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The Role of Serum Procalcitonin in Establishing Diagnosis of Bone and Joint Infections

Journal of Clinical Orthopaedics | Vol 5 | Issue 1 |  Jan-Jun 2020   | page: 3-7 | John Nolan, Putu Feryawan Meregawa


Author: John Nolan [1], Putu Feryawan Meregawa [2]

[1] Faculty of Medicine, Udayana University, Denpasar.
[2] Departement of Orthopaedic and Traumatology, Medical Faculty, Udayana University-Sanglah General Hospital Denpasar, Indonesia.

Address of Correspondence
John Nolan,
Faculty of Medicine, Udayana University, Denpasar
E-mail: johnnolan@student.unud.ac.id


Abstract

Background: Acute bone and joint infection such as septic arthritis and osteomyelitis diagnostic are still considered as a pitfall especially in the emergency department. Some laboratory markers, such as total Count (TC), Erythrocyte Sedimentation Rate (ESR) and C – Reactive Protein (CRP) assessed regularly whereas those are not specific. Serum PCT has a role as a sensitive and specific marker in supporting the diagnosis of bone and joint infections.
Method: Literature review is done by searching journals with “serum procalcitonin”, “bone infections”, “diagnosis”, and “joint infections” on the search engines. From 37 journals that were reviewed, 34 were found suitable as reference for this paper.
Outcome: High level of serum PCT indicate the activation of immune system, specifically the innate immune system due to microbial infections. One of the most different aspect with CRP is serum PCT infrequently elevates in response to viral infection, which means PCT is useful in differentiating bacterial and viral infections Serum PCT concentration elevates following the endotoxin or cytokines release such as interleukin (IL)- 6, tumor necrosis factor (TNF)-alpha, and IL-1b which usually appears in bone and joint infections. Although its benefits, there are some limitation interfering the usage and levels of serum PCT.
Conclusion: Serum PCT has a role as a sensitive and specific marker in supporting the diagnosis of bone and joint infections due to its sensitivity following endotoxins release. Further researches and studies are required to identify the appropriate usage, interfering factors, and clinical application of serum PCT in establishing the diagnosis of bone and joint infections.
Keywords: Procalcitonin, Bone infections, joint infections, Diagnosis.


References

1. Calhoun J, Manring M, Shirtliff M. Osteomyelitis of the Long Bones. Seminars in Plastic Surgery. 2009;23(02):059-072.
2. Goergens ED, McEvoy A, Watson M, Barrett IR. Acute osteomyelitis and septic arthritis in children. Journal of paediatrics and child health. 2005 Jan;41(1‐2):59-62.
3. Mathews CJ, Weston VC, Jones A, Field M, Coakley G. Bacterial septic arthritis in adults. The Lancet. 2010 Mar 6;375(9717):846-55.
4. Timsit S, Pannier S, Glorion C, Chéron G. Acute osteomyelitis and septic arthritis in children: one year experience. Archives de pediatrie: organe officiel de la Societe francaise de pediatrie. 2005 Jan;12(1):16-22.
5. Bonhoeffer J, Haeberle B, Schaad UB, Heininger U. Diagnosis of acute haematogenous osteomyelitis and septic arthritis: 20 years experience at the University Children’s Hospital Basel. Swiss medical weekly. 2001 Oct 6;131(39-40):575-81.
6. Kremers HM, Nwojo ME, Ransom JE, Wood-Wentz CM, Melton III LJ, Huddleston III PM. Trends in the epidemiology of osteomyelitis: a population-based study, 1969 to 2009. The Journal of bone and joint surgery. American volume. 2015 May 20;97(10):837.
7. Perron AD, Brady WJ, Miller MD. Orthopedic pitfalls in the ED: osteomyelitis. The American journal of emergency medicine. 2003 Jan 1;21(1):61-7.
8. Kolinsky DC, Liang SY. Musculoskeletal Infections in the Emergency Department. Emergency Medicine Clinics. 2018 Nov 1;36(4):751-66.
9. Shen CJ, Wu MS, Lin KH, Lin WL, Chen HC, Wu JY, Lee MH, Lee CC. The use of procalcitonin in the diagnosis of bone and joint infection: a systemic review and meta-analysis. European journal of clinical microbiology & infectious diseases. 2013 Jun 1;32(6):807-14.
10. Maharajan K, Patro DK, Menon J, Hariharan AP, Parija SC, Poduval M, Thimmaiah S. Serum Procalcitonin is a sensitive and specific marker in the diagnosis of septic arthritis and acute osteomyelitis. Journal of orthopaedic surgery and research. 2013 Dec 1;8(1):19.
11. Casado JF, Blanco AQ. Procalcitonin. A new marker for bacterial infection. Anales espanoles de pediatria. 2001 Jan;54(1):69-73.
12. Alkholi UM, Al-Monem NA, El-Azim AA, Sultan MH. Serum procalcitonin in viral and bacterial meningitis. Journal of global infectious diseases. 2011 Jan;3(1):14.
13. Wang C, Zhong DA, Liao Q, Kong L, Liu A, Xiao H. Procalcitonin levels in fresh serum and fresh synovial fluid for the differential diagnosis of knee septic arthritis from rheumatoid arthritis, osteoarthritis and gouty arthritis. Experimental and therapeutic medicine. 2014 Oct 1;8(4):1075-80.
14. Saeed K, Dryden M, Sitjar A, White G. Measuring synovial fluid procalcitonin levels in distinguishing cases of septic arthritis, including prosthetic joints, from other causes of arthritis and aseptic loosening. Infection. 2013 Aug 1;41(4):845-9.
15. Sigmund IK, McNally MA. Diagnosis of bone and joint infections. Orthopaedics and Trauma. 2019 Jun 1;33(3):144-52.\
16. Tsaras G, Maduka-Ezeh A, Inwards CY, Mabry T, Erwin PJ, Murad MH, Montori VM, West CP, Osmon DR, Berbari EF. Utility of intraoperative frozen section histopathology in the diagnosis of periprosthetic joint infection: a systematic review and meta-analysis. JBJS. 2012 Sep 19;94(18):1700-11.
17. Unkila-Kallio L, Kallio MJ, Peltola H, Eskola J. Serum C-reactive protein, erythrocyte sedimentation rate, and white blood cell count in acute hematogenous osteomyelitis of children. Pediatrics. 1994 Jan 1;93(1):59-62.
18. Gaigneux E, Cormier G, Varin S, Mérot O, Maugars Y, Le Goff B. Ultrasound abnormalities in septic arthritis are associated with functional outcomes. Joint Bone Spine. 2017 Oct 1;84(5):599-604.
19. Merlini L, Anooshiravani M, Ceroni D. Concomitant septic arthritis and osteomyelitis of the hip in young children; a new pathophysiological hypothesis suggested by MRI enhancement pattern. BMC medical imaging. 2015 Dec 1;15(1):17.
20. Fritz JM, McDonald JR. Osteomyelitis: approach to diagnosis and treatment. The Physician and sportsmedicine. 2008 Jan 1;36(1):50-4.
21. Wang S, Yin P, Quan C, Khan K, Wang G, Wang L, Cui L, Zhang L, Zhang L, Tang P. Evaluating the use of serum inflammatory markers for preoperative diagnosis of infection in patients with nonunions. BioMed research international. 2017;2017.
22. Colston J, Atkins B. Bone and joint infection. Clinical Medicine. 2018 Apr;18(2):150.
23. Assicot M, Bohuon C, Gendrel D, Raymond J, Carsin H, Guilbaud J. High serum procalcitonin concentrations in patients with sepsis and infection. The Lancet. 1993 Feb 27;341(8844):515-8.
24. Koramutla HK, Koyagura B, Ravindran B. Evaluation of serum procalcitonin as a significant marker in cases of septic arthritis and osteomyelitis: a two year study. International Journal of Research in Orthopaedics. 2018 Jul;4(4):601.
25. Ibrahim KA, Abdel-Wahab AA, Ibrahim AS. Diagnostic value of serum procalcitonin levels in children with meningitis: a comparison with blood leukocyte count and C-reactive protein. JPMA-Journal of the Pakistan Medical Association. 2011 Apr 1;61(4):346.
26. Chan T, Gu F. Early diagnosis of sepsis using serum biomarkers. Expert review of molecular diagnostics. 2011 Jun 1;11(5):487-96.
27. Agency for Healthcare Research and Quality. Effective Health Care Program. EPC Project. Project Title: Procalcitonin for diagnosis and Management of Sepsis. Research protocol. 2011. Apr, Available at:http://www.effectivehealthcare.ahrq.gov
28. Schuetz P, Christ-Crain M, Muller B. Procalcitonin and other biomarkers to improve assessment and antibiotic stewardship in infections–hope for hype?. Swiss medical weekly. 2009 Jun 13;139(23):318.
29. Mehanic S, Baljic R. The importance of serum procalcitonin in diagnosis and treatment of serious bacterial infections and sepsis. Materia socio-medica. 2013 Dec;25(4):277.
30. Christ-Crain M, Muller B. Procalictonin–you only find what you look for, and you only look for what you know. J Am Geriatr Soc. 2006 Mar 1;54(3):546.
31. Limper M, De Kruif MD, Duits AJ, Brandjes DP, van Gorp EC. The diagnostic role of procalcitonin and other biomarkers in discriminating infectious from non-infectious fever. Journal of Infection. 2010 Jun 1;60(6):409-16.
32. Müller B, Becker KL, Schächinger H, Rickenbacher PR, Huber PR, Zimmerli W, Ritz R. Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Critical care medicine. 2000 Apr 1;28(4):977-83.
33. Koramutla HK, Koyagura B, Ravindran B. Evaluation of serum procalcitonin as a significant marker in cases of septic arthritis and osteomyelitis: a two year study. International Journal of Research in Orthopaedics. 2018 Jul;4(4):601.
34. Reinhart K, Bauer M, Riedemann NC, Hartog CS. New approaches to sepsis: molecular diagnostics and biomarkers. Clinical microbiology reviews. 2012 Oct 1;25(4):609-34..


How to Cite this article: Nolan J, Meregawa P.F. The Role of Serum Procalcitonin in Establishing Diagnosis of Bone and Joint Infections. Journal of Clinical Orthopaedics Jan-Jun 2020;5(1): 3-7.

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