alexa Immunoinflammation and Elevated Serum Procalcitonin In Patients with Resistant Strain Mycobacterium Tuberculosis in Benin Metropolis | Open Access Journals
ISSN: 2161-0703
Journal of Medical Microbiology & Diagnosis
Like us on:
Make the best use of Scientific Research and information from our 700+ peer reviewed, Open Access Journals that operates with the help of 50,000+ Editorial Board Members and esteemed reviewers and 1000+ Scientific associations in Medical, Clinical, Pharmaceutical, Engineering, Technology and Management Fields.
Meet Inspiring Speakers and Experts at our 3000+ Global Conferenceseries Events with over 600+ Conferences, 1200+ Symposiums and 1200+ Workshops on
Medical, Pharma, Engineering, Science, Technology and Business

Immunoinflammation and Elevated Serum Procalcitonin In Patients with Resistant Strain Mycobacterium Tuberculosis in Benin Metropolis

Ibeh Nnanna Isaiah*

Health Services Department, University of Benin, Nigeria

*Corresponding Author:
Ibeh Nnanna Isaiah
Health Services Department
University of Benin, Nigeria
Tel: 08034834189
E-mail: [email protected]

Received Date: July 18, 2014; Accepted Date: August 27, 2014; Published Date: August 29, 2014

Citation: Isaiah IN (2014) Immunoinflammation and Elevated Serum Procalcitonin In Patients with Resistant Strain Mycobacterium Tuberculosis in Benin Metropolis. J Med Microb Diagn 3:154. doi: 10.4172/2161-0703.1000154

Copyright: © 2014 Isaiah IN. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use,distribution, and reproduction in any medium, provided the original author and source are credited.

Visit for more related articles at Journal of Medical Microbiology & Diagnosis

Abstract

Background: The utility of serum procalcitonin (PCT) for differentiating pulmonary tuberculosis (TB) from bacterial acquired pneumonia (AP) in Benin Metropolis (Nigeria), a country with an intermediate TB burden.

Aim: To determine the bacterial acquired Pnuemonia from Mycobacterium tuberculosis associated pneumonia with the aid of procalcitonin levels

Methods: We conducted a prospective study, enrolling 170 participants with suspected AP in a community-based referral hospital. A clinical assessment was performed before treatment, serum and PCT were measured. The test results were compared to the final diagnoses.

Results: Of the 170 patients, 98 had bacterial acquired pneumonia and 52 had pulmonary TB. The median PCT level was 0.528 ng/mL (range, 0.01 to 27.75) with bacterial acquired pneumonia and 0.042 ng/mL (range, 0.01 to 0.87) with pulmonary TB (p<0.001). No difference was detected in the discriminative values of PCT (p=0.733).

Conclusions: The concentrations of PCT differed significantly in patients with pulmonary TB and bacterial acquired Pneumonia. The high sensitivity and negative predictive value for differentiating pulmonary TB from bacterial acquired pneumonia suggest a supplementary role of PCT in the diagnostic exclusion of pulmonary TB from bacterial AP in areas with an intermediate prevalence of pulmonary TB.

Keywords

Pneumonia; Acquired; Procalcitonin; Tuberculosis; Serum

Introduction

In countries with a high tuberculosis (TB) burden, Mycobacterium tuberculosis is a frequent cause of community-acquired pneumonia (CAP) [1-4], and the differential diagnosis of TB from common bacterial pneumonia is difficult. The varying clinical and radiographic presentation of CAP and TB according to patient age and comorbidity and the low sensitivity of acid-fast bacillus microscopy make it even more difficult to distinguish TB from common bacterial pneumonia [5-7]. Therefore, an adjunct diagnostic method that can determine whether CAP is caused by pulmonary TB or other bacterial pathogens would have a clinical role in terms of isolating patients with TB and administering appropriate anti-TB medication or antibiotic treatment at an early stage.

Acquired pneumonia (AP) is a major cause of hospital admission and the most important infectious cause of death [1]. A rapid diagnosis and appropriate antibiotic treatment are essential to reduce the morbidity and mortality from AP.

PCT (Procalcitonin) a 116 amino acid protein is a biomarker of severe systemic infectious bacterial disease [8-11]. Recently, PCT has also been introduced as a promising alternative to CRP in guiding the antibiotic treatment of CAP and acute exacerbations of chronic obstructive pulmonary disease [12,13] based on the ability of PCT to discriminate between patients with or without bacterial infection. In addition, PCT does not appear to be significantly elevated in patients with pulmonary TB [14-16], making it an attractive potentially rapid diagnostic method for differentiating pulmonary TB from bacterial AP.

Therefore, we investigated the utility of serum PCT for differentiating pulmonary TB from other bacterial AP in Benin Metropolis (Nigeria), a country with an intermediate TB burden.

Patients and Method

Patients

Of the 200 eligible patients, 30 were excluded because the final diagnosis was inconclusive or they had other diagnoses, such as pulmonary embolism, acute exacerbation of interstitial lung disease, or non-small cell lung cancer. One hundred and seventy patients were classified with pulmonary TB or bacterial CAP. None of the patients in this study was HIV-positive.

Patients were recruited between April 2013 and April 2014 after the study protocol had been approved by the Ethics Review Committee. Adult patients who visited the emergency department or outpatient clinic with respiratory symptoms and chest radiograph abnormalities were eligible for enrollment in this study.

Patients were considered to have pulmonary TB when M. tuberculosis was cultured from their sputum or lavage fluid, and the concentration of adenosine deaminase in the effusion was >65 IU/dL in lymphocyte-predominant exudative pleural effusions combined with a lung parenchymal lesion. Bacterial CAP was diagnosed when the subjects had clinical signs of pneumonia and a new infiltrate on chest X-ray, and these resolved completely with antibiotic treatment and cultures of sputum or lavage fluid were negative for M. tuberculosis during follow-up. For the microbiologic evaluation of the patients with AP, sputum Gram stains and cultures was performed, two blood cultures, and urinary antigen assays to detect Legionella pneumophila and Streptococcus pneumoniae.

Additionally, demographic data, a white blood cell (WBC) count and differential, and the Pneumonia Patient Outcomes Research Team (PORT) [17] score were collected. The results of these tests were compared to the final diagnostic group scores.

Methods

The PCT level was measured using a monoclonal immunoluminometric assay (LIA PCT sensitive; BRAHMS Diagnostica, Berlin, Germany). After separating the serum, it was aliquoted and frozen at -70°C until analyzed. The functional assay sensitivity for PCT with a 20% inter-assay variation coefficient was 0.05 ng/mL.

Statistics

Differences between the two groups were tested using the nonparametric Mann-Whitney U-test for continuous variables. Pearson’s ?2 test or Fisher’s exact test was used for categorical variables, and the Spearman rank correlation coefficient was calculated. Optimal cutoffs for predicting pulmonary TB or bacterial AP were investigated using receiver-operating characteristics (ROC) analysis, and the diagnostic accuracy was assessed from the area under the ROC curves (AUCs). A p<0.05 was regarded as statistically significant, and analyses were performed using SPSS version 15.0 (SPSS Inc., Chicago, IL, USA).

Results

Of the 170 patients who met the inclusion criteria, 98 had bacterial AP and 52 had pulmonary TB. The median age of the bacterial AP and pulmonary TB groups was 68 years (range, 18 to 88) and 46 years (range, 18 to 82), respectively. The responsible pathogen was determined in 42 patients (24.7%) with bacterial AP.

Fourty eight (93%) with pulmonary TB had positive respiratory specimen cultures for M. tuberculosis. The patients’ demographic characteristics, symptoms, and laboratory results are compared in Table 1.

Bacterial pneumonia
(n=98)
Tuberculosis
(n=52)
p value
Demographiccharacteristics    
Age,yr68 (18-88) 46 (18-82) <0.001*
Sex,male/female36 /21 18 /12 0.77
Historyoftuberculosis14 (24.6) 6(20.0) 0.63
Symptoms    
Cough62 (63.2) 48 (93.0) 0.10
Sputum48 (84.2) 22 (73.3) 0.22
Fever52 (91.2) 15 (50.0) <0.001
Dyspnea34 (59.6) 12 (40.0) 0.08
Nightsweats0(0) 7(23.3) <0.001
Weightloss1(1.8) 8(26.7) 0.001
Chestpain11 (19.3) 9(30.0) 0.30
Laboratory test    
Whitebloodcell,×103/µL15.21(2.30-39.92) 8.38(5.07-22.99) <0.001
Neutrophils,×103/µL11.06(1.70-37.92) 5.85(3.07-20.23) <0.001*
Monocyte, µL503 (0-1210) 535 (253-5009) 0.053*
Procalcitonin,ng/mL0.528(0.013-27.754) 0.042(0.01-0.873) <0.001*
Upperlobe dominance18 (28.1) 23 (76.7) <0.001
Cavitarylesion0(0) 11 (36.7) <0.001
Effusion11 (19.3) 9(30.0) 0.26
PORTscore94 (18-187) 76.4(10-126) <0.001*
Valuesare presented as number(%) ormedian(range).    
PORT,PneumoniaPatientOutcomesResearch Team.    
*Mann-WhitneyU-test.    
Pearsonχ2test.
Fisher’sexacttest.
   

Table 1: Patients and Laboratory diagnosis

The respective median PCT level was 0.528 ng/mL (range, 0.013 to 27.754) and 0.042 ng/mL (range, 0.01 to 0.873) (p<0.001). A significant positive correlation was detected with the PCT concentrations (r=0.648, p=0.01).
 

Diagnostic accuracy for discriminating TB from bacterial AP

Discriminative value of 0.857 (95% confidence interval [CI], 0.778 to 0.936), and the PCT concentration had a discriminative value of 0.872 (95% CI, 0.792 to 0.951). No difference was found in the discriminative value of PCT (p=0.733). At a cutoff value of 12.5 mg/dL, the PCT concentration had a sensitivity of 93.1% and a specificity of 59.6% (Table 2).

  Sensitivity Specificity Positive predictive value Negative predictive value
PCT, ng/mL        
<0.1 86.2 78.9 67.6 91.8
<0.25 93.1 59.6 54.0 94.4
<0.5 93.1 50.9 49.1 93.5
<1.0 100.0 31.6 42.6 100.0

Table 2: Diagnostic validity of procalcitonin (PCT) in differentiating pulmonary tuberculosis from bacterial acquired pneumonia according to the different value

Discussion

The results of this study are suggestive that PCT can help to discriminate between pulmonary TB and other common bacterial AP in a setting of intermediate TB prevalence. Significantly lower PCT serum concentrations were found with pulmonary TB compared to the other bacterial AP in the initial diagnosis stage. About 46,000 cases of TB are newly diagnosed annually in South Korea [18], and the rapid, accurate differential diagnosis of TB from common bacterial AP has important public health implications for the isolation care of patients with TB and early appropriate anti-TB medication or antibiotic treatment.

Discriminating pulmonary TB from bacterial AP is frequently impossible based on patient history, physical examination, and radiographic findings. Therefore, PCT might have a role in the diagnostic algorithm as rapid, noninvasive tests.

There was no difference observed in the discriminating power of PCT for differentiating pulmonary TB and other bacterial infections in this study. PCT has also been investigated as a predictor of bacterial infection and is considered a more accurate marker of various bacterial infections [9,19]. Therefore, the absence of a difference of PCT in our study should be considered in light of several factors. First, the low yield of a causative pathogen in bacterial AP (24.7%) suggests the possibility of including bacterial AP with an atypical etiology, such as Mycoplasma pneumoniae, Chlamydia pneumoniae, and respiratory viruses. These atypical pathogens produce lower PCT levels than classical bacterial pneumonia such as pneumococcal pneumonia [20,21]. Second, because the hospital in which this study was conducted is a secondary referral hospital, although it is a community-based hospital, more than 24 hours had passed from the onset of symptoms to the time some patients visited the hospital. The variable time interval from the onset of symptoms before evaluating PCT might have affected the results because of the kinetics of each inflammatory marker [22,23].

Conclusion

In conclusion, serum PCT concentrations differed significantly in patients with pulmonary TB and those with bacterial AP at the initial diagnosis stage. The high sensitivity and negative predictive value for differentiating the diagnosis of pulmonary TB from bacterial AP suggest a supplementary role for PCT in the diagnostic exclusion of pulmonary TB from bacterial AP in areas with an intermediate prevalence of active pulmonary TB.

Acknowledgement

We are indebted to the intensive care unit nursing staff for their invaluable contribution to the management of the neonates and also the National Academy for the Advancement of Science, Nigeria, for their financial contribution and academic tutelage.

References

Select your language of interest to view the total content in your interested language
Post your comment

Share This Article

Relevant Topics

Recommended Conferences

Article Usage

  • Total views: 11696
  • [From(publication date):
    December-2014 - Sep 25, 2017]
  • Breakdown by view type
  • HTML page views : 7908
  • PDF downloads :3788
 

Post your comment

captcha   Reload  Can't read the image? click here to refresh

Peer Reviewed Journals
 
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2017-18
 
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

Agri, Food, Aqua and Veterinary Science Journals

Dr. Krish

[email protected]

1-702-714-7001 Extn: 9040

Clinical and Biochemistry Journals

Datta A

[email protected]

1-702-714-7001Extn: 9037

Business & Management Journals

Ronald

[email protected]

1-702-714-7001Extn: 9042

Chemical Engineering and Chemistry Journals

Gabriel Shaw

[email protected]

1-702-714-7001 Extn: 9040

Earth & Environmental Sciences

Katie Wilson

[email protected]

1-702-714-7001Extn: 9042

Engineering Journals

James Franklin

[email protected]

1-702-714-7001Extn: 9042

General Science and Health care Journals

Andrea Jason

[email protected]

1-702-714-7001Extn: 9043

Genetics and Molecular Biology Journals

Anna Melissa

[email protected]

1-702-714-7001 Extn: 9006

Immunology & Microbiology Journals

David Gorantl

[email protected]

1-702-714-7001Extn: 9014

Informatics Journals

Stephanie Skinner

[email protected]

1-702-714-7001Extn: 9039

Material Sciences Journals

Rachle Green

[email protected]

1-702-714-7001Extn: 9039

Mathematics and Physics Journals

Jim Willison

[email protected]

1-702-714-7001 Extn: 9042

Medical Journals

Nimmi Anna

[email protected]

1-702-714-7001 Extn: 9038

Neuroscience & Psychology Journals

Nathan T

[email protected]

1-702-714-7001Extn: 9041

Pharmaceutical Sciences Journals

John Behannon

[email protected]

1-702-714-7001Extn: 9007

Social & Political Science Journals

Steve Harry

[email protected]

1-702-714-7001 Extn: 9042

 
© 2008-2017 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version
adwords