European Journal of Internal Medicine 13 (2002) 493–495 www.elsevier.com / locate / ejim Original article Could procalcitonin be a predictive biological marker in systemic fungal infections? Study of 14 cases * Sofia Christofilopoulou, Ekatherina Charvalos , George Petrikkos Laboratory of Infectious Diseases and Antimicrobial Chemotherapy, Laikon General Hospital, University of Athens, 9 28th October St., Agia Paraskevi, 153 41 Athens, Greece Received 11 December 2001; received in revised form 2 July 2002; accepted 19 August 2002 Abstract Background: Procalcitonin (PCT) is a recently described inflammatory marker that has been shown to increase significantly in patients with severe systemic bacterial infections or sepsis. Reports on the diagnostic and predictive value of PCT in systemic fungal infections are limited. Methods: In order to evaluate the role of PCT in systemic mycosis, 14 patients (mean age 40 years) with proven or probable systemic fungal infections were investigated. Blood samples were collected on days 1, 3, 5, and 10 after the onset of signs and symptoms of systemic fungal infection (clinical and / or laboratory diagnosis and / or radiographic evidence). PCT measurements were performed using an immunoluminometric assay. Results: In five patients with severe fungal infection and an unfavorable course (patient group 2), PCT levels were moderately elevated on day 3 (0.5–1.0 ng / ml), whereas they were normal in the patients who recovered (patient group 1). High PCT levels ($1.11 ng / ml) were detected on the 10th day of the course of the illness in patient group 2. A normal or moderate elevation of PCT on day 10 was observed in patient group 1. The difference in mean PCT levels in patient groups 1 and 2 on days 3 and 10 were statistically significant. Conclusions: PCT levels seem to correlate with the severity and outcome of systemic fungal infection. If this finding can be confirmed in a larger number of patients, it could serve as a prognostic indicator.  2002 Elsevier Science B.V. All rights reserved. Keywords: Procalcitonin; Mycoses; Prognostic indicator 1. Introduction diagnostic and / or predictive indicator of systemic fungal infections, we have undertaken the present study. Procalcitonin (PCT) is the 116-amino acid (AA) pro- hormone of calcitonin [1]. An elevation in PCT during severe lung injuries and sepsis was observed 9 years ago, 2. Patients and methods and its role in the diagnosis and follow-up of patients with severe bacterial infections was also confirmed [2]. In Patients enrolled in this study fulfilled the criteria of the systemic mycoses, the diagnostic and predictive role of European Organization for Research and Treatment of PCT remains unclear [3–5]. Cancer patients (EORTC) for proven or probable mycoses. To further elucidate the importance of PCT as a possible The criteria for proven fungal infection are: (1) positive histo- or cytopathology showing hyphae or yeast cells from tissue or needle aspiration, (2) positive culture from a *Corresponding author. Tel. / fax: 130-1-600-5268. E-mail address: gasson@aegean.gr (E. Charvalos). normally sterile site with concomitant clinical or radiolo- 0953-6205 / 02 / $ – see front matter  2002 Elsevier Science B.V. All rights reserved. PII: S0953-6205(02)00160-7