Determination of PCT on admission is a useful tool for the assessment of disease severity in travelers with imported Plasmodium falciparum malaria

Abstract

Procalcitonin (PCT) and C-reactive protein (CRP) may be useful to predict complicated forms of malaria. A total of 30 consecutive travelers diagnosed with Plasmodium falciparum malaria over a two-year period were included in the study. Patients with complicated Plasmodium falciparum malaria showed higher levels of parasitemia (P = 0.0001), PCT (P = 0.0018), CRP (P = 0.0005), bilirubinemia (P = 0.004), and a lower platelet count (P<0.0001) compared with patients with uncomplicated forms. PCT levels above 5 ng/mL showed the highest value of specificity (0.86) and positive predictive factor (0.67) among other parameters, and equal sensitivity (0.67) was displayed by CRP levels above 150 mg/dl. None of the patients with complicated malaria showed PCT levels within normal limits (<0.5 ng/ml). Both PCT and CRP correlated with parasitemia (P<0.001) and showed areas under ROC curve of 0.83. At multivariate analysis, only PCT was associated with an increased risk of complicated malaria (OR 8.2, IC 95% 1.2-57.2, P = 0.03). The determination of PCT on admission showed better results compared to CRP, platelet count, and bilirubinemia and can be useful in non-endemic areas for the initial clinical assessment of disease severity in travelers with Plasmodium falciparum malaria.

Procalcitonin (PCT)-guided antibiotic stewardship in Asia-Pacific countries: adaptation based on an expert consensus meeting

“…The group also noted an important lack of trials focusing on some specific patient populations important to Asia-Pacific countries, such as tropical diseases [16][17][18][19][20][21][22][23][24][25][26]. Because of the lack of strong trial data currently limiting the clinical utility in these patients, there is need for adaptation of the proposed algorithms.…”

“…A drop in PCT from the peak by ≥80% and/or fall below the cut-off was taken as a strong indicator for resolution of illness, and earlier discontinuation of antibiotics is recommended when the patient is clinically stable. Discussing the application of the algorithms in the context of the Asia-Pacific patient population, it was emphasized that for patients with clinical suspicion of tropical diseases such as malaria, Dengue fever or hemorrhagic fever, and other diseases with high prevalence in the region, such as tuberculosis or typhus, there is a lack of systematic PCT studies in general and of antibiotic stewardship studies in particular [16][17][18][19][20][21][22]. There are some studies suggesting that PCT may help to risk-stratify these patients and provide prognostic information, but more research is needed to understand the role of PCT in these clinical conditions before applying PCT-guided antibiotic stewardship to them.…”

“…Lack of evidence for some patient populations Tropical disease Few studies have looked at tropical diseases (e.g. malaria, dengue fever, rickettsia, typhoid); current data have been inconclusive on whether PCT improves stewardship, PCT may provide prognostic information [16][17][18][19][20][21][22][23][24][25][26] Tuberculosis Few studies on tuberculosis, PCT remains low in patients with tuberculosis limited to the lung but increases in severe cases with systemic infection [27,28] Hemorrhagic fever syndrome Few studies have looked at hemorrhagic fever syndromes, PCT has been reported to be increased in severe cases despite lack of bacterial infection, PCT seems to provide prognostic information [16,17] Lack of research in Asia-Pacific countries There has been little research done in Asia-Pacific countries, particularly regarding interventional research; thus unclear how PCT impacts antibiotic use in clinical routine in the very different countries and health care environments in this region [29,30] Resources Cost to the hospital Added costs for PCT testing are often only compared to the very low antibiotic costs in some countries, without considering other potential cost savings like from shorter LOS, reduced adverse effects like C. diff. etc.…”

Prognostic Value of Procalcitonin Recovery Level for Malaria Recrudescence

“…According to domestic and foreign scholars in recent years (15)(16)(17), the procalcitonin level also significantly increases in the pathogenetic process. The slow decline of high procalcitonin levels after treatment indicates a serious condition and poor prognosis, while a procalcitonin level that declines sharply after treatment can be taken as a marker for judging the curative effect.…”

Epidemiological and clinical features of imported malaria at the three main hospitals of the Friuli-Venezia Giulia Region, Italy

“…Interestingly, several recent studies have focused on investigation of an inflammatory marker able to predict malaria severity. In one such study, it has been demonstrated that procalcitonin and C-reactive protein may be useful in predicting complicated forms of P. falciparum malaria [15].…”