Question:

My daughter (18h was admitted to the ER a week following surgery for a perilymph fistula repair, exhibiting signs of mental confusion and severe headache, with fear of possible meningitis or sepsis. She was placed on IV antibiotics and blood cultures were sent out. She recovered, although the cultures came back negative, with the procalcitonin test at < 0.2.
6 weeks later she was showing signs of confusion and severe headache again and was re-admitted to the ER, again for fear of infection. She was kept overnight and released after receiving one dose of IV antibiotics. The thought from her surgeon was that since the infection tests were negative the first time that they’ll likely be negative again so she was released. Today we got the tests back and the procalcitonin test was 1.6 which appears to be positive.
We are not sure how to interpret this result. Her surgeon said to contact her PCP and that he didn’t know how to read that test. She continues to have headaches.

Answer:

Generally speaking a reading of 1.6 would indicate that there some kind of response to an infection or some kind of tissue injury. I would definitely proceed with further investigation to identify what is the cause and source of the problem. Although this does not appear to be an emergency since levels are less than 2. A complete examination by your family physician is needed with appropriate testing depending on the medical history of your daughter and if there are other symptoms present. Here are some other points that need to be considered.

1 : PCT levels may be elevated in patients who do not have sepsis. Plasma levels in these cases
usually are not very high (<2 ng/mL), but they may increase significantly in certain conditions, e.g.
following liver transplantation, during severe and prolonged cardiogenic shock, in patients with heat
shock, severe pancreatitis, and rhabdomyolysis (>2-10 ng/mL).

THUS IT SHOWS THAT ( PCT ) LEVEL LOWER THEN THE LEVEL 2 DOESN’T INDICATE SEPSIS AND
CAN BE RAISED BY CERTAIN OTHER FACTORS AS MENTIONED ABOVE.

2 : depending upon the previous clinical history of the patient, labs should be done to determine whether any
clinical problem exists or not.
Nature of labs and investigation of patient should be according to previous clinical history of the
patient If any treatment or any surgery was carried out previously.

3 : if the Procalcitonin ( PCT ) level is less then 2 ( <2.0 ) it doesn’t indicate there is sepsis ( infection )
and thus its not any emergency to rush but it’s the sign that you should consider to have a complete checkup.