McMaster Textbook of Internal Medicine

McMaster Textbook of Internal Medicine
Interviews
Respirology
Excluding bacterial respiratory tract infection: Procalcitonin vs CRP

Excluding bacterial respiratory tract infection: Procalcitonin vs CRP

2018-12-18

Jadwiga Wedzicha

Recorded at the 4th McMaster International Review Course in Internal Medicine (MIRCIM).

Can a bacterial respiratory tract infection be excluded only based on procalcitonin levels? Is it necessary to measure C-reactive protein (CRP) levels?

Jadwiga Wedzicha, MD: The use of procalcitonin is interesting. I will deal with that first. I think it is useful in pneumonia, it has been useful potentially in intensive care. We started [measuring] procalcitonin in COPD because there had been some studies. And we actually found the change is very small.

The problem is that in chronic obstructive pulmonary disease (COPD) you have underlying airway bacterial colonization. The changes in procalcitonin may be relatively small. CRP goes up. The higher the CRP, the more likely you are to have a bacterial infection. But as we know, CRP is not that specific. That is the problem.

See also

Antibiotic treatment in COPD patients The old Anthonisen criteria are often used to select patients in whom antibiotic treatment is necessary. Are these criteria evidence-based? What about patients without purulent sputum but with fever? Should we rather use antibiotics as a standard treatment in all exacerbations?
Chest x-ray positioning: Is PA projection alone sufficient? Should we always use a posteroanterior (PA) and lateral chest x-ray during the diagnostic workup of patients with respiratory signs and symptoms, or is the PA projection alone sufficient in some instances?
Treatment of COPD with long-term noninvasive ventilation in Canada How many patients with COPD in Canada are treated with long-term noninvasive ventilation? Is this number growing?
Long-term use of inhaled corticosteroids as the cause of dysphonia Can long-term use of inhaled corticosteroids – eg, in asthma – affect the larynx and cause dysphonia?
Contraindications to the use of biologics in asthma Are there any common contraindications to the use of biologics in asthma?
Current treatment of COPD A lecture by Dr Jadwiga Wedzicha, from Imperial College London, UK, delivered at McMaster International Review Course in Internal Medicine in Kraków in May 2017.
Risk of TB among bordering countries with different TB incidence rates In the European Union, the incidence of drug-resistant tuberculosis TB is low. However, the situation in Russia and former Soviet republics is very concerning. As these countries border Poland and are frequently travelled to and from, should we expect that the incidence of drug-resistant TB may increase in the regions of Poland adjacent to the border?

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