Detection of Procalcitonine in the Serum as a Marker for Fungal Infection in Patients Receiving Treatment for Hematological Malignancies.

P.E. VERWEIJ*, J.H.A.J. CURFS, H. VAN DER LEE, R. DE KEYSER, J.F.G.M. MEIS

Abstract: 

We investigated the performance of procalcitonine (PCT) detection by commercial immunoluminometric assay (LUMItest(r)}, Campro Scientific, Veenendaal, The Netherlands) with serum for diagnosing and managing invasive fungal infections in patients who receive cytotoxic treatment for hematological malignancies. Consecutive serum samples from different patient groups were tested for the presence of PCT, including 9 patients with invasive aspergillosis (IA; 120 samples) and 10 patients with invasive candidosis (IC; 82 samples). Control groups included neutropenic patients with bacteremia (25 samples), those with fever and mucositis (8 patients, 47 samples), non-neutropenic patients before BMT (15 patients), and from 40 healthy donors. The time of first detection of PCT was compared with that of the Aspergillus antigen galactomannan (GM) by ELISA (Platelia Aspergillus(r)}, Sanofi Diagnostics Pasteur, Marnes-La-Coquette, France) for patients with IA and with that of positive culture from blood or skin biopsy for patients with IC. Furthermore, the course of the PCT titer during antifungal therapy was compared with that of GM for patients with IA. A cut-off value of 0.8 ng/ml was used. PCT was not detected in serum samples from 40 healthy donors, but 14 of 15 patients before BMT showed moderately elevated levels of PCT (mean: 2.1 +/- 1.4 ng/ml). 23 of 25 bacteremic patients had elevated levels of PCT (5.6 +/- 16.3 ng/ml). All patients with fever and mucositis had positive PCT levels in at least one sample (2.0 +/- 5.6 ng/ml). Moderately elevated levels of PCT were detected in the serum of 8 of 9 patients with IA (range 0.8-10 ng/ml). PCT was detected 4 days prior to GM in one patient but after GM was detected in 7 serum samples (mean: 8.7 d; range 2-24). The concentration of PCT tended to decrease during treatment with antifungal agents although the level tended to show considerable variation. Moderate levels of PCT were also detected in all patients with IC (range 0.8-5 ng/ml). Only one patient showed high levels of PCT with a maximum level of 236.6 ng/ml. The PCT level was elevated before positive culture in 4 patients (range 2-14 d) and after positive culture in 3 patients (range 3-7 d). The detection of PCT does not appear to significantly contribute to the diagnosis of invasive mycoses in patients receiving treatment for hematological malignancies.
1998

abstract No: 

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Full conference title: 

38th Interscience Conference on Antimicrobial Agents and Chemotherapy
    • ICAAC 38th