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Procalcitonin as a diagnostic aid in osteomyelitis and septic arthritis
Yonatan Butbul-Aviel1, Ariel Koren, Raphael Halevy
1Pediatric Department B, Ha'Emek Medical Center, Afula, Israel.
Insights
Plasma procalcitonin (PCT) is useful for diagnosing osteomyelitis in children with fever and limping. However, PCT levels were not consistently elevated in cases of septic arthritis, suggesting it is not a reliable marker for this condition.
Area of Science:
- Pediatric Infectious Diseases
- Biomarker Discovery
- Skeletal Inflammatory Conditions
Background:
- Plasma procalcitonin (PCT) is a biomarker that elevates during bacterial infections, aiding in differentiating bacterial from viral causes.
- High PCT levels are associated with severe bacterial infections like meningitis, septic shock, bacteremia, and renal parenchymal damage.
- Fever and limping in children can indicate serious skeletal inflammatory diseases such as osteomyelitis and septic arthritis, requiring accurate diagnosis.
Purpose of the Study:
- To evaluate the diagnostic utility of plasma procalcitonin (PCT) analysis in pediatric patients presenting with fever and limping.
- To differentiate between osteomyelitis, septic arthritis, and other inflammatory conditions affecting the skeletal system.
- To assess the role of PCT as a biomarker in pediatric skeletal infections.
Main Methods:
- Conducted a study on pediatric patients admitted with fever, limping, and suspected osteomyelitis or septic arthritis.
- Measured white blood cell count, erythrocyte sedimentation rate, C-reactive protein, and plasma procalcitonin (PCT) levels.
- Utilized an immunochromatography assay for PCT measurement, employing monoclonal and polyclonal antibodies against katacalcin.
Main Results:
- Of 44 children, 12 had osteomyelitis, 11 septic arthritis, and others had soft tissue infections or other inflammatory diseases.
- Elevated PCT levels were observed in 58.3% of osteomyelitis cases, while only 27.2% of septic arthritis cases showed mildly elevated PCT.
- A statistically significant difference (P < 0.001) was found in PCT values between skeletal infections and other diagnoses, with no positive PCT in non-skeletal infections.
Conclusions:
- Plasma procalcitonin (PCT) demonstrated utility as a diagnostic marker for osteomyelitis in pediatric patients.
- PCT was found to be less reliable for diagnosing septic arthritis in this study cohort.
- Further research with a larger patient group is recommended to validate these findings regarding PCT's role in pediatric skeletal infections.
Objectives:
Plasma procalcitonin (PCT) increases rapidly during bacterial infections but remains low in viral infections and other inflammatory processes. High plasma PCT typically occurs in children with bacterial meningitis, severe bacterial infections, particularly in cases of septic shock or bacteremia, and in renal parenchymal damage. The aim of this study was to test the usefulness of plasma PCT analysis in the diagnosis of osteomyelitis, septic arthritis, and other skeletal inflammatory diseases in pediatric patients admitted because of fever and limping.
Methods:
White blood cell count, erythrocyte sedimentation rate, C-reactive protein, and PCT levels were measured in children admitted to the pediatric department with fever, limping, and suspected osteomyelitis or septic arthritis. PCT levels were measured by an immunochromatography assay, based on monoclonal and polyclonal antibodies against katacalcin.
Results:
Forty-four children were evaluated: 12 (27.3%) were diagnosed with osteomyelitis, 11 (25%) had septic arthritis, 5 children (11.4%) were diagnosed as a soft tissue infection, and transient synovitis or reactive arthritis was diagnosed in another 6 children (13.6%). Four children (9.1%) were diagnosed as having juvenile rheumatoid arthritis, and 6 (13.6%) with different diseases. PCT value was elevated in 7 patients (58.3%) with osteomyelitis, and only 3 children (27.2%) with the diagnosis of septic arthritis had a mildly elevated value. Among the children with other diagnosis, there were no positive PCT values (P < 0.001 between skeletal infection and all other diagnosis).
Conclusions:
In this study, PCT was found to be a useful marker in the diagnosis of osteomyelitis and not in septic arthritis. A larger group of patients needed to be studied to confirm our findings.
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