The Impact of Treatment on Serum Level of Procalcitonin in Patients with Active Pulmonary Tuberculosis


1 Pulmonologist, Department of Internal Medicine (Pulmonary Division) Ardabil University of Medical Sciences, Ardabil, Iran.

2 Pulmonologist, COPD Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Community Medicine Specialist , Ardabil University of Medical Sciences, Department of Community Medicine, Ardabil, Iran.

4 Infectious Disease Specialist, Department of Infectious Disease, Ardabil University of Medical Sciences, Ardabil, Iran.

5 Community Medicine Specialist , Department of Community Medicine, Ardabil University of Medical Sciences, , Ardabil, Iran.


Introduction: About one third of the world's population is infected with tuberculosis (TB) and each year, about 1.5 to 2 million people die from TB. Procalcitonin (PCT) is an inflammatory marker that its level has variable
Materials and Methods: This conducted on patients with pulmonary TB. Data were collected using a check list. The serum level of PCT was measured by ELISA test at the beginning and after six months of treatment. All data were analyzed using SPSS 16.
Results: There are some discussions in the utilization of PCT as a diagnostic marker in active pulmonary TB. The aim of this study was to compare serum PCT before and after treatment in patients with pulmonary TB.
Results: Forty-two patients with active pulmonary TB entered in this study. The mean age of the patients was 45.48 ± 12.54 years and 54.8% of them were male. Most of the patients (59.5 %) were rural inhabitants. There was a family history of TB in 26% of patients. The most common symptom (45.2%) was cough. Mean PCT prior to treatment was 1.25 ± 0.98 ng/ml. and 81% of the patients had PCT higher than 0.5 to 5. After treatment PCT level reduced significantly (P<0.001). The mean erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) before treatment were 45.88 ± 21.87 and 7.16 ± 3.98 respectively that were reduced significantly after treatment (P<0.001). Neutrophil counts before treatment was 6221 ± 3161 Cells per ml. and decreased statistically significant after treatment (P=0.01).
Conclusion: Our results showed that the PCT levels in pulmonary TB were high in active disease and reduced after treatment. PCT level may be used for follow-up as a discriminative marker between active and cured pulmonary TB and predict treatment response, although the PCT assay cannot be substituted for microbiological and pathological data.


1-      Lange C, Sester M. TB or not TB: the role of immunodiagnosis. Eur J Immunol, 2012 Nov;42:2840-3.

2-      Young DB, Gideon HP, Wilkinson RJ. Eliminating latent tuberculosis. Trends in microbiology, 2009;17:183-8.

3-      Delogu G, Zumbo A, Fadda G. Microbiological and immunological diagnosis of tuberculous spondylodiscitis. Eur Rev Med Pharmacol Sci, 2012 Apr;16 Suppl 2:73-8.

4-      Baganha MF, Pego A, Lima MA, Gaspar EV, Cordeiro AR. Serum and pleural adenosine deaminase. Correlation with lymphocytic populations. Chest, 1990;97:605-10.

5-      Trajman A, Pai M, Dheda K, van Zyl Smit R, Zwerling A, Joshi R, et al. Novel tests for diagnosing tuberculous pleural effusion: what works and what does not? Eur Respir  J,  2008;31:1098-106.

6-      Maertzdorf J, Weiner J, 3rd, Kaufmann SH. Enabling biomarkers for tuberculosis control. Int J Tuberc Lung Dis, 2012 Sep;16:1140-8.

7-      Kang YA, Kwon S-Y, Yoon HIL, Lee JH, Lee C-T. Role of C-Reactive Protein and Procalcitonin in Differentiation of Tuberculosis from Bacterial Community Acquired Pneumonia. The Korean Journal of Internal Medicine. 2009;24:337.

8-      San Jose ME, Valdes L, Vizcaino LH, Mora T, Pose A, Soneira E, et al. Procalcitonin, C-reactive protein, and cell counts in the diagnosis of parapneumonic pleural effusions. J Investig Med, 2010 Dec;58:971-6.

9-      Wang CY, Hsiao YC, Jerng JS, Ho CC, Lai CC, Yu CJ, et al. Diagnostic value of procalcitonin in pleural effusions. Eur J Clin Microbiol Infect Dis, 2011 ;30: 313-8

10-  Baylan O, Balkan A, Inal A, Kisa O, Albay A, Doganci L, et al. The predictive value of serum procalcitonin levels in adult patients with active pulmonary tuberculosis. Japanese journal of infectious diseases. 2006;59:164.

11-  Naderi M, Hashemi M, Kouhpayeh H, Ahmadi R. The status of serum procalcitonin in pulmonary tuberculosis and nontuberculosis pulmonary disease. J Pak Med Assoc. 2009 Sep;59:647-8

12-  Malekmohammad M, Naghan PA, Tabarsi P, Pourabdollah M, Mohajerani SA, Fotoohi F, et al. The diagnostic value of pleural effusion pro-calcitonin level in different etiologies of exudative pleural effusion. African Journal of Microbiology Research. 2012;6:3237-41.

13-  Rasmussen T, Sogaard O, Camara C, Andersen PL, Wejse C. Serum procalcitonin in pulmonary tuberculosis. The International Journal of Tuberculosis and Lung Disease. 2011;15:251-6.

14-  Ugajin M, Miwa S, Shirai M, Ohba H, Eifuku T, Nakamura H, et al. Usefulness of serum procalcitonin levels in pulmonary tuberculosis. Eur Respir  j, 2010;37:371-5.

15-  Cakir E, Deniz O, Ozcan O, Tozkoparan E, Yaman H, Akgul EO, et al. Pleural fluid and serum procalcitonin as diagnostic tools in tuberculous pleurisy. Clinical Biochemistry. 2005;38:234-8.

16-  Nyamande K, Lalloo U. Serum procalcitonin distinguishes CAP due to bacteria, Mycobacterium tuberculosis and PJP. The International Journal of Tuberculosis and Lung Disease. 2006; 10:510-5.

17-  Kosanke R, Beier W, Lipecky R, Meisner M. Clinical Benefits of Procalcitonin. Tanaffos. 2008;7:14-8.

18-  Christ-Crain M. Procalcitonin Guidance of Antibiotic Therapy in Community-acquired Pneumonia: A Randomized Trial. American Journal of Respiratory and Critical Care Medicine. 2006;174:84-93.

19-  Roach DR, Bean AG, Demangel C, France MP, Briscoe H, Britton WJ. TNF regulates chemokine induction essential for cell recruitment, granuloma formation, and clearance of mycobacterial infection. The Journal of immunology. 2002; 168:4620-7.

20-  Schleicher G, Herbert V, Brink A, Martin S, Maraj R, Galpin J, et al. Procalcitonin and C-reactive protein levels in HIV-positive subjects with tuberculosis and pneumonia. Eur  Respir J, 2005;25:688-92.

21-  Hashemi A, Shojaei H, Heidarieh P, Aslani MM, Naser AD. Genetic diversity of Iranian clinical isolates of Mycobacterium tuberculosis. New Microbiol, 2012; 35:61-5.