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The diagnostic value of serum levels of C-reactive protein and procalcitonin in differentiation between active pulmonary TB and CAP

Egyptian Journal of Bronchology volume 9, pages 178–182 (2015)Cite this article

Abstract

Introduction

C-reactive protein (CRP) and procalcitonin (PCT) levels are elevated in patients with community-acquired pneumonia (CAP), but PCT does not increase in patients with pulmonary tuberculosis (TB).

Aim

To evaluate the diagnostic value of serum levels of CRP and PCT in differentiating between active pulmonary TB and CAP.

Participants and methods

The present study was carried out on 90 individuals divided into the following groups: group I included 10 control participants, group II included 40 patients with active pulmonary TB, and group III included 40 patients with CAP. Serum levels of CRP and PCT were measured.

Results

CRP was significantly increased in group III compared with groups I and II. PCT was significantly increased in group III compared with groups I and II; also, there was a significant increase in group II compared with group I. The cut-off value of CRP between group II and group III was more than 24 (mg/dl), with a sensitivity of 100%, a specificity of 70%, and that of PCT was more than 530 (pg/ml), with a sensitivity of 67% and a specificity of 97.5%.

Conclusion

Measurements of CRP and PCT were complementary to each other to differentiate between pulmonary TB and CAP.

References

  1. Rasmussen TA, Sogaard SO, Camara C. Serum procalcitonin in pulmonary tuberculosis. Int J Tuberc Lung Dis 2011; 15:2.

    Google Scholar 

  2. Naderi M, Hashemi M, Kouhpayeh H. The status of serum procalcitonin in pulmonary tuberculosis and non tuberculosis pulmonary disease, Research Center for Infectious diseases and Tropical Medicine, Department of Clinical Biochemistry, Cellular and Molecular Resaerch Center School of Medicine. J Pak Med Assoc 2009; 59:647–648.

    PubMed  Google Scholar 

  3. Kang YA, Kwon SY, Yoon HI, Lee JH, Lee CT. Role of C-reactive protein and procalcitonin in differentiation of tuberculosis from bacterial community acquired pneumonia. Korean J Intern Med 2009; 24:337–342.

    Article  CAS  Google Scholar 

  4. Chalmers JD, Singanayagam A, Hill AT. C-reactive protein is an independent predictor of severity in community-acquired pneumonia. Am J Med 2008; 121:219–225.

    Article  CAS  Google Scholar 

  5. Bafadhel M, Clark TW, Reid C, Medina MJ, Batham S, Barer MR, et al. Procalcitonin and C-reactive protein in hospitalized adult patients with community-acquired pneumonia or exacerbation of asthma or COPD. Chest 2011; 139:1410–1418.

    Article  CAS  Google Scholar 

  6. Polzin A, Pletz M, Erbes R, Raffenberg M, Mauch H, Wagner S, et al. Procalcitonin as a diagnostic tool in lower respiratory tract infections and tuberculosis. Eur Respir J 2003; 21:939–943.

    Article  CAS  Google Scholar 

  7. Hedlund J, Hansson LO. Procalcitonin and C-reactive protein levels in community-acquired pneumonia: correlation with etiology and prognosis. Infection 2000; 28:68–73.

    Article  CAS  Google Scholar 

  8. Moulin F, Raymond J, Lorrot M, Marc E, Coste J, Iniguez JL, et al. Procalcitonin in children admitted to hospital with community acquired pneumonia. Arch Dis Child 2001; 84:332–336.

    Article  CAS  Google Scholar 

  9. Kofoed K, Andersen O, Kronborg G, Tvede M, Petersen J, Eugen-Olsen J, Larsen K. Use of plasma C-reactive protein, procalcitonin, neutrophils, macrophage migration inhibitory factor, soluble urokinase-type plasminogen activator receptor, and soluble triggering receptor expressed on myeloid cells-1 in combination to diagnose infections: a prospective study. Crit Care 2007; 11: R38.

    Article  Google Scholar 

  10. Farr BM, Kaiser DL, Harrison BD, Connolly CK. Prediction of microbial aetiology at admission to hospital for pneumonia from the presenting clinical features. British Thoracic Society Pneumonia Research Subcommittee. Thorax 1989; 44:1031–1035.

    Article  CAS  Google Scholar 

  11. Mandell LA, Bartlett JG, Dowell SF, File TM Jr, Musher DM, Whitney C, Infectious Diseases Society of America. Update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults. Clin Infect Dis 2003; 37:1405–1433.

    Article  Google Scholar 

  12. British Thoracic Society Standards of Care Committee. BTS guidelines for the management of community acquired pneumonia in adults. Thorax 2001; 56 (Suppl 4): IV1–I V64.

    Article  Google Scholar 

  13. Caroline MP, Micheal RL. Community acquired pneumonia: assessment and treatment. Clinical Medicine 2012; 12:283–286.

    Article  Google Scholar 

  14. Fishman AP, Elias JA, Fishman JA, et al. Fishman’s manual of pulmonary diseases and disorders. 3rd ed. USA: McGraw-Hill Companies Inc.; 2002. Fishman JA, Approach to the patient with pulmonary infection. 661–699

    Google Scholar 

  15. Gilbert DN. Procalcitonin as a biomarker in respiratory tract infection. Clin Infect Dis 2011; 52 (Suppl 4): S346–S350.

    Article  CAS  Google Scholar 

  16. Delèvaux I, André M, Colombier M, Albuisson E, Meylheuc F, Bègue RJ, et al. Can procalcitonin measurement help in differentiating between bacterial infection and other kinds of inflammatory processes? Ann Rheum Dis 2003; 62:337–340.

    Article  Google Scholar 

  17. Sahin F, Yildiz P. Distinctive biochemical changes in pulmonary tuberculosis and pneumonia. Arch Med Sci 2013; 9:656–661.

    Article  CAS  Google Scholar 

  18. Yoon NB, Son C, Um SJ. Role of the neutrophil-lymphocyte count ratio in the differential diagnosis between pulmonary tuberculosis and bacterial community-acquired pneumonia. Ann Lab Med 2013; 33:105–110.

    Article  Google Scholar 

  19. Ugajin M, Miwa S, Shirai M, Ohba H, Eifuku T, Nakamura H, et al. Usefulness of serum procalcitonin levels in pulmonary tuberculosis. Eur Respir J 2011; 37:371–375.

    Article  CAS  Google Scholar 

  20. Nyamande K, Lalloo UG. Serum procalcitonin distinguishes CAP due to bacteria, Mycobacterium tuberculosis and PJP. Int J Tuberc Lung Dis 2006; 10:510–515.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Chest, Tanta University, Elgeish street, Tanta, 31515, Egypt

    Basem I. El-Shafey MD, Hoda M. Bahr & Salwa A. Ganna

  2. Department of Clinical Pathology, Tanta University, Tanta, Egypt

    Mohmad S. Attia

  3. Abbassia Chest Hospital Ministry of Health, Cairo, Egypt

    Mamdouh M. El Rakhawy

Authors
  1. Basem I. El-Shafey MD
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  2. Hoda M. Bahr
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  3. Salwa A. Ganna
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  4. Mohmad S. Attia
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  5. Mamdouh M. El Rakhawy
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Corresponding author

Correspondence to Basem I. El-Shafey MD.

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El-Shafey, B.I., Bahr, H.M., Ganna, S.A. et al. The diagnostic value of serum levels of C-reactive protein and procalcitonin in differentiation between active pulmonary TB and CAP. Egypt J Bronchol 9, 178–182 (2015). https://doi.org/10.4103/1687-8426.158071

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  • DOI: https://doi.org/10.4103/1687-8426.158071

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