performing porphyrin studies in patients diagnosed with HIV and photosensitivity and of prompting physicians to test for HIV and HCV infection in individuals who are diagnosed with PCT is discussed. Because HIV has been isolated from cutaneous blister fluid in patients with PCT and HIV, caregivers should be aware of the infection risk associated with the vesicles and erosions in these patients.     

血清降钙素原在早期诊断和监控脓毒症中的临床应用评价

血清降钙素原(procalcitonin,PCT)作为一个炎症指标,较传统炎症指标和C反应蛋白(CRP)在诊断脓毒症方面有较高的特异性.PCT浓度和炎症的严重程度呈正相关,可以监测脓毒症的病情变化、估计预后和观察疗效.本文对PCT的生理特性、诊断地位,并和常用炎症指标(如CRP)作进一步分析比较,来科学评估PCT对脓毒症的早期诊断和监控价值.     

Follow-up of chimerism in children with hematological diseases after allogeneic hematopoietic progenitor cell transplants.

Using in situ hybridization with an X and Y chromosome probe mixture, 106 bone marrow samples from 38 patients with malignant and non-malignant hematological diseases who received sex-mismatched allogeneic hematopoietic progenitor cell transplants (PCT) in a single institution within short-term intervals (1, 3, 6, 12, 24 and >24 months) have been sequentially studied. The patients received either HLA-identical (n = 31) or non-identical (n = 7) PCT. Twenty-six children showed donor chimerism, 10 children showed mixed chimerism (MC) and two children presented autologous reconstitution. Chimerism status with different parameters has been related (age, sex, donor, disease status before PCT, conditioning regimen, GVHD prophylaxis, relapse, GVHD and survival). Our results indicate that female patients (P = 0.011) and a less intensive conditioning regimen (P = 0.039) are significantly associated with the MC status. Mixed chimerism is not, per se, significantly associated with leukemia relapse but an increase of the MC is indicative of clinical relapse.     

Porphyria cutanea tarda in Brazilian patients: association with hemochromatosis C282Y mutation and hepatitis C virus infection

OBJECTIVE: Porphyria cutanea tarda (PCT) is commonly associated with iron overload and hepatitis C virus (HCV) infection. Association between hemochromatosis C282Y or H63D mutations and PCT has been observed, although not uniformly, and iron overload is also commonly found in chronic HCV hepatitis. The aim of the present study was to investigate the frequency of C282Y and H63D mutations and HCV infection in Brazilian patients with PCT and their relationship with iron overload. METHODS: Twenty-three patients (19 men) aged 39.6 +/- 11.1 yr were studied. All had dermatological lesions of PCT and high levels of urinary uroporphyrin. HCV infection and iron overload were investigated. DNA samples were analyzed for the presence of HFE mutations. RESULTS: The frequency of C282Y was significantly higher in PCT patients than in 278 healthy individuals (17.4% vs 4%, odds ratio = 5.1, 95% confidence interval 1.5-17.6, p = 0.02), whereas no difference was observed regarding the H63D mutation (30.4% vs 31%, odds ratio = 1, 95% confidence interval 0.4-2.4, p = 1). Biochemical tests in PCT patients showed iron overload with transferrin saturation = 47.3 +/- 20.7% and ferritin = 566.8 +/- 425 ng/ml. Fifteen of 23 (65.2%) patients had HCV infection and alcohol ingestion was observed in 17 of 23 (73.9%). CONCLUSIONS: PCT patients exhibited evidence of iron overload, a high frequency of HCV, and an association with C282Y mutation. These data further support the notion that both acquired and inherited factors contribute to the occurrence of PCT, and indicate that screening for C282Y may be justified in PCT patients.