Although there are many diagnostic tests available for the diagnosis of infections, all have their own limitations with regard to time, sensitivity and specificity. As a result, there is an unnecessary and prolonged use of antibiotics, leading to multidrug resistance and antibiotic misuse. Increasing evidence supports the use of procalcitonin (PCT) in diagnosing bacterial infections as early as possible and titrating the antibiotics according to the dynamics of PCT value. PCT helps in the early diagnosis of the upper and lower respiratory tract infections, meningitis, post-operative cases, sepsis in intensive care units and the judicial use of antibiotics according to PCT algorithms. PCT is a reliable marker as compared to the other markers such as C-reactive protein, interleukin 1, 6, IF-gamma and tumour necrosis factor-alfa. PCT value is not affected by neutropenia, immunodeficiency disorders and with the use of steroid and non-steroid anti-inflammatory drugs. The aim of this review article is to summarise the current evidence for PCT in different infections and clinical settings and discusses the diagnostic and prognostic value of PCT in different types of infections, its limitations and the economics of usage of PCT.

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Blood components, especially plasma, are excellent volume expanders but increased osmotic loads draw volume into the intravascular space resulting in volume overload, particularly in patients with cardiac and renal insufficiency. In addition, allogeneic blood transfusion exposes the recipient to large amounts of alloantigen which can create a variety of immunological responses including alloimmunisation and down regulation of immune response. All children between the age of 1 year to 15 years admitted to PICU at our teaching Hospital over a 24 month period with acute systemic infections were evaluated. In our study, of the total of 178 cases, seventy two cases (40%) received fresh frozen plasma for deranged coagulation profile which was considered as an appropriate indication. Eighty two cases (46%) received fresh frozen plasma for hypotension and thirty one cases (17%) for low serum albumin which were both considered as inappropriate indications. Clinical outcome in these two groups of patients showed that there was no significant difference in duration of hospital stay. There was an increase incidence of mortality in children who received FFP for inappropriate indications, though it was not statistically significant (P=0.375). It was also noted that a statistically significant increase in morbidity in the form of increased requirement of ventilatory support for the inappropriately transfused group (P=0.008) was seen in our study.

Sepsis is a common, life-threatening condition in the pediatric ICU. Severe sepsis and septic shock occurs in all settings and age groups and many of these children often have associated co-morbidities such as prematurity or malignancy. However, in the community at large, recent epidemiologic data indicate that more than half the cases of severe sepsis occur in children without a predisposing condition. Presence of two or more of the following symptoms, i.e. temperature instability (core temp >38.5/<36), tachycardia/bradycardia, tachypnea or mechanical ventilation, leukocytosis/leucopenia. Sepsis is SIRS with infection. Clinical features and laboratory parameters in patients with sepsis, viral hemorrhagic fever and other acute systemic infections were noted. Details of blood component therapy as administered to them were noted along with the reasons and indication for doing so. Of the total 178 cases included in the study, mortality was noted at 18.6% (33 patients). In the septicemia group, the mortality rate was higher (52.9%) as compared with the viral hemorrhagic group (13.1%) which was statistically significant (P<0.001).