Procalcitonin and C-reactive protein levels in HIV-positive subjects with tuberculosis and pneumonia

Abstract

Pulmonary tuberculosis (PTB) and pneumococcal community-acquired pneumonia (PCAP) are common causes of lower respiratory tract infections in HIV-seropositive patients and may have similar clinical and radiological features. This study aimed to assess the value of serum procalcitonin (PCT) and C-reactive protein (CRP) levels in HIV-seropositive patients with pneumonia, and to investigate their potential role in differentiating pneumococcal from mycobacterial infections.HIV-seropositive patients admitted with pneumonia were evaluated prospectively, 34 with PTB and 33 with PCAP.All 33 patients in the PCAP group and 20 of 34 patients in the PTB group had elevated PCT levels (.0.1 ng?mL -1 ). All patients in both groups had elevated CRP levels (.10 mg?L -1). The PTB group had significantly lower CD4 T-lymphocyte counts, lower CRP levels, lower white cell counts, and lower PCT levels than the PCAP group. Receiver operating characteristic analysis showed that optimal discrimination between PTB and PCAP could be performed at a cut-off point of 3 ng?mL -1 for PCT (sensitivity 81.8%; specificity 82.35%) and 246 mg?L -1 for CRP (sensitivity 78.8%; specificity 82.3%).In conclusion, HIV-seropositive patients with pneumococcal community-acquired pneumonia had significantly higher procalcitonin and C-reactive protein levels than those with pulmonary tuberculosis. A procalcitonin level .3 ng?mL -1 and a C-reactive protein level .246 mg?L -1 were both highly predictive of pneumococcal infection.

A prospective audit of the use of diagnostic laparoscopy to establish the diagnosis of abdominal tuberculosis

“…In patients with ESR less than 100, acquired pneumonia have significantly higher CRP levels than those with pulmonary tuberculosis despite similar clinical and radiological appearances. 92 Chaudhary et al 93 reported that symptomatic mild inflammatory disease or HIV infection commonly increases CRP concentration mildly and CRP was negatively correlated with CD4 counts in HIV positive patients.…”

“…Specimens were divided into two parts; one for 92 histological and the other for microbiological examinations. Due to the logistical constraints we were unable to retrieve the microbiological results back.…”

Role of Serum Procalcitonin Level in Differentiating between Pulmonary Tuberculosis and Community-Acquired Pneumonia

“…Ugajin M et al (2011) studied PCT level in pulmonary tuberculosis patients and Pneumonia patients he also reported significant difference in PCT level in the two group (mean PCT in PTB group was 210 ± 490 pg/ml and in Pneumonia group was 4100 ± 8680 pg/ml) [7]. In a study by G.K. Schleicher et al on Pneumococcal pneumonia and pulmonary tuberculosis in HIV positive patients mean PCT level was 1030 pg/ml and 19050 pg/ml in the two group, respectively, with P value of <0.0005 [8].…”

Pulmonary Manifestations of HIV Disease

“…Similarly thrombocytopenia (count of less than 100,000 x10 9 /l) appears to signify severe disease that necessitates aggressive treatment including admission to the intensive care unit 118 . Measurement of the CRP has not been documented to be able to discriminate between PcP and BP 119 , however, using the cut off value of 3ng/ml for procalcitonin and 246 mg/l for CRP one group of investigators reported an increased capability to distinguish BP from TB with a sensitivity of 81.8% and a specificity of 82.5% for the procalcitonin and 78.8% and 82.3% respectively for the CRP 120 . In hospitalized patients the measurement of blood urea, creatinine, sugar, albumin, bilirubin, AST and ALT helps to place patients in specific risk groups for poor outcomes using the CURB -65 121 and or Pneumonia Severity Index criteria 122 The microbiological diagnosis of CABP is dependent on the detection of the pathogen itself in culture, components of the pathogen (antigen) in body fluids or the antibody response to the pathogen.…”