procal

Q: All of the following can cause a false negative procalcitonin (procal) level EXCEPT? - select one

A) cystitis

B) abscesses

C) empyemas 

D) malaria

E) skin/soft tissue infections

Answer: D

Procal is great for antibiotic stewardship, but it should be used cautiously as many false positives and negatives may occur. It is mainly related to bacterial infections, but non-bacterial infections, like malaria or invasive candida infections, can also cause them to rise.

On the other hand, if a bacterial infection is contained in localized infections like tonsillitis, sinusitis, cystitis, uncomplicated skin/soft tissue infections, abscesses, or empyemas, it may not be elevated. This can cause a clinician to not initiate antibiotic treatment, which can have subsequent harmful consequences for the patient.

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References:

1. Uzzan B, Izri A, Durand R, et al. Serum procalcitonin in uncomplicated falciparum malaria: a preliminary study. Travel Med Infect Dis 2006; 4:77.

2. Charles PE, Castro C, Ruiz-Santana S, et al. Serum procalcitonin levels in critically ill patients colonized with Candida spp: new clues for the early recognition of invasive candidiasis? Intensive Care Med 2009; 35:2146.

3. Pallin DJ, Bry L, Dwyer RC, et al. Toward an Objective Diagnostic Test for Bacterial Cellulitis. PLoS One 2016; 11:e0162947.