Korean J Intern Med.  2009 Dec;24(4):337-342. 10.3904/kjim.2009.24.4.337.

Role of C-Reactive Protein and Procalcitonin in Differentiation of Tuberculosis from Bacterial Community Acquired Pneumonia

• Kang YA
• Kwon SY
• Yoon HI
• Lee JH
• Lee CT

• KMID: 1776662
• DOI: http://doi.org/10.3904/kjim.2009.24.4.337

Abstract

BACKGROUND/AIMS
We investigated the utility of serum C-reactive protein (CRP) and procalcitonin (PCT) for differentiating pulmonary tuberculosis (TB) from bacterial community-acquired pneumonia (CAP) in South Korea, a country with an intermediate TB burden. METHODS: We conducted a prospective study, enrolling 87 participants with suspected CAP in a community-based referral hospital. A clinical assessment was performed before treatment, and serum CRP and PCT were measured. The test results were compared to the final diagnoses. RESULTS: Of the 87 patients, 57 had bacterial CAP and 30 had pulmonary TB. The median CRP concentration was 14.58 mg/dL (range, 0.30 to 36.61) in patients with bacterial CAP and 5.27 mg/dL (range, 0.24 to 13.22) in those with pulmonary TB (p<0.001). The median PCT level was 0.514 ng/mL (range, 0.01 to 27.75) with bacterial CAP and 0.029 ng/mL (range, 0.01 to 0.87) with pulmonary TB (p<0.001). No difference was detected in the discriminative values of CRP and PCT (p=0.733). CONCLUSIONS: The concentrations of CRP and PCT differed significantly in patients with pulmonary TB and bacterial CAP. The high sensitivity and negative predictive value for differentiating pulmonary TB from bacterial CAP suggest a supplementary role of CRP and PCT in the diagnostic exclusion of pulmonary TB from bacterial CAP in areas with an intermediate prevalence of pulmonary TB.

Keyword

C-reactive protein; Pneumonia, community acquired; Procalcitonin; Tuberculosis

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
C-Reactive Protein/*analysis
Calcitonin/*blood
Community-Acquired Infections/blood/*diagnosis
Diagnosis, Differential
Female
Humans
Male
Middle Aged
Pneumonia, Bacterial/blood/*diagnosis
Prospective Studies
Protein Precursors/*blood
Severity of Illness Index
Tuberculosis, Pulmonary/blood/*diagnosis