Page 20 - pest-POSTEN nr 4, 1995

-pest-POSTEN Side 20

bacterial meningitis, septic shock and severe blood cell count ande Creative protein (CRP) have
pneumonia. Accccordingly, downmodulation of redused value.
the inflammatory response might improve the Objective: To evaluate Calprotectin as a
outcome of infection. Prostaglandins seem to play diagnostic serum marker of acute PCP and as a
a central role in the acute inflammatory response marker for treatment response.
and inhibition of prostaglandin synthesis by non- Methods: Retrospective study of 13 cases with
steroidal anti-inflammatory drugs (NSAIDS) may verified PCP. Serum was sampled on a routine
offer an adjunct in the treatment of infectious basis. Calprotectin was analyzed with a non
diseases. competitive enzyme immunoassay (upper
In experimental bacterial meningitis, indomethacin reference range: 5.3 mg/L) and compared til ESR,
has effectively reduced brain edema, but no CRP and serum lactate dehydrogenase (LD).
significant effect has been demonstrated on Results: The figure shows (figur ikke vist - red.
cerebrospinal fluid, leukocyte counts, lactate and anm.) the Calprotectin levels at the time of PCP
protein concentrations, and intracisternal pressure. diagnosis (0) and 1 and 2 months before (-1 & -2)
Oxindanac has had a most favourable effect om and after this diagnosis (1 & 2). Each line
mortality in experimental meningitis and has been represents one patient. Elevated serum
superior to both indomethacin and dexamethasone. Calprotectin was found in 12/13 patients at the
A number of experimental studies has focused time of PCP diagnosis and all 11 patients with a
upon the effects of NSAIDS in septic shock and serum sample prior to PCP diagnosis had a rise in
endotoxin induced lung injury, and the benficial Calprotectin. Clinical response to treatment was
effects of ibuprofen in these conditions have been parallelled by a fall of Calprotectin. Two cases
most convincingly demonstrated. In animal models with a persistently elevated Calprotectin level had
of severe pneumonia, piroxicam has maintained Tbc and PCP recurrence. The sensitivity as a
pulmonary defence aginst infection while diagnostic marker for PCP was better than LD,
diminishing inflammatory responses. Little is CRP and ESR.
known about the effects of NSAIDS in infectious Conclusion: AIDS patients respond with an
disease patients, and clinical trials with these drugs adequate rise of Calprotectin in serum.
should be encouraged. Calprotectin is a useful marker for acute PCP and
—— to follow response to treatment.
____

5th European Conference on Clinical A CASE OF PRESUMED DISSEMINATED
Aspects and Treatment of HIV Infection PENICILLIOSIS CAUSED BY
HISTOPLASMA CAPSULATUM.
København: (se referat s. 7) Mæland Arild, Department of Infectious Diseases
Ullevål University Hospital, N-0407 Oslo, Norway
CALPROTECTIN - A DIAGNOSTIC SERUM
MARKER IN Pneumocystis carinii Case history: A 33-year old HIV-infected woman
PNEUMONIA (PCP).
Dunlop Oona, von der Lippe E, Bruun JN, from the northern part of Laos who had moved to
Norway 6 years ago presented with high fever,
Myrvang B, Fagerhol MK. Department of
Infectious Diseases & Bloodbank and Department general debilitation, a unilateral tumorous swelling
of lymph nodes in the neck and multiple papulo-
of Immunology, Ullevål University Hospital, Oslo,
Norway. pustular skin lesions, but without clinical or
radiological pulmonary signs. A biopsy from the
Background: Calprotectin is a recently lymph nodes, smears from skin lesion, peripheral
described protein with antimicrobial properties, blood buffy coat and bone marrow prepartions all
produced by granulocytes and macrofages and revealed multiple fungus-like organisms. Because
behaves as an acute phase protein. Preliminary of the patient`s origin pencilliosis was suspected
results indicate that AIDS patients have a and 9 recent publications on this mycosis
preserved response of Calprotectin. In acute PCP including one witch thoroughly discussed
diagnostics like sedimentation rate (ESR), white
- fortsetter på side 28.