ABSTRACT
Procalcitonin (PCT) is a biomarker that is increasingly being used to help in decision making when managing febrile patients. This is a non exhaustive review of the literature regarding the use of PCT in deciding to begin or discontinue antibiotic treatment. PCT appears to be useful in patients with respiratory infections or sepsis. In both these situations and using evaluated algorithms, a low PCT (< 0.25 microg), enables withholding or discontinuing antibiotic treatment, without negatively affecting clinical outcomes. For other indications there is however insufficient evidence to support the systematic measurement of PCT in all febrile patients. In particular, in patients with autoimmune disease or in the postoperative setting, PCT is insufficiently sensitive or specific to rule out or confirm a bacterial infection requiring antibiotic treatment.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Bacterial Infections/diagnosis , Calcitonin/analysis , Protein Precursors/analysis , Algorithms , Anti-Bacterial Agents/administration & dosage , Bacterial Infections/drug therapy , Biomarkers/analysis , Calcitonin Gene-Related Peptide , Decision Making , Fever/diagnosis , Fever/drug therapy , Humans , Respiratory Tract Infections/diagnosis , Respiratory Tract Infections/drug therapy , Sensitivity and Specificity , Sepsis/diagnosis , Sepsis/drug therapyABSTRACT
Autoimmune hepatitis is a systemic disease, difficult to diagnose due the high variability of the clinical presentation and some non specific histological features. The recent identification of additional autoantibodies used as serological markers, as well as simplified diagnostic criteria should help the primary care physician to advance with the diagnostic process. These progresses are crucial as undiagnosed and therefore untreated autoimmune hepatitis has a poor prognosis, whereas immunosuppressive therapy leads to remission in a majority of cases.
