Departments of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
Departments of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
Am J Trop Med Hyg. 2019 Jan;100(1):146-149. doi: 10.4269/ajtmh.17-0892.
The local signs and symptoms following snakebites are similar to those of cellulitis caused by bacterial infections. This leads to empirical treatment with antibiotics, which however is not supported by evidence. Procalcitonin (PCT) is a biomarker with good diagnostic accuracy for bacterial infection. We studied serum PCT concentration in 100 patients aged 13 years or more, presenting to the hospital with significant local manifestations (crossing the joint proximal to the bitten wound) within 24 hours after snakebite. The extent and progression of local manifestations were monitored 12 hourly. Baseline PCT measurement was carried out for all patients and measurement was repeated 12 hourly only in those patients with progressive local manifestations. The median interqartile range PCT concentration did not differ significantly by the severity of local manifestation at presentation (Grade 2 = 0.28 [0.26-0.30]; Grade 3 = 0.28 [0.26-0.32]; Grade 4 = 0.27 [0.26-0.32] ng/mL; = 0.15). Furthermore, we did not observe an increase in PCT concentration on serial estimation in those with progressive local manifestation (0.28, 0.29, and 0.29 ng/mL) over 36 hours. These observations suggest that the local manifestations following snakebites were not caused by bacterial infection.
被蛇咬伤后的局部症状和体征与由细菌感染引起的蜂窝织炎相似。这导致了经验性的抗生素治疗，但这种治疗方法没有证据支持。降钙素原 (PCT) 是一种对细菌感染具有良好诊断准确性的生物标志物。我们研究了 100 名年龄在 13 岁及以上的患者的血清 PCT 浓度，这些患者在蛇咬伤后 24 小时内出现明显的局部表现（跨过咬伤伤口近端的关节）。每 12 小时监测一次局部表现的程度和进展。对所有患者进行基线 PCT 测量，仅对局部表现进展的患者每 12 小时重复测量。PCT 浓度的中位数（四分位间距）在就诊时局部表现的严重程度方面无显著差异（2 级=0.28 [0.26-0.30]；3 级=0.28 [0.26-0.32]；4 级=0.27 [0.26-0.32]ng/mL；=0.15）。此外，我们在那些局部表现进展的患者中观察到，在 36 小时内，PCT 浓度在连续评估中并没有增加（0.28、0.29 和 0.29ng/mL）。这些观察结果表明，蛇咬伤后的局部表现不是由细菌感染引起的。
