Assessment of procalcitonin values in deep mycosis associated with high β-D-glucan values

Introduction

Measurement of serum β-D-glucan values has come into widespread use in routine clinical practice as a means of diagnosing deep mycosis. We have previously reported on the usefulness of measuring procalcitonin (PCT) as a means of diagnosing infections and sepsis and assessing the severity of mycoses, and the fact that PCT values do not increase in deep mycoses that are single infections.

Methods

In the present study we made simultaneous measurements of the PCT values of patients with hyper-β-D-glucanemia and assessed the results.

Results

Fungi were isolated from every patient by local or blood culture. In 16 patients with β-D-glucan values of 100 pg/ml or more it was also possible to continuously measure both β-D-glucan values and PCT values, and six of them had β-D-glucan values that exceeded 1,000 pg/ml. There were eight patients with fungal infections alone, and all of them had PCT values below 0.5 pg/ml. There were four patients with mixed infections caused by fungi and Gram-negative bacteria, and three of them had PCT values of 0.5 pg/ml or more. There were also five cases of mixed infection by fungi and Gram-positive bacteria, and in three of them the PCT value exceeded 0.5 pg/ml. When there was a fungal infection alone, the PCT value never rose, even when the β-D-glucan value exceeded 1,000 pg/ml. No significant correlation was found between the β-D-glucan values and the PCT values.

Conclusion

Simultaneous measurement of β-D-glucan values and PCT values was shown to be useful in making the differential diagnosis between mycoses alone and mixed infections.