title: Intrathoracic administration of OK-432 elevates the serum procalcitonin levels.
abstract: OBJECTIVE
  The intrathoracic administration of OK-432, a lyophilized preparation of the heat- and penicillin-treated Su-strain of type 3, group A Streptococcus pyogenes, is performed in Japan for pleurodesis of malignant pleural effusion or pneumothorax. Persistent fever is often observed after pleurodesis. To elucidate whether procalcitonin (PCT) is useful for distinguishing between the side effects of OK-432 and infection, we measured the serum PCT levels before and after pleurodesis.
  
  
  METHODS
  We performed a prospective study of 12 patients with refractory pleural effusion or pneumothorax who required pleurodesis using OK-432 between August 2011 and February 2012. The serum PCT and C-reactive protein (CRP) levels were measured on days 1 and 3.
  
  
  RESULTS
  Of the 12 patients, five had pneumothorax and seven had uncontrolled pleural effusion with carcinomatous pleurisy. The median serum levels of PCT and CRP increased from 0.055 to 1.59 ng/mL (p=0.0022) and from 1.52 to 16.82 mg/dL (p=0.0022), respectively. The fevers subsided without antibiotic administration.
  
  
  CONCLUSIONS
  The serum PCT level may not be useful for distinguishing fever caused by side effects of OK-432 from that caused by bacterial infection. The intrathoracic administration of OK-432 increased the serum levels of both PCT and CRP in the absence of any bacterial infection.
authors.affiliation: Department of Respiratory Medicine, Hamamatsu Medical Center, Japan. shikatarawasagao@gmail.com
authors.forename: Takashi
authors.initials: T
authors.lastname: Ogasawara
authors.forename: Hiroki
authors.initials: H
authors.lastname: Umezawa
authors.forename: Shinpei
authors.initials: S
authors.lastname: Kato
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Yano
authors.forename: Norio
authors.initials: N
authors.lastname: Kasamatsu
authors.forename: Ikko
authors.initials: I
authors.lastname: Hashizume
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D001424:Bacterial Infections / Q000097:blood / Q000175:diagnosis; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D008297:Male; D010844:Picibanil / Q000008:administration & dosage* / Q000009:adverse effects; D016066:Pleural Effusion, Malignant / Q000097:blood / Q000175:diagnosis / Q000628:therapy; D018700:Pleurodesis / Q000009:adverse effects; D011030:Pneumothorax / Q000097:blood / Q000175:diagnosis / Q000628:therapy; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*
chemical_list: D000970:Antineoplastic Agents; C000606589:CALCA protein, human; D011498:Protein Precursors; D010844:Picibanil; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide