ResearchPad - infectious-disease https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Not sick enough to worry? "Influenza-like" symptoms and work-related behavior among healthcare workers and other professionals: Results of a global survey]]> https://www.researchpad.co/article/elastic_article_13852 Healthcare workers (HCWs) and non-HCWs may contribute to the transmission of influenza-like illness (ILI) to colleagues and susceptible patients by working while sick (presenteeism). The present study aimed to explore the views and behavior of HCWs and non-HCWs towards the phenomenon of working while experiencing ILI.MethodsThe study was a cross-sectional online survey conducted between October 2018 and January 2019 to explore sickness presenteeism and the behaviour of HCWs and non-HCWs when experiencing ILI. The survey questionnaire was distributed to the members and international networks of the International Society of Antimicrobial Chemotherapy (ISAC) Infection Prevention and Control (IPC) Working Group, as well as via social media platforms, including LinkedIn, Twitter and IPC Blog.ResultsIn total, 533 respondents from 49 countries participated (Europe 69.2%, Asia-Pacific 19.1%, the Americas 10.9%, and Africa 0.8%) representing 249 HCWs (46.7%) and 284 non-HCWs (53.2%). Overall, 312 (58.5%; 95% confidence interval [CI], 56.2–64.6) would continue to work when sick with ILI, with no variation between the two categories. Sixty-seven (26.9%) HCWs and forty-six (16.2%) non-HCWs would work with fever alone (p<0 .01) Most HCWs (89.2–99.2%) and non-HCWs (80%-96.5%) would work with “minor” ILI symptoms, such as sore throat, sinus cold, fatigue, sneezing, runny nose, mild cough and reduced appetite.ConclusionA future strategy to successfully prevent the transmission of ILI in healthcare settings should address sick-leave policy management, in addition to encouraging the uptake of influenza vaccine. ]]> <![CDATA[A systematic review of alternative surveillance approaches for lymphatic filariasis in low prevalence settings: Implications for post-validation settings]]> https://www.researchpad.co/article/elastic_article_13802 Lymphatic filariasis (LF) is a mosquito-borne disease, which can result in complications including swelling affecting the limbs (lymphoedema) or scrotum (hydrocele). LF can be eliminated by mass drug administration (MDA) which involves whole communities taking drug treatment at regular intervals. After MDA programmes, country programmes conduct the Transmission Assessment Survey (TAS), which tests school children for LF. It is important to continue testing for LF after elimination because there can be a 10-year period between becoming infected and developing symptoms, but it is thought that the use of TAS in such settings is likely to be too expensive and also not sensitive enough to detect low-level infections. Our study assesses the results from 44 studies in areas of low LF prevalence that have investigated methods of surveillance for LF which differ from the standardised TAS approach. These include both human and mosquito studies. Results show that there is currently no standardised approach to testing, but that surveillance can be made more sensitive through the use of new diagnostic tests, such as antibody testing, and also by targeting higher risk populations. However, further research is needed to understand whether these approaches work in a range of settings and whether they are affordable on the ground.

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<![CDATA[HIV efficiently infects T cells from the endometrium and remodels them to promote systemic viral spread]]> https://www.researchpad.co/article/elastic_article_12744 The female reproductive tract (FRT) is the most common site of infection during HIV transmission to women, but viral remodeling complicates characterization of cells targeted for infection. Here, we report extensive phenotypic analyses of HIV-infected endometrial cells by CyTOF, and use a ‘nearest neighbor’ bioinformatics approach to trace cells to their original pre-infection phenotypes. Like in blood, HIV preferentially targets memory CD4+ T cells in the endometrium, but these cells exhibit unique phenotypes and sustain much higher levels of infection. Genital cell remodeling by HIV includes downregulating TCR complex components and modulating chemokine receptor expression to promote dissemination of infected cells to lymphoid follicles. HIV also upregulates the anti-apoptotic protein BIRC5, which when blocked promotes death of infected endometrial cells. These results suggest that HIV remodels genital T cells to prolong viability and promote viral dissemination and that interfering with these processes might reduce the likelihood of systemic viral spread.

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<![CDATA[How HIV exploits T cells in the endometrium]]> https://www.researchpad.co/article/elastic_article_12718 Immune cells in the endometrium are targeted by HIV and re-programmed to allow them to survive and spread the virus throughout the body.

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<![CDATA[SKAP2 is required for defense against <i>K. pneumoniae</i> infection and neutrophil respiratory burst]]> https://www.researchpad.co/article/elastic_article_12711 Klebsiella pneumoniae is a type of bacteria that can cause life-threatening infections – including pneumonia, blood stream infections, and urinary tract infections – in hospitalized patients. These infections can be difficult to treat because some K. pneumoniae are resistant to antibiotics. The bacteria are normally found in the human intestine, and they do not usually cause infections in healthy people. This implies that healthy people’s immune systems are better able to fend off K. pneumoniae infections; learning how could help scientists develop new ways to treat or prevent infections in hospitalized patients.

In healthy people, a type of immune cell called neutrophils are the first line of defense against bacterial infections. Several different proteins are needed to activate neutrophils, including a protein called SKAP2. But the role of this protein in fighting K. pneumoniae infections is not clear.

To find out what role SKAP2 plays in the defense against pneumonia caused by K. pneumoniae, Nguyen et al. compared infections in mice with and without the protein. Mice lacking SKAP2 in their white blood cells had more bacteria in their lungs than normal mice. The experiments showed that neutrophils from mice with SKAP2 produce a burst of chemicals called “reactive oxygen species”, which can kill bacteria. But neutrophils without the protein do not. Without SKAP2, several proteins that help produce reactive oxygen species do not work.

Understanding the role of SKAP2 in fighting infections may help scientists better understand the immune system. This could help clinicians to treat conditions that cause it to be hyperactive or ineffective. More studies are needed to determine if SKAP2 works the same way in human neutrophils and if it works against all types of K. pneumoniae. If it does, then scientists might be able use this information to develop therapies that help the immune system fight infections.

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<![CDATA[A Hemodialysis Patient with Severe COVID-19 Pneumonia]]> https://www.researchpad.co/article/elastic_article_11601 Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a novel coronavirus that has spread rapidly, resulting in a worldwide pandemic. Even though end-stage renal disease (ESRD) patients are particularly susceptible to COVID-19 infection and can develop severe to critical disease, there are limited studies and case reports about COVID-19 in ESRD patients. We report a case of a 63-year-old gentleman with ESRD on regular hemodialysis. We describe the clinical presentation of this patient, the diagnostic process, the laboratory and imaging investigations, as well as the course of treatment. He positively responded to a 14-day course of Lopinavir-Ritonavir, Ribavirin, Azithromycin, and Hydroxychloroquine.

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<![CDATA[Cutaneous Myiasis: An Unusual Cause of Posterior Auricular and Occipital Lymphadenopathy in a Toddler]]> https://www.researchpad.co/article/elastic_article_11585 Cutaneous myiasis is a condition that involves an infestation of fly larvae into human tissue, most commonly caused by Dermatobia (D.) hominis or the bot fly. While this is a condition most commonly seen in tropical regions of the globe due to increased travel to endemic regions, physicians must increasingly be aware of this as a potential diagnosis. In addition, there is minimal literature on cutaneous myiasis in the pediatric patient and its potential associated symptoms. This case report thus highlights a toddler that presented to our facility with a raised, erythematous scalp lesion and associated preauricular and occipital lymphadenopathy. Of note, the patient had a recent travel history to Belize, an endemic area where she was likely infected. As there are multiple other differentials for not only scalp swellings in the pediatric population, in addition to regional adenopathy, a high index of suspicion was needed to make the diagnosis. Ultrasound was the imaging modality used to visualize the fly larva, and surgical excision was the mechanism of treatment. Thus, this case highlights a unique presentation of cutaneous myiasis in a toddler and aims to add to the growing body of literature on a condition likely to be encountered by physicians at a greater frequency.

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<![CDATA[Interdigital Tinea Nigra]]> https://www.researchpad.co/article/elastic_article_11580 Tinea nigra is an uncommon superficial dermatomycosis precipitated by Hortaea werneckii, a halophilic and halothermic yeast-like fungus capable of producing a melanin-like substance. This pathogen infiltrates the stratum corneum in the setting of microtrauma and produces an asymptomatic brown to black macule or patch that appears similarly to melanocytic nevi or melanoma. We present a case of a 52-year-old woman who presented to clinic several months after developing a painless, nonpruritic dark brown patch in her left foot inside the fourth toe web. The coloration and location of this lesion would typically prompt biopsy; however, Wood’s lamp examination and potassium hydroxide (KOH) preparation were pursued first and demonstrated evidence of infection by H. werneckii. The patient was treated with topical clotrimazole cream and miconazole powder for one month, and her lesions cleared completely. Her lesions did not recur at her three-month follow-up appointment.

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<![CDATA[Tinea Corporis-associated Erythroderma: Case Report and Review of Erythrodermic Patients with Chronic Dermatophyte Infection]]> https://www.researchpad.co/article/elastic_article_11572 Erythroderma presents as generalized skin redness. The features of a 39-year-old man who presented with erythroderma are described. His skin biopsy revealed hyphae in the stratum corneum, which established the diagnosis of tinea corporis. His erythroderma resolved following treatment with an oral antifungal agent. Several conditions can be associated with erythroderma. Common etiologies for erythroderma include medications, neoplasms, and papulosquamous disorders. Superficial dermatophyte-associated erythroderma is rare. However, although erythroderma caused by generalized superficial mycosis is infrequently encountered, tinea corporis should be included in the new-onset or chronic erythroderma. The detection of fungal hyphae in the stratum corneum of a biopsy of the erythrodermic skin can not only establish dermatophyte infection as the underlying cause of the individual’s erythroderma but also an alternative cause of erythroderma. 

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<![CDATA[A biological control model to manage the vector and the infection of <i>Xylella fastidiosa</i> on olive trees]]> https://www.researchpad.co/article/elastic_article_11237 Xylella fastidiosa pauca ST53 is the bacterium responsible for the Olive Quick Decline Syndrome that has killed millions of olive trees in Southern Italy. A recent work demonstrates that a rational integration of vector and transmission control measures, into a strategy based on chemical and physical control means, can manage Xylella fastidiosa invasion and impact below an acceptable economic threshold. In the present study, we propose a biological alternative to the chemical control action, which involves the predetermined use of an available natural enemy of Philaenus spumarius, i.e., Zelus renardii, for adult vector population and infection biocontrol. The paper combines two different approaches: a laboratory experiment to test the predation dynamics of Zelus renardii on Philaenus spumarius and its attitude as candidate for an inundation strategy; a simulated experiment of inundation, to preliminary test the efficacy of such strategy, before eventually proceeding to an in-field experimentation. With this double-fold approach we show that an inundation strategy with Zelus renardii has the potential to furnish an efficient and “green” solution to Xylella fastidiosa invasion, with a reduction of the pathogen incidence below 10%. The biocontrol model presented here could be promising for containing the impact and spread of Xylella fastidiosa, after an in-field validation of the inundation technique. Saving the fruit orchard, the production and the industry in susceptible areas could thus become an attainable goal, within comfortable parameters for sustainability, environmental safety, and effective plant health protection in organic orchard management.

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<![CDATA[Cytomegalovirus Proctitis in a Patient with Chronic Lymphocytic Leukemia on Ibrutinib Therapy: A Case Report]]> https://www.researchpad.co/article/elastic_article_10709 Ibrutinib is a Bruton tyrosine kinase (BTK) inhibitor that has shown significant efficacy in patients with lymphoid carcinomas, mostly chronic lymphocytic leukemia (CLL). Cytomegalovirus (CMV) infection is not a common infectious complication associated with ibrutinib. To increase the clinical awareness about this rare entity, we present the first case of CMV proctitis in an immunocompromised host who was being treated with ibrutinib.

An 88-year old female with a history of CLL treated with ibrutinib presented with two days of painless hematochezia. Physical examination revealed cachexia and temporal wasting; bright red blood was observed on the digital rectal examination. A complete blood count demonstrated a significant decrease in hemoglobin from her baseline. Subsequent colonoscopy revealed a circumferential rectal ulcer; biopsy of the rectal ulcer was positive for CMV immunostain. The patient was treated with intravenous ganciclovir and later transitioned to valganciclovir for a total of 21 days of treatment. Her condition resolved, and she was found doing well at the follow-up visit.

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<![CDATA[Coronavirus Disease 2019 (COVID-19) in Cancer Patients]]> https://www.researchpad.co/article/elastic_article_10705 The Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become the most talked-about clinical entity in early 2020. As an infection that spreads easily and has a significant mortality rate, it has caused global panic rarely seen before. Many of the measures taken by governments worldwide will have long-lasting impacts on the wellbeing of the population at large. It has been widely reported that the most vulnerable patients have been most negatively affected by SARS-CoV-2 (COVID-19). In this study, we have tried to search the currently available data on the outcomes of infected cancer patients. Most of the data points to the very challenging nature of treating such patients. Their overall outcomes seem to be worse than in the general population, and it may be difficult to differentiate which potential complications are a result of the primary oncologic disease versus the infection. Management presents its own set of challenges, including but not limited to, deciding whether postponing cancer treatment until the infection resolves is going to benefit the patient and how to organize all aspects of patient care when social contact is as limited as it is for patients newly diagnosed with COVID-19. We believe that as more data becomes available, it is going to be necessary to publish detailed guidelines on how to approach this unique clinical challenge.

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<![CDATA[Severe Lower Extremity Cellulitis Caused by an Unusual Pathogen: Haemophilus Influenzae Type F]]> https://www.researchpad.co/article/elastic_article_10545 We present a case of unusual cellulitis of the lower extremities caused by Haemophilus influenzae (HI). A 64-year-old female with human immunodeficiency virus (HIV) with a suppressed viral load on treatment, presented with severe, very painful cellulitis of her lower extremity. CT scan did not show any gas or collections; however, she was taken to the operating room for concern of necrotizing fasciitis but no evidence of deep tissue involvement was found. Blood culture and wound culture were positive forHI type F (HiF), a newly emergent pathogenic capsulatedHI that has emerged post-HI type B (HiB) vaccination.

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<![CDATA[Association of Oxidative Stress and Production of Inflammatory Mediators Matrix Metalloproteinase-9 and Interleukin 6: Systemic Events in Radicular Cysts]]> https://www.researchpad.co/article/elastic_article_10535 Background

Matrix metalloproteinase-9 (MMP-9) and antioxidants are associated with the pathogenesis of cysts and may initiate and sustain the formation of new capillaries.

Objective

The objective of this study was to determine the association of oxidative stress and the production of inflammatory mediators MMP-9 and interleukin 6 (IL-6) in systemic events in radicular cyst growth.

Materials and methods

Fifty patients (34 men, 16 women) with periapical granulomas and radicular cysts were included in this cross-sectional study. Twenty subjects (12 men, eight women) with no signs of periodontal diseases were recruited as controls. Blood serum levels of MMP-9, IL-6, superoxide dismutase (SOD), malondialdehyde (MDA), and glutathione peroxidase (GPx) were recorded. We also recorded body mass index (BMI) and tumor necrosis factor-alpha (TNF-alpha) levels.

Results

The mean age of the test group patients and control patients was 45.9 and 48.8 years, respectively. The BMI of test group patients (23.77± 3.88 kg/m2) was higher than that of the controls (27.98 ± 3.88 kg/m2; p ≤ 0.000). Levels of serum MDA (p ≤ 0.033), IL-6 (p ≤ 0.041), TNF-alpha (p ≤ 0.004), and MMP-9 (p ≤ 0.033) were significantly increased in patients as compared with control values. SOD (p ≤ 0.003) and GPx (p ≤ 0.033) levels were significantly reduced in patients as compared with controls.

Conclusion

Oxidative imbalance and the increased production of inflammatory mediators may be associated with systemic events in radicular cysts. Bone-resorbing mediators and proinflammatory cytokines that were evaluated in the study (MMP-9, IL-6, C-reactive protein, TNF-alpha) were also elevated in the serum of the ailing group, thus documenting a well-established role for these circulating biochemical variables in the course of the progression and pathogenesis of radicular cyst development.

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<![CDATA[Guillain-Barre Syndrome, Neuroborreliosis, or Both]]> https://www.researchpad.co/article/elastic_article_10529 Guillain-Barre syndrome (GBS) is an acute paralytic neuropathy. Limited reports of GBS caused by tick-borne pathogens exist. Lyme disease is a tick-borne infectious disease that is commonly caused by Borrelia burgdorferi. The nervous system may be involved and is called neuroborreliosis.

In this case, we report a 30-year-old female who presented to the emergency department with one week of diffuse, increasing weakness in the upper/lower extremities and face after a recent gastrointestinal illness and travel to the Northeastern United States. Areflexia was noted in bilateral lower extremities. Lumbar puncture results together with clinical presentation were consistent with a diagnosis of GBS. Lab results later revealed a possible Lyme infection in cerebrospinal fluid, which along with recent travel to endemic area gave high suspicion for Lyme disease. The patient was treated for both diseases with significant improvement.

Taking a good history is an essential first step in diagnosis, as travel history was key in testing for Lyme.

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<![CDATA[Pneumonia Caused by Three Separate Microorganisms Simultaneously in a Patient Infected with Human Immunodeficiency Virus]]> https://www.researchpad.co/article/elastic_article_10519 Community-acquired pneumonia (CAP) is usually caused by a single microorganism. Streptococcus pneumoniae is the most common organism associated with CAP. However, in immunocompromised patients, especially those infected with human immunodeficiency virus (HIV), pneumonia may be caused by multiple organisms simultaneously. This report describes a previously healthy 29-year-old man who presented with acute CAP. Blood tests showed that he was positive for HIV antigen/antibody, and urinalysis showed that he was initially positive for pneumococcal antigen. Although blood cultures showed growth of Streptococcus pneumoniae, he did not respond to invasive anti-pneumococcal treatment with ceftriaxone and vancomycin. Rather, his pneumonia worsened, and he was intubated for hypoxic respiratory failure. His bronchoalveolar lavage fluid was positive for Pneumocystis pneumonia and methicillin-resistant Staphylococcus aureus. These findings indicate that pneumonia in immunocompromised patients may be caused by multiple organisms. Patients who fail to respond to treatment for a single identified organism should be suspected of being infected with other pathogenic organisms.

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<![CDATA[Bradycardia, Renal Failure, Atrioventricular Nodal Blockade, Shock, and Hyperkalemia (BRASH) Syndrome as a Presentation of Coronavirus Disease 2019]]> https://www.researchpad.co/article/elastic_article_10511 The novel coronavirus disease 2019 (COVID-19) has led to a global pandemic. While acute respiratory failure has been the predominant concern, there have been reports of other end-organ damage such as renal failure. We report a case of an elderly woman who presented with BRASH syndrome, a constellation of bradycardia, renal failure, atrioventricular (AV) nodal blockade, shock, and hyperkalemia (BRASH), which was likely triggered by COVID-19.

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<![CDATA[Infective Endocarditis Caused by Rhodococcus equi in an Immunocompetent Patient]]> https://www.researchpad.co/article/elastic_article_10502 Rhodococcus equi (R. equi) is a rare zoonotic organism that is found in the feces of grazing animals and in farm soil. It typically causes pulmonary disease, but it can also cause extrapulmonary disease. Immunocompromised patients are at a higher risk of developing the infection, but it has been reported in individuals with competent immune system as well. We present a unique case of infectious endocarditis (IE) due to a R. equi infection in an immunocompetent patient.

A 77-year-old male with a history of coronary artery disease, prior myocardial infarction, systolic heart failure, hypertension, hyperlipidemia, aortic stenosis, and benign prostatic hypertrophy was evaluated by cardiothoracic surgery for coronary and valvular heart disease. His transesophageal echocardiogram and cardiac catheterization demonstrated severe aortic stenosis and multivessel coronary artery disease. The patient underwent coronary artery bypass grafting and simultaneous aortic valve replacement. Intraoperatively, there was exudative material covering his aortic valve, which was sent for tissue culture. Tissue culture was positive for R. equi and Enterococcus faecium. 

R. equi endocarditis is a rare presentation of this organism. R. equi endocarditis is a very challenging diagnosis due to its varying presentation compared to typical IE. Detailed history taking and physical exam are extremely important to determine if further evaluation is needed. Prolonged oral and intravenous antibiotics are recommended for effective treatment. 

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<![CDATA[The Effect of Irrigation Fluid on Periprosthetic Joint Infection in Total Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis]]> https://www.researchpad.co/article/elastic_article_10501 Introduction

Rates of osteoarthritis and total joint arthroplasty (TJA) are on the rise globally. Periprosthetic joint infection (PJI) is the most devastating complication of TJA. A number of different intraoperative interventions have been proposed in an effort to reduce infection rates, including antibiotic cements, local antibiotic powder, and various irrigation solutions. The evidence on the importance of irrigation solutions is limited but has gained prominence recently, including the publication of a large randomized controlled trial (RCT). Thus, the purpose of this study was to evaluate the effectiveness of various irrigation solutions and pressures at reducing the rates of PJI.

Methods

A systematic review was performed using the electronic databases MEDLINE, Embase, and Web of Science. All records were screened in duplicate. Data collected included basic study characteristics, the details of the intervention and comparison solutions, if applicable, and rates of superficial and deep infection. A meta-analysis of comparative studies was performed to assess for consistency and potential direction of effect. 

Results

A total of ten studies were included, of which one was an RCT, eight were retrospective cohorts, and one was a case series. In total, there were 29,630 TJAs in 29,596 patients. The mean age ranged from 61 to 80 years. Six studies compared povidone-iodine (Betadine®) to normal saline, two studies compared chlorhexidine to saline, one study compared “triple prophylaxis” to standard practice, and one study used gentamicin but had no comparison group. The pooled risk ratio for deep infection in studies using Betadine® compared to saline was 0.62 (95% confidence interval [CI]: 0.33-1.19), while for chlorhexidine it was 0.74 (95%CI: 0.33-1.65).

Discussion

Current evidence on the relative efficacy of irrigating solutions as prophylaxis for infection following TJA remains inconclusive. Imprecision of estimates vindicates the need for a definitive trial to further inform their use in surgical practice. 

Conclusion

Antiseptic irrigation during TJA with solutions (Betadine®, chlorhexidine) may decrease PJI risk in patients undergoing primary and revision total hip and knee arthroplasties. Wide confidence intervals and heterogeneity among studies, however, render conclusions untrustworthy. Well-conducted RCTs are very much needed to help further investigate this issue.

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<![CDATA[Serum Procalcitonin Level Is Associated with Positive Blood Cultures, In-hospital Mortality, and Septic Shock in Emergency Department Sepsis Patients]]> https://www.researchpad.co/article/elastic_article_10499 This study examines the accuracy of initial and subsequent serum procalcitonin (PCT) levels in predicting positive blood cultures, in-hospital mortality, and development of septic shock in emergency department (ED) patients with severe sepsis. This study includes all patients who presented to our ED with an admission diagnosis of severe sepsis over a period of nine months. The median initial PCT was 0.58 ng/mL, interquartile range (IQR) 0.16-5.39. The median subsequent serum PCT was 2.1 ng/mL, with an IQR of 0.3-11.1. The PCT trend over the initial three hours increased in 67% of the study population. Blood cultures were positive in 38% of the cohort. The median maximum PCT in those with a negative blood culture was 1.06 ng/mL compared to 4.19 ng/mL in those with a positive blood culture (p=0.0116). Serum PCT levels >2.0 ng/mL display significant correlation with positive blood cultures, in-hospital mortality, and development of septic shock and as such may serve as a biomarker for more serious infections.

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