Skip to main content
NCBI home page
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 2002 Apr;86(4):282–285. doi: 10.1136/adc.86.4.282

Procalcitonin as a diagnostic marker of meningococcal disease in children presenting with fever and a rash

E Carrol 1, P Newland 1, F Riordan 1, A Thomson 1, N Curtis 1, C Hart 1
PMCID: PMC1719162  PMID: 11919107

Abstract

Background: Procalcitonin (PCT), a precursor of calcitonin, is a recognised marker of bacterial sepsis, and high concentrations correlate with the severity of sepsis. PCT has been proposed as an earlier and better diagnostic marker than C reactive protein (CRP) and white cell count (WCC). This comparison has never been reported in the differentiation of meningococcal disease (MCD) in children presenting with a fever and rash.

Aim: To determine if PCT might be a useful marker of MCD in children presenting with fever and rash.

Methods: PCT, CRP, and WCC were measured on admission in 108 children. Patients were classified into two groups: group I, children with a microbiologically confirmed clinical diagnosis of MCD (n = 64); group II, children with a self limiting illness (n = 44). Median ages were 3.57 (0.07–15.9) versus 1.75 (0.19–14.22) years respectively. Severity of disease in patients with MCD was assessed using the Glasgow Meningococcal Septicaemia Prognostic Score (GMSPS).

Results: PCT and CRP values were significantly higher in group I than in group II (median 38.85 v 0.27 ng/ml and 68.35 v 9.25 mg/l; p < 0.0005), but there was no difference in WCC between groups. Sensitivity, specificity, and positive and negative predictive values were higher for PCT than CRP and WCC. In group I, procalcitonin was significantly higher in those with severe disease (GMSPS ≥8).

Conclusions: PCT is a more sensitive and specific predictor of MCD than CRP and WCC in children presenting with fever and a rash.

Full Text

The Full Text of this article is available as a PDF (103.3 KB).

Figure 1 .

Figure 1

Open in a new tab

Box and whisker plot showing median, quartiles, and extreme values (log10) for WCC, CRP, and PCT. Box represents the interquartile range, and the whiskers extend from the lowest to the highest values, excluding outliers. Outliers are shown as Δ.

Figure 2 .

Figure 2

Open in a new tab

ROC plot comparing CRP and PCT as diagnostic markers of MCD in children presenting with fever and a rash.

Figure 3 .

Figure 3

Open in a new tab

Scatter plot of CRP versus PCT values. Axis taken back to -100 to allow better demonstration of spread of points around zero.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Assicot M., Gendrel D., Carsin H., Raymond J., Guilbaud J., Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet. 1993 Feb 27;341(8844):515–518. doi: 10.1016/0140-6736(93)90277-N. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Baines P. B., Thomson A. P., Fraser W. D., Hart C. A. Hypocalcaemia in severe meningococcal infections. Arch Dis Child. 2000 Dec;83(6):510–513. doi: 10.1136/adc.83.6.510. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bone R. C. Toward a theory regarding the pathogenesis of the systemic inflammatory response syndrome: what we do and do not know about cytokine regulation. Crit Care Med. 1996 Jan;24(1):163–172. doi: 10.1097/00003246-199601000-00026. [DOI] [PubMed] [Google Scholar]
  4. Brogan P. A., Raffles A. The management of fever and petechiae: making sense of rash decisions. Arch Dis Child. 2000 Dec;83(6):506–507. doi: 10.1136/adc.83.6.506. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Brunkhorst F. M., Heinz U., Forycki Z. F. Kinetics of procalcitonin in iatrogenic sepsis. Intensive Care Med. 1998 Aug;24(8):888–889. doi: 10.1007/s001340050683. [DOI] [PubMed] [Google Scholar]
  6. Carrol E. D., Thomson A. P., Mobbs K. J., Hart C. A. The role of RANTES in meningococcal disease. J Infect Dis. 2000 Jun 30;182(1):363–366. doi: 10.1086/315680. [DOI] [PubMed] [Google Scholar]
  7. Carrol E. D., Thomson A. P., Riordan F. A., Fellick J. M., Shears P., Sills J. A., Hart C. A. Increasing microbiological confirmation and changing epidemiology of meningococcal disease on Merseyside, England. Clin Microbiol Infect. 2000 May;6(5):259–262. doi: 10.1046/j.1469-0691.2000.00078.x. [DOI] [PubMed] [Google Scholar]
  8. Dandona P., Nix D., Wilson M. F., Aljada A., Love J., Assicot M., Bohuon C. Procalcitonin increase after endotoxin injection in normal subjects. J Clin Endocrinol Metab. 1994 Dec;79(6):1605–1608. doi: 10.1210/jcem.79.6.7989463. [DOI] [PubMed] [Google Scholar]
  9. Gendrel D., Bohuon C. Procalcitonin as a marker of bacterial infection. Pediatr Infect Dis J. 2000 Aug;19(8):679–688. doi: 10.1097/00006454-200008000-00001. [DOI] [PubMed] [Google Scholar]
  10. Gendrel D., Raymond J., Coste J., Moulin F., Lorrot M., Guérin S., Ravilly S., Lefèvre H., Royer C., Lacombe C. Comparison of procalcitonin with C-reactive protein, interleukin 6 and interferon-alpha for differentiation of bacterial vs. viral infections. Pediatr Infect Dis J. 1999 Oct;18(10):875–881. doi: 10.1097/00006454-199910000-00008. [DOI] [PubMed] [Google Scholar]
  11. Hatherill M., Tibby S. M., Sykes K., Turner C., Murdoch I. A. Diagnostic markers of infection: comparison of procalcitonin with C reactive protein and leucocyte count. Arch Dis Child. 1999 Nov;81(5):417–421. doi: 10.1136/adc.81.5.417. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Leclerc F., Chenaud M., Delepoulle F., Diependaele J. F., Martinot A., Hue V. Prognostic value of C-reactive protein level in severe infectious purpura: a comparison with eight other scores. Crit Care Med. 1991 Mar;19(3):430–432. doi: 10.1097/00003246-199103000-00026. [DOI] [PubMed] [Google Scholar]
  13. Lind L., Carlstedt F., Rastad J., Stiernström H., Stridsberg M., Ljunggren O., Wide L., Larsson A., Hellman P., Ljunghall S. Hypocalcemia and parathyroid hormone secretion in critically ill patients. Crit Care Med. 2000 Jan;28(1):93–99. doi: 10.1097/00003246-200001000-00015. [DOI] [PubMed] [Google Scholar]
  14. Marzouk O., Bestwick K., Thomson A. P., Sills J. A., Hart C. A. Variation in serum C-reactive protein across the clinical spectrum of meningococcal disease. Acta Paediatr. 1993 Sep;82(9):729–733. doi: 10.1111/j.1651-2227.1993.tb12547.x. [DOI] [PubMed] [Google Scholar]
  15. Müller B., Becker K. L., Schächinger H., Rickenbacher P. R., Huber P. R., Zimmerli W., Ritz R. Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Crit Care Med. 2000 Apr;28(4):977–983. doi: 10.1097/00003246-200004000-00011. [DOI] [PubMed] [Google Scholar]
  16. Nijsten M. W., Olinga P., The T. H., de Vries E. G., Koops H. S., Groothuis G. M., Limburg P. C., ten Duis H. J., Moshage H., Hoekstra H. J. Procalcitonin behaves as a fast responding acute phase protein in vivo and in vitro. Crit Care Med. 2000 Feb;28(2):458–461. doi: 10.1097/00003246-200002000-00028. [DOI] [PubMed] [Google Scholar]
  17. Riordan F. A., Thomson A. P., Sills J. A., Hart C. A. Who spots the spots? Diagnosis and treatment of early meningococcal disease in children. BMJ. 1996 Nov 16;313(7067):1255–1256. doi: 10.1136/bmj.313.7067.1255. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Sinclair J. F., Skeoch C. H., Hallworth D. Prognosis of meningococcal septicaemia. Lancet. 1987 Jul 4;2(8549):38–38. doi: 10.1016/s0140-6736(87)93067-4. [DOI] [PubMed] [Google Scholar]
  19. Thomson A. P., Sills J. A., Hart C. A. Validation of the Glasgow Meningococcal Septicemia Prognostic Score: a 10-year retrospective survey. Crit Care Med. 1991 Jan;19(1):26–30. doi: 10.1097/00003246-199101000-00010. [DOI] [PubMed] [Google Scholar]
  20. Ugarte H., Silva E., Mercan D., De Mendonça A., Vincent J. L. Procalcitonin used as a marker of infection in the intensive care unit. Crit Care Med. 1999 Mar;27(3):498–504. doi: 10.1097/00003246-199903000-00024. [DOI] [PubMed] [Google Scholar]
  21. Wenner H. A. Virus diseases associated with cutaneous eruptions. Prog Med Virol. 1973;16:269–336. [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES