Background: This study aims to answer the question if procalcitonin tests allow distinguishing
bacterial from AdV infections in cases in which acute phase values are
significantly elevated. Methods:
40 patients of infant and toddler age were divided into two patient groups (n =
23) and (n = 17) for comparison based on PCT 0.5 μg/L. AdV was determined by
polymerase-chain-reaction. Results:
The PCT value in Group 1 is 0.21 ± 0.12 μg/L, median 0.2, and 1.56 ± 1.07 μg/L,
median 1.3 (p = 0.0001) in Group 2.
At a cut-off value of <0.5 μg/L, C-reactive protein, leucocytes, age, fever
temperature, and the duration of fever did not differ significantly. This conclusion
also applies to a PCT value to <0.9 μg/L. Conclusions: In AdV infections, CRP values of >40 mg/L are
observed in more than 80% of patients. A clinically relevant conclusion of our
findings is that independent of CRP levels antibiotic therapy is not indicated
up to PCT levels of 0.5 μg/l.
References
[1]
Padiatrische Infektiologie (Hrsg.) (2013) DGPI Handbuch Infektionen bei Kindern und Jugendlichen. 6. vollst.
überarb. Aufl., G. Thieme
Verlag, Stuttgart, New York, 142-146.
[2]
Lynch, J.P., Fishbein, M. and Echavarria, M. (2011) Adenovirus. Seminars in
Respiratory and Critical Care Medicine, 32, 494-511. http://dx.doi.org/10.1055/s-0031-1283287
Meisner, M. (2010) Procalcitonin—Biochemie und
klinische Diagnostik. 1. Auflage-Bremen: UNI-MED.
[5]
Heim, A., Ebnet, C., Harste, G., et al.(2003) Rapid and Quantitative Detection of Human
Adenovirus DNA by Real-Time PCR. Journal of Medical
Virology, 70, 228-239. http://dx.doi.org/10.1002/jmv.10382
[6]
Cheng, C.C., Huang, L.M., Kao, C.L., et al.(2008) Molecular and Clinical Characteristics of Adenoviral
Infections in Taiwanese Children in 2004-2005. European Journal of Pediatrics, 167, 633-640. http://dx.doi.org/10.1007/s00431-007-0562-4
[7]
Chuang, Y.Y., Chiu, C.H., Wong, K.S., et al. (2003) Severe Adenovirus Infection in Children. Journal of Microbiology, Immunology and Infection, 36, 37-40.
[8]
Chen, H.L.,
Chiou, S.S.,
Hsioao, H.P., et al. (2004) Respiratory Adenoviral Infections in Children:
A Study of Hospitalized Cases in Southern Taiwan in 2001-2002. Journal of Tropical Pediatrics, 50, 279-284. http://dx.doi.org/10.1093/tropej/50.5.279
[9]
Dominguez, O., Rojo, P., de las Heras, S., et al. (2005) Clinical Presentation and Characteristics
of Pharyngeal Adenovirus Infections. The Pediatric Infectious Disease Journal, 24, 733-734. http://dx.doi.org/10.1097/01.inf.0000172942.96436.2d
[10]
Tabain, I., Ljubin-Sternak, S., Cepin-Bogovic, L., et al. (2012) Adenovirus Respiratory
Infections in Hospitalized Children: Clinical Findings in Relation to Species and
Serotypes. The Pediatric Infectious
Disease Journal, 31, 680- 684. http://dx.doi.org/10.1097/INF.0b013e318256605e
[11]
Lin, C.H., Huang, Y.C., Chiu, C.H., Huang, C.G., Tsao, K.C. and Lin, T.Y. (2007) A
Cluster of Adenovirus Serotype 3 Infections in Children in Northern Taiwan:
Clinical Features and Laboratory Findings. Journal
of Microbiology, Immunology and
Infection, 40, 302-309.
[12]
Kunze, W., Beier, D. and Groger, K. (2010) Adenovirus
Respiratory Infections in Children. Do They Mimic Bacterial Infections? WebMedCentralPAEDIATRICS, 1, Article ID: WMC001098. http://www.webmedcentral.com/article_view/1098
[13]
Farng, K.T., Wu, K.G., Lee, Y.S., Lin, Y.H. and Hwang, B.T. (2002) Comparison
of Clinical Characteristics of Adenovirus and Non-Adenovirus Pneumonia in
Children. Journal of Microbiology, Immunology and Infection, 35, 37-41.
[14]
Kawasaki, Y., Hosoya, M., Katayose, M. and Suzuki, H. (2002) Correlation between Serum Interleukin 6 and C-Reactive Protein Concentrations in
Patients with Adenoviral Respiratory Infection. The Pediatric Infectious Disease Journal, 21, 370-374. http://dx.doi.org/10.1097/00006454-200205000-00004
[15]
Oda, K. and Yamamoto, Y. (2008) Serum Interferon-γ,
Interleukin-4, and Interleukin-6 in
Infants with Adenovirus
and Respiratory Syncytial Virus Infection. Pediatrics International, 50, 92-94. http://dx.doi.org/10.1111/j.1442-200X.2007.02522.x
[16]
Appenzeller, C., Amman, R.A., Duppenthaler, A., Gorgievski-Hrisoho, M. and Aebi, C. (2002) Serum C-Reactive Protein in Children with Adenovirus Infection. Swiss Medical Weekly, 132, 345-350.
[17]
Rocholl, C., Gerber, K., Daly, J., Pavia, A.T. and Byington, C.L.(2004) Adenoviral Infections in Children: The
Impact of Rapid Diagnosis. Pediatrics,
113, e51-e56. http://dx.doi.org/10.1542/peds.113.1.e51
[18]
Van Lierde, S., Corbeel, L. and Eggermont, E. (1989) Clinical and Laboratory Findings in
Children with Adenovirus Infections.European
Journal of Pediatrics, 148, 423-425. http://dx.doi.org/10.1007/BF00595902
[19]
Korppi, M. and Kroger, L. (1993) C-Reactive Protein in Viral and
Bacterial Respiratory Infection in Children. Scandinavian Journal of Infectious Diseases, 25, 207-213. http://dx.doi.org/10.3109/00365549309008486
[20]
Korppi, M., Leinonen, M., Makela, P.H. and Launiala, K. (1991) Mixed Infection Is Common in Children
with Respiratory Adenovirus Infection. Acta
Paediatrica, 80, 413-417. http://dx.doi.org/10.1111/j.1651-2227.1991.tb11875.x
[21]
Elenius, V., Peltola, V., Ruuskanen, O., Yliharsila, M. and Waris, M. (2011) Plasma Procalcitonin Levels in
Children with Adenovirus Infection. Archives of
Disease in Childhood, 97, 582-583. http://dx.doi.org/10.1136/archdischild-2011-301308
[22]
Galetto-Lacour, A., Zamora, S.A. and Gervaix, S.A. (2003) Bedside Procalcitonin
and C-Reactive Protein Tests in Children with Fever without Localizing Signs of
Infection Seen in a Referral
Center. Pediatrics, 112, 1054-1060. http://dx.doi.org/10.1542/peds.112.5.1054
[23]
Hatherill, M., Tibby, S.M., Sykes, K., Turner, C. and Murdoch, I.A. (1999) Diagnostic Markers of Infection: Comparison
of Procalcitonin with C-Reactive Protein and Leucocyte Count. Archives of Disease in Childhood, 81, 417-421. http://dx.doi.org/10.1136/adc.81.5.417
[24]
Fernández Lopez, A., Luaces Cubells, C., García García, J.J. and Fernández Pou, J., Spanish Society of Pediatric Emergencies (2003) Procalcitonin in Pediatric Emergency Departments for
the Early Diagnosis of Invasive Bacterial Infections in Febrile Infants:
Results of a Multicenter Study and Utility of a Rapid Qualitative Test for This
Marker. The Pediatric Infectious Disease
Journal, 22, 895-904. http://dx.doi.org/10.1097/01.inf.0000091360.11784.21
[25]
Limper, M., Smit, P.M., Bongers, K.M., van Zanten,
A.P., Smits, P.H.M., Brandjes, D.P.M., et
al.(2010) Procalcitonin
in Children with Suspected Novel Influenza A (H1N1) Infection. Journal of
Infection, 61, 351-353. http://dx.doi.org/10.1016/j.jinf.2010.07.005
[26]
Toikka, P., Irjala, K., Juvén, T., Virkki, R., Mertsola, J., Leinonen, M. and Ruuskanen, O. (2000) Serum Procalcitonin, C-Reactive Protein and
Interleukin-6 for Distinguishing Bacterial and Viral Pneumonia in Children. The Pediatric Infectious Disease Journal,
19, 598-602. http://dx.doi.org/10.1097/00006454-200007000-00003
[27]
Matesanz, J.L., Fernández, E., Fernández, J.M. and Viejo, G.(2003) Plasma
Procalcitonin and C-Reactive Protein Concentrations in Pediatric Patients with
Epstein-Barr Virus Infection. Clinical Chemistry, 49, 2103-2104. http://dx.doi.org/10.1373/clinchem.2003.023499
[28]
Resch, B., Gusenleitner, W.
and Müller, W. (2003) Procalcitonin,
Interleukin-6, C-Reactive Protein and Leukocyte Counts in Infants with
Bronchiolitis. The Pediatric Infectious Disease Journal, 22, 475-476. http://dx.doi.org/10.1097/01.inf.0000066196.23839.b0
[29]
Piacentini, E., Sánchez, B., Arauzo, V.,Calbo, E., Cuchi, E. and Nava, J.M.(2011) Procalcitonin Levels Are Lower in Intensive Care
Unit with H1N1 Influenza A Virus Pneumonia than in Those with Community-Acquired Bacterial Pneumonia: A Pilot Study. Journal of
Critical Care, 26, 201-205. http://dx.doi.org/10.1016/j.jcrc.2010.07.009
[30]
Ingram, P.R., Inglis, T., Moxon, D. and Speers, D. (2010) Procalcitonin and C-Reactive Protein in
Severe 2009 H1N1 Influenza Infection. Intensive
Care Medicine, 36, 528-532. http://dx.doi.org/10.1007/s00134-009-1746-3
[31]
Cuquemelle, E., Soulis, F., Villers, D., Roche-Campo,
F., Ara Somohano, C., Fartoukh, M., et
al., A/H1N1 REVA-SRLF
Study Group (2011) Can Procalcitonin
Help Identify Associated Bacterial Infection in Patients with Severe Influenza
Pneumonia? A Multicenter Study. Intensive Care
Medicine, 37, 796-800. http://dx.doi.org/10.1007/s00134-011-2189-1
[32]
Albrich, W.C., Dusemund, F., Bocher, B., Meyer, S., Thomann, R., Kühn, F., et al. (2012) Effectiveness and Safety of Procalcitonin-Guided
Antibiotic Therapy in Lower Respiratory Tract Infections in “Real Life”: An
International Multicenter Poststudy Survey (ProREAL). Archives of Internal Medicine, 172, 715-722. http://dx.doi.org/10.1001/archinternmed.2012.770
[33]
Burkhardt, O., Ewing, S., Haagen, U., Giersdorf, S.,
Hartmann, O., Wegscheider, K., et al. (2010) Procalcitonin-Guidance
and Reduction of Antibiotic Use in Acute Respiratory Tract Infection. European Respiratory
Journal, 36, 601-607. http://dx.doi.org/10.1183/09031936.00163309
[34]
Schützle, H., Forster, J., Superti-Furga, A. and Berner, R. (2009) Is Serum
Procalcitonin a Reliable Diagnostic Marker in Children with Acute Respiratory
Tract Infections? A Retrospective Analysis. European Journal of Pediatrics, 168, 1117-1124. http://dx.doi.org/10.1007/s00431-008-0899-3
[35]
Baer, G., Baumann, P., Buettcher, M.,Heininger, U., Berthet, G., Schafer, J., et al. (2013) Procalcitonin Guidance to Reduce Antibiotic Treatment of Lower
Respiratory Tract Infection in Children and Adolescents (ProPAED): A Randomized
Controlled Trial. PLoS ONE, 8, e68419. http://dx.doi.org/10.1371/journal.pone.0068419
[36]
Linscheid, P., Seboek, D., Schaer, D.J., Zulewski, H., Keller, U. and Müller, B. (2004) Expression and
Secretion of Procalcitonin and Calcitonin Gene-Related Peptide by Adherent
Monocytes and by Macrophage-Activated Adipocytes. Critical Care Medicine, 32, 1715-1721. http://dx.doi.org/10.1097/01.CCM.0000134404.63292.71
[37]
Higginbotham, J.N., Seth, P., Blaese, R.M. and Ramsey, W.J. (2002) The Release of
Inflammatory Cytokines from Human Peripheral Blood Mononuclear Cells in Vitro Following Exposure to
Adenovirus Variants and Capsid. Human
Gene Therapy, 13, 129-141. http://dx.doi.org/10.1089/10430340152712683
[38]
Diaz, P.V., Calhoun, W.J., Hinton, K.L., Avendano, L.F., Gaggero, A., Simon, V., et
al. (1999) Differential
Effects of Respiratory Syncytial Virus and
Adenovirus on Mononuclear Cell Cytokine Responses. American Journal of Respiratory and Critical Care Medicine, 160, 1157-1164. http://dx.doi.org/10.1164/ajrccm.160.4.9804075
