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Elevated procalcitonin as a diagnostic marker in meningococcal disease

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Abstract

Patients with meningococcal disease who seek medical attention can create a diagnostic dilemma for clinicians due to the nonspecific nature of the disease’s presentation. This study assesses the diagnostic accuracy of procalcitonin levels in the setting of meningococcal disease. Two emergency department cohorts (A and B) were studied between 2002 and 2005, during the current epidemic of serogroup B meningococcal disease in New Zealand. Cohort A consisted of 171 patients, all with confirmed meningococcal disease (84 children, 87 adults). Cohort B consisted of a large (n=1,524) consecutively recruited population of febrile patients who presented to the emergency department, 28 of whom had confirmed meningococcal disease. Within the meningococcal disease cohort (cohort A), the geometric mean procalcitonin level was 9.9 ng/ml, with levels being higher in children than in adults (21.6 vs. 4.6 ng/ml, p=0.01). The overall sensitivity of elevated procalcitonin, using a cutoff of 2.0 ng/ml in children and 0.5 ng/ml in adults, was 0.93 (95%CI: 0.88–0.96). Despite the higher cutoff level for paediatric patients, a trend towards greater sensitivity existed in children (0.96 vs. 0.90; p=0.08). Elevated procalcitonin was correlated with whole blood meningococcal load (r=0.50) and Glasgow Meningococcal Sepsis Prognostic Score (r=0.40). Within the cohort of patients who were febrile on presentation (cohort B), the specificity of elevated procalcitonin in meningococcal disease was 0.85 (95% CI: 0.83–0.87), the positive and negative likelihood ratios were 6.1 and 0.08, respectively, and the sensitivity of elevated procalcitonin (0.93; 95% CI: 0.76–0.99) was corroborated. Measurement of procalcitonin is a useful tool in patients with nonspecific febrile illnesses when the possibility of meningococcal disease is present. The diagnostic accuracy surpasses that of current early laboratory markers, allowing results to be used to guide decisions about patient management.

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Acknowledgements

We thank the patients with MCD and their families for agreeing to participate in this study, the public health units who arranged for the consent and timely notification of patients to the coordinating site, and the Waikato Hospital biochemistry department for undertaking the LUMItest PCT testing.

The Waikato Medical Research Foundation and the Waikato Hospital Respiratory Research Unit provided funding for this study. The Waikato District Health Board funded summer studentships for H Lala and M Oehley (medical students). The funding sources had no role in design, analysis, or the writing of the study report.

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Authors and Affiliations

  1. Infectious Diseases Department, Waikato Hospital, Private Bag 3200, Hamilton, New Zealand

    G. D. Mills, H. M. Lala & M. R. Oehley

  2. Paediatric Department, Waikato District Health Board, Private Bag 3200, Hamilton, New Zealand

    A. B. Craig & N. E. Manikkam

  3. Molecular Biology Department, Waikato District Health Board, Private Bag 3200, Hamilton, New Zealand

    K. Barratt

  4. Waikato Public Health Service, Waikato District Health Board, Private Bag 3200, Hamilton, New Zealand

    D. Hood

  5. General Medicine, Waikato District Health Board, Private Bag 3200, Hamilton, New Zealand

    P. Reeve

  6. Auckland Regional Public Health Service, Auckland District Health Board, Private Bag 92605, Symonds Street, Auckland, New Zealand

    C. N. Thornley

  7. Wellington Regional Public Health, Hutt Valley District Health Board, Private Bag 31907, Lower Hutt, New Zealand

    A. Nesdale

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  1. G. D. Mills
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Correspondence to G. D. Mills.

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Mills, G.D., Lala, H.M., Oehley, M.R. et al. Elevated procalcitonin as a diagnostic marker in meningococcal disease. Eur J Clin Microbiol Infect Dis 25, 501–509 (2006). https://doi.org/10.1007/s10096-006-0179-y

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