The etiologic, microbiologic, clinical and outcome characteristics of immunocompetent young children <2 years of age hospitalized with acute neutropenia

Abstract

Background: To describe the etiologic, microbiologic, clinical and outcome characteristics of acute neutropenia (absolute neutrophil count, ANC, <1.5 Â 10 9 /L) in hospitalized immunocompetent children. Methods: Serious bacterial infections (SBI) were defined as culture-positive blood, urine, cerebrospinal fluid, articular fluid or stool infections, alveolar pneumonia, Brucellosis and Rickettsiosis. Results: 431/671 (64.2%) healthy infants and children hospitalized with acute neutropenia were <2 years of age; 176 (40.8%), 167 (38.8%) and 88 (20.4%) patients were aged 0e3, 4 e12 and 13e24 months, respectively. There were 19 (4.4%), 53 (12.3%), 140 (32.5%) and 209 (50.8%) patients with ANC count <200, 200e500, 501e1000 and 1001e1500 Â 10 9 cells/L, respectively. Severe neutropenia (<500 Â 10 9 /L) was recorded in 72 (16.7%) patients. Fever >38 C was present in 208/431 (48.3%) patients. Blood cultures were positive in 10 (2.3%), with Brucella melitensis, Staphylococcus aureus and Enterobacter spp. identified in 4, 3 and 2 patients, respectively; 5/10 patients with positive blood cultures were <3 months of age. Overall, 55/431 (12.7%) and 65/431 (15.1%) patients were diagnosed with SBIs and bacterial infections, respectively. Nasal washings-PCR for respiratory viruses was positive in 139/293 (47.4%) patients tested. An infectious etiology (bacterial and/or viral) was diagnosed in 190/

Diagnosis and therapeutic decision-making for the neutropenic patient

“…25,26 Higher rates of bac te rial infec tions have been reported in stud ies focused on hos pi tal ized neutropenic patients (12.7%-14.9%, with 1 study dem on strat ing 0%), 27 which may have resulted from the admis sion of sicker patients and the infec tious envi ron ment of the pop u la tion, as bru cel losis and rick ett sia, bac te rial infec tions known to be asso ci ated with neutropenia, were reported eti ol o gies in 3 out of 4 of these inpa tient-only stud ies. [28][29][30][31] The con clu sion from these stud ies is that the risk of bac te rial infec tion in the out pa tient set ting for the well-appearing pediat ric patient with iso lated and unsus pected neutropenia is low and sim i lar to patients with nonneutropenic fever. Screening for bac te rial infec tion, includ ing a blood cul ture, a uri nal y sis with urine cul ture, and, for symp tom atic patients, a chest x-ray, is suggested, but aggres sive man age ment includ ing admis sion and empiric anti bi ot ics may not be nec es sary for all patients.…”

Acute neutropenia in young children with immunocompetency: Is it a sign of benign viral infection or a risk of severe bacterial infection?

“…These findings were not novel and similar to that previously reported in the medical literatures. 7 However, the study still gave us the specific findings that after one-month follow-up period, the resolution of neutropenia occurred in almost half of them without any association with age subgroups and the severity of neutropenia. Additionally, nasal washings and PCR for respiratory viruses were positive in 47.4% of tested patients, and respiratory syncytial virus, adenovirus, parainfluenza, and influenza A were found to be the main viruses associated with acute neutropenia.…”

“…Tschernin et al described the etiology and clinical characters of acute neutropenia in hospitalized immunocompetent children aged under two years. 7 Besides culture-based and serologic techniques, the molecular approaches including multiplex real-time polymerase chain reaction (PCR) were also performed for the identification of 12 respiratory viruses. They found that young children aged under two years, especially aged 0e3 months, was the majority of hospitalized patients diagnosed with acute neutropenia.…”

Brucellosis: A Rare Cause of Febrile Neutropenia in a Child

“…Recent studies have reported that acute neutropenia occurs more commonly in young infants (<2 years of age) than in older children (16.7% of these children have severe neutropenia and 12.7% show SBI). 9,11.…”

“…9,11. Brucellosis and rickettsiosis, which affect up to 34% of patients, are the most common infections observed among SBIs. 9,[11][12][13]…”