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Interdisciplinary Perspectives on Infectious Diseases
Volume 2009 (2009), Article ID 137609, 7 pages
http://dx.doi.org/10.1155/2009/137609
Research Article

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

1Department of Internal Medicine, Harbour Hospital, Institute for Tropical Diseases, Haringvliet 2, 3011 TD Rotterdam, The Netherlands
2Department of Internal Medicine, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
3Department of Microbiology, Vlietland Hospital, P.O. Box 215, 3100 AE Schiedam, The Netherlands

Received 22 June 2009; Accepted 8 September 2009

Academic Editor: Ann Moormann

Copyright © 2009 Dennis A. Hesselink et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Fever in a returned traveller may be the manifestation of a self-limiting, trivial infection but it can also presage an infection that can be rapidly progressive and lethal. We studied the diagnostic accuracy of procalcitonin (PCT) as a biomarker for a bacterial cause of fever in a cohort of 157 consecutive travellers with fever after a stay in the (sub)tropics. Elevated procalcitonin levels were observed not only in about 50% of travellers with proven bacterial infection, but also in a significant proportion of travellers with a likely infection. Using a cutoff point of 0.5 ng/mL, procalcitonin had a sensitivity of 0.52 and a specificity of 0.76 for a bacterial cause of fever on admission. Interestingly, only 1 out of 16 patients with a proven viral infection had a marginally elevated PCT concentration on admission, suggesting that an increased PCT level likely excludes a viral infection as the cause of fever. However, the diagnostic accuracy of this semiquantitative procalcitonin test for a bacterial cause of fever on admission is too poor to advocate its use in the initial clinical evaluation of fever in a setting of ill-returned travellers.