ABSTRACT
Background: It is very important to distinguish between non-infectious systemic inflammatory response (SIRS) and culture negative sepsis as the management of the two conditions is different this often creates diagnostic challenge in day to day practice. The aim of present study is to investigate the diagnostic accuracy of serum PCT and CRP to differentiate between culture negative bacterial sepsis and non-infective SIRS. We have also studied their diagnostic efficacy in culture-positive sepsis. Materials and methods: 178 cases who were admitted in acute medical care unit in tertiary care centre, were included in the study. The cases were divided into three groups. Group I (culture positive sepsis) patients with positive microbial culture and 2 or more signs of sepsis. Group II (culture negative sepsis) includes patients with 2 or more sign of SIRs and clinical suspicion of infection with negative culture result. Group III (non-infective SIRs) includes patient with 2 or more sign of SIRS without evidence of any infection. Samples were collected for blood culture, differential count, PCT and CRP along with other routine investigation. The diagnostic performance of PCT and CRP was demonstrated with ROC curve analysis. Results: The median Procalcitonin was approximately 9 fold higher in culture negative group compared to non-infective SIRS and it was statistically significant (P<0.01) whereas CRP showed Siraj Ahmed Khan, Iyyapu Krishna Mohan, Bhavya Sirivelu, Rachel Jacob. Role of Procalcitonin and C-reactive protein in differentiating culture negative bacterial sepsis and systemic inflammatory response. IAIM, 2017; 4(3): 24-29. Page 25 only 2-3 fold increase between these groups. ROC curve analysis for PCT and CRP between culture negative and SIRS groups for prediction of systemic infection were performed. The area under the curve for PCT and CRP were 0.986 and 0.785 respectively. Conclusion: Biomarkers such as PCT and CRP are strongly associated with infection likelihood and sepsis and they can serve as useful adjuncts to routine clinical information. These markers were also able to distinguish between patients with non-infective SIRS and sepsis.
ABSTRACT
Background & objectives: Chikungunya (CHIK) fever is a mosquito-borne disease caused by chikungunya virus (CHIKV). Chikungunya infection was first reported from India in 1963 from Kolkata. We report the serological and molecular evidence of an outbreak of chikungunya in northeast India that occurred in Tura, a hilly and forested terrain in Garo Hills district of Meghalaya. Methods: blood samples (3 ml) collected from hospitalized patients during the outbreak were tested for IgM antibodies against CHIKV and followed up four months later. A repeat survey was carried out in the same area after four months from where cases had been reported. Blood samples were also collected from people with history of fever and body ache in the last four months. Persons showing IgM positivity against CHIKV in the repeat survey were followed up one and a half years later. All samples were also processed by RT-PCR assay for CHIK Envelope (E) 1 gene. Immature mosquitoes were collected, link reared and identified with standard keys. Virus incrimination studies were done on Aedes aegypti and Ae. albopictus mosquitoes collected during the survey. Results: Fever, headache and joint pain were the primary clinical presentations. Twenty three (35.93 %) of 64 samples reported during the outbreak were IgM positive for CHIK. Three samples showed PCR amplification. All these were IgM positive. The sequenced E1 gene revealed that the strains belonged to East Central South African (ECSA) genotype. Interpretation & conclusions: Field survey done after four months revealed that some individuals still had joint pain associated with episodes of headache and fever. It could be inferred that these persons might have contracted infection during the CHIK outbreak four months ago or during the intervening period which caused persistence of sequelae. ECSA genotype was found to be involved in the outbreak. Aedes albopictus was the predominant mosquito species collected during the outbreak.