Clinical Value of Procalcitonin as a Biomarker for Detecting a Primary Tuberculous Spinal Infection: Case Report and Review of the Literature.
This article has been Reviewed by the following groups
Discuss this preprint
Start a discussion What are Sciety discussions?Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Procalcitonin is a biomarker, potentially useful in the diagnosis of sepsis and severe bacterial infections. Few studies have examined the usefulness of this biological marker in the diagnosis of tuberculous spondylodiscitis. We report the case of a 37-year-old woman with an unremarkable medical history who was newly diagnosed with tuberculous spondylodiscitis while the procalcitonin test was negative. This case confirms the hypothesis that procalcitonin is not a useful parameter to support the diagnosis of primary tuberculous spondylodiscitis.
Article activity feed
-
Thank you very much for submitting your manuscript to Access Microbiology. It has now been reviewed by two experts in the field, whose comments are attached at the bottom of this email. Unfortunately, the reviewers have pointed out that there is no solid background behind this report that can sustain its claim and that the premise of the study is flawed (e.g. PCT is high in acute infections, but the patient had a history of disease of 6 months; plasma PCT is high in patients with bacterial pneumonia, but not in patients with viral or bacterial infections). For this reason, we have decided to no longer consider the manuscript for publication. I really hope this feedback is helpful for your future research and that this decision does not discourage you from submitting further works to Access Microbiology.
-
Comments to Author
Please ONLY put comments for the Author(s) in here This is an interesting case report, regarding the usefulness or otherwise of including measurement of procalcitonin as a diagnostic biomarker for tuberculous spondylodiscitis. The case does shed some light on this question, but the manuscript could be made clearer to support the stated conclusions. Major points: Abstract: One case is nowhere near enough to claim that "procalcitonin is not a useful parameter to support the diagnosis of primary tuberculous spondylodiscitis." To make such a concrete claim, there would need to be a much greater, and calculated, sample size. Abstract (and Discussion): Could it be possible that the lack of procalcitonin induction could be a useful differential marker to determine the type of bacterial spinal infection?
Comments to Author
Please ONLY put comments for the Author(s) in here This is an interesting case report, regarding the usefulness or otherwise of including measurement of procalcitonin as a diagnostic biomarker for tuberculous spondylodiscitis. The case does shed some light on this question, but the manuscript could be made clearer to support the stated conclusions. Major points: Abstract: One case is nowhere near enough to claim that "procalcitonin is not a useful parameter to support the diagnosis of primary tuberculous spondylodiscitis." To make such a concrete claim, there would need to be a much greater, and calculated, sample size. Abstract (and Discussion): Could it be possible that the lack of procalcitonin induction could be a useful differential marker to determine the type of bacterial spinal infection? Line 77 - patient was treated "according to the national protocol" - either the protocol or the nation should be stated for clarity. I would suggest including the clinical and geographical setting as part of the methods. The conclusion at the end of the discussion does not match that given in the Abstract, ie that there is no value in measuring PCT in tuberculous spondylodiscitis. Indeed it is not clear what the authors mean by their conclusion - is it worth optimising PCT measurement, and if so, why? An argument could be made that is it useful in differentiating infectious causative agents, but if so, this should be consistent throughout the Abstract, Discussion and Conclusion Minor Points: Introduction: It is not clear what is meant by "Infections should be recognized as quickly as possible for physiological… reasons" - please explain what is meant by "physiological reasons" (line 34). The four purposes given for the usefulness of measuring serum PCT are overlapping, and more detail about the distinctions would be helpful (lines 39ff). Some grammatical improvements could be made - eg lines 39ff. Typo in line 67 for CRP units. Line 81 - 10 million people per year develop Line 82, It is stated that TB is the third most common cause of death from infectious disease, presumably currently/recently behind covid-10, but it is not clear what else would be considered to have a higher mortality than TB? Line 98 - is this associated tuberculous infections?
Please rate the quality of the presentation and structure of the manuscript
Poor
To what extent are the conclusions supported by the data?
Partially support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
-
Comments to Author
I have reviewed the case report by Lhalou et al. No biomarker is 100% sensitive nor specific, so claiming that "This case confirms the hypothesis that procalcitonin is not a useful parameter to support the diagnosis of primary tuberculous spondylodiscitis." Authors included a reference (1) citing "…many other studies suggest that PCT is not helpful in diagnosing tuberculosis spondylodiscitis (1)." When stating studies, there should be series of citations. Secondly, the paper does not refer to TB specifically. Other papers, have already demonstrated that the plasma levels of PCT are highly elevated in subjects with bacterial pneumonia. Conversely, in viral and mycobacterial infection, the plasma PCT levels are not elevated due to interferon-gamma (IFN-γ) mediated down-regulation of PCT. So there is no …
Comments to Author
I have reviewed the case report by Lhalou et al. No biomarker is 100% sensitive nor specific, so claiming that "This case confirms the hypothesis that procalcitonin is not a useful parameter to support the diagnosis of primary tuberculous spondylodiscitis." Authors included a reference (1) citing "…many other studies suggest that PCT is not helpful in diagnosing tuberculosis spondylodiscitis (1)." When stating studies, there should be series of citations. Secondly, the paper does not refer to TB specifically. Other papers, have already demonstrated that the plasma levels of PCT are highly elevated in subjects with bacterial pneumonia. Conversely, in viral and mycobacterial infection, the plasma PCT levels are not elevated due to interferon-gamma (IFN-γ) mediated down-regulation of PCT. So there is no need for this case report to corroborate anything. The patient has a history of disease of 6 months. PCT is elevated in acute infections, or acute reactivations of inflammatory or infectious process. This is why "serum level of PCT is lower in tuberculous spondylodiscitis compared to pyogenic spondylodiscitis". The paper is disorganized, which required explanation of what PCT is placed at the very end of the paper. The text needs to be revised, as some statements are difficult to read, or just appear as isolated disconnected phrases, e.g. "To determine the likelihood f death in critically ill patients with sepsis." The claim weakens even more when no backup references are included after stating that "Nevertheless, few studies have examined the utility of this biological marker in the diagnosis of infectious spondylodiscitis, particularly tuberculous spondylodiscitis."
Please rate the quality of the presentation and structure of the manuscript
Very poor
To what extent are the conclusions supported by the data?
Not at all
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
No: Nothing appears disclosed regarding the patient's consent
-
