Research Article

Procalcitonin (PCT) levels in pulmonary tuberculosis patients with acid fast bacilli positive and negative smear at Haji Adam Malik General Hospital, Medan, Indonesia

Dina Fikry , Ricke Loesnihari, Parluhutan Siagian

Dina Fikry
Postgraduate Program in Clinical Pathology Specialization, Faculty of Medicine, Universitas Sumatera Utara, Indonesia. Email: dinafikry1983@yahoo.com

Ricke Loesnihari
Department of Clinical Pathology, Faculty of Medicine, Universitas Sumatera Utara/Haji Adam Malik General Hospital, Medan, Indonesia

Parluhutan Siagian
Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sumatera Utara/ Haji Adam Malik General Hospital, Medan, Indonesia
Online First: March 26, 2020 | Cite this Article
Fikry, D., Loesnihari, R., Siagian, P. 2020. Procalcitonin (PCT) levels in pulmonary tuberculosis patients with acid fast bacilli positive and negative smear at Haji Adam Malik General Hospital, Medan, Indonesia. Intisari Sains Medis 11(1): 239-244. DOI:10.15562/ism.v11i1.566


Background: Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis which enters the droplet nuclei into the mouth or nasal passages to reach the pulmonary alveoli. The sputum smear examination for smear-positive and negative smear pulmonary tuberculosis is challenging due to requiring a longer time to get the results. Therefore, a specific marker is needed that is able to detect bacterial infections immediately, such as procalcitonin (PCT). This study aims to determine the levels of PCT in pulmonary tuberculosis patients with acid-fast bacilli positive and negative smear at Haji Adam Malik General Hospital, Medan, Indonesia.

Method: A cross sectional was conducted among 40 pulmonary tuberculosis patients who met the inclusion and exclusion criteria at Haji Adam Malik General Hospital, Medan, Indonesia. The subjects were 20 positive smears and 20 negative smears. PCT examination with mini VIDAS BRAHMS was carried out using the Sandwich principle using the ELFA method (Enzyme-Linked Fluorescent Assay). Sputum examination was carried out by smear of Zhiel Neelsen smear, which was analyzed by the Mann-Whitney (Non-Parametric) test using SPSS version 17 for Windows. 

Results: Most of the respondents were males in both positive and negative smears group (65.0% and 70.0%, respectively) and not significantly different (P>0.05). The age of subjects was slightly older in positive smear (49.75 ± 17.993 years) compare with negative smear group (42.50 ± 14.816 years) but not statistically significant (P=0.172). The PCT levels in pulmonary tuberculosis patients with positive smear (0.1550; 21.65 ng/mL) differ significantly from the PCT levels in pulmonary tuberculosis patients with negative smear (0.05; 3.14 ng/mL) (p=0.0001). The cut off value using ROC found 0.06 ng/mL (AUC: 0.842) with a sensitivity of 80% and a specificity of 80%.

Conclusion: There was a significant difference in the level of procalcitonin in patients with pulmonary tuberculosis who smear-positive and smear-negative.

References

Furlow B. Tuberculosis: a review and update. Radiol Technol. 2010;82(1):33–52.

Glaziou P, Floyd K, Raviglione MC. Global Epidemiology of Tuberculosis. Semin Respir Crit Care Med. 2018;39(3):271–285.

Khan MK, Islam MN, Ferdous J, Alam MM. An Overview on Epidemiology of Tuberculosis. Mymensingh Med J. 2019;28(1):259–266.

Ryu YJ. Diagnosis of pulmonary tuberculosis: recent advances and diagnostic algorithms. Tuberc Respir Dis (Seoul). 2015;78(2):64–71.

Moussa HSh, Bayoumi FS, Mohamed AM. Gene Xpert for Direct Detection of Mycobacterium Tuberculosis in Stool Specimens from Children with Presumptive Pulmonary Tuberculosis. Ann Clin Lab Sci. 2016;46(2):198–203.

Sharma SK, Vashishtha R, Chauhan LS, Sreenivas V, Seth D. Comparison of TST and IGRA in Diagnosis of Latent Tuberculosis Infection in a High TB-Burden Setting. PLoS One. 2017;12(1):e0169539.

Agarwal SK, Gupta S, Bhowmik D, Mahajan S. Tuberculin skin test for the diagnosis of latent tuberculosis during renal replacement therapy in an endemic area: A single center study. Indian J Nephrol. 2010;20(3):132–136.

Cudahy P, Shenoi SV. Diagnostics for pulmonary tuberculosis. Postgrad Med J. 2016;92(1086):187–193.

Parsons LM, Somoskövi A, Gutierrez C, et al. Laboratory diagnosis of tuberculosis in resource-poor countries: challenges and opportunities. Clin Microbiol Rev. 2011;24(2):314–350.

Schuetz P, Albrich W, Mueller B. Procalcitonin for diagnosis of infection and guide to antibiotic decisions: past, present and future. BMC Med. 2011;9:107.

Assicot M., Bohuon C., Gendrel D., Raymond J., Carsin H., Guilbaud J. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet. 1993;341(8844):515–518.

Philips JA, Ernst JD. Tuberculosis pathogenesis and immunity. Annu Rev Pathol. 2012;7:353–384.

Hesselink DA, Bosmans-Timmerarends H, Burgerhart JS, Petit PL, van Genderen PJ. Procalcitonin as a Biomarker for a Bacterial Infection on Hospital Admission: A Critical Appraisal in a Cohort of Travellers with Fever after a Stay in (Sub)tropics. Interdiscip Perspect Infect Dis. 2009;2009:137609.

Ugajin M, Miwa S, Shirai M, et al. Usefulness of serum procalcitonin levels in pulmonary tuberculosis. Eur Respir J. 2011;37(2):371–375.

Naderi M, Hashemi M, Kouhpayeh H, Ahmadi R. The status of serum procalcitonin in pulmonary tuberculosis and nontuberculosis pulmonary disease. J Pak Med Assoc. 2009;59(9):647–648.

Baylan O, Balkan A, Inal A, et al. The predictive value of serum procalcitonin levels in adult patients with active pulmonary tuberculosis. Jpn J Infect Dis. 2006;59(3):164–167.

Dotulong JFJ, Sapulete MR, Kandou GD. Hubungan Faktor Risiko Umur, Jenis Kelamin dan Kepadatan Hunian dengan Kejadian Penyakit TB Paru di Desa Wori Kecamatan Wori. Jurnal Kedokteran Komunitas dan Tropik. 2015;3(2):57-65

Shameem M, Fatima N, Nabeela, Khan HM. Association of TNF-α serum levels with response to antitubercular treatment in MDR tuberculosis patients. Ann Trop Med Public Health 2015;8:258-61

Ghobadi H, Lari SM, Amani F, Habibzadeh Sh , Karimi A H, Pourfarzi P. The Impact of Treatment on Serum Level of Procalcitonin in Patients with Active Pulmonary Tuberculosis. J Cardiothorac Med. 2014; 2(4): 238-242.

Lin CY, Chen TC, Lu PL, et al. Effects of gender and age on development of concurrent extrapulmonary tuberculosis in patients with pulmonary tuberculosis: a population based study. PLoS One. 2013;8(5):e63936.

Lacour AG, Gervaix A, Zamora SA, et al. Procalcitonin, IL-6, IL-8, IL-1 receptor antagonist and C-reactive protein as identificators of serious bacterial infections in children with fever without localising signs. Eur J Pediatr. 2001;160(2):95–100.

Lee H. Procalcitonin as a biomarker of infectious diseases. Korean J Intern Med. 2013;28(3):285–291.

Flynn JL, Chan J, Triebold KJ, Dalton DK, Stewart TA, Bloom BR. An essential role for interferon gamma in resistance to Mycobacterium tuberculosis infection. J Exp Med. 1993;178(6):2249–2254.

Jeong JE, Soh JE, Kwak JH, et al. Increased procalcitonin level is a risk factor for prolonged fever in children with Mycoplasma pneumonia. Korean J Pediatr. 2018;61(8):258–263.

Ceriotti F, Marino I, Motta A, Carobene A. Analytical evaluation of the performances of Diazyme and BRAHMS procalcitonin applied to Roche Cobas in comparison with BRAHMS PCT-sensitive Kryptor. Clin Chem Lab Med. 2017;56(1):162–169.


No Supplementary Material available for this article.
Article Views      : 3
PDF Downloads : 1