title: Procalcitonin and neopterin levels do not accurately distinguish bacterial from viral infections in ill-returned travellers with fever.
abstract: The diagnostic performance of procalcitonin and neopterin as markers for bacterial and viral causes of fever was evaluated in a cohort of 69 febrile travellers with known etiological agents. Our aim was to establish a decision rule to minimize empirical antibiotic treatment. Compared with C-reactive protein (CRP) and leukocyte (differential) counts, procalcitonin and neopterin had a disappointing diagnostic accuracy. Refraining from antibiotics in case of combined presence of lymphocytosis and/or CRP ≤10 mg/l would result in an 85% reduction in unwanted antibiotic treatment in patients with viral disease but in adequate antibiotic coverage of all patients with bacterial disease.
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands. r.tewitt@erasmusmc.nl
authors.forename: René
authors.initials: R
authors.lastname: te Witt
authors.forename: Robert-Jan
authors.initials: RJ
authors.lastname: Hassing
authors.forename: Pieter P
authors.initials: PP
authors.lastname: Petit
authors.forename: Alex
authors.initials: A
authors.lastname: van Belkum
authors.forename: Perry J
authors.initials: PJ
authors.lastname: van Genderen
mesh_terms: D001424:Bacterial Infections / Q000097:blood* / Q000150:complications; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D005334:Fever / Q000097:blood* / Q000209:etiology* / Q000382:microbiology / Q000821:virology; D006801:Humans; D008297:Male; D019798:Neopterin / Q000097:blood*; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood*; D012680:Sensitivity and Specificity; D014195:Travel; D014777:Virus Diseases / Q000097:blood* / Q000150:complications
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D019798:Neopterin; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide