Transient and chronic neutropenias detected in children with different viral and bacterial infections

Abstract

Aim: The aim of the study was to identify the relationship of acquired neutropenias with infections in childhood and to assess their course, complications, short and long‐term outcome. Method: During a two‐year period, all children admitted to the pediatric ward with neutropenia were investigated for underlying infections with indices of infection, cultures of body fluids and serological tests. Results: Sixty‐seven previously healthy children, aged (median, 25–75%) 0.7 years (0.2–1.5), were identified with neutropenia (frequency: 2.0%). An infectious agent was identified in 34/67 cases (50.7%) (viral infection: n=24, bacterial: n=10). In 50/67 (74.6%) children, neutropenia recovered within 2 months (transient neutropenia, TN), while in 17/67 (25.4%) of them it persisted for more than two months. Two years after diagnosis 50/67 children (74.6%) accepted to be reassessed. Of these children, 8/50 (16%) remained neutropenic (neutropenic children, NC), while 42/50 had recovered completely. Conclusion: Neutropenia during childhood is usually transient, often following viral and common bacterial infections, does not present serious complications and in the majority, it resolves spontaneously. However, in a significant percentage of patients, neutropenia is discovered during the course of an infection, on a ground of a preceding chronic neutropenic status.

Biomarker‐guided clinical development of the first‐in‐class anti‐inflammatory FPR2/ALX agonist ACT‐389949

“…Our data from the SAD and MAD studies showed that all cytokines measured (IL‐6, IL‐8, IL‐10, MCP‐1 and TNF‐α) demonstrated the same transient, rapid activation pattern, and in the MAD study no further stimulation under steady‐state conditions was observed. A feature of a pro‐inflammatory reaction is the transient induction of neutropenia in peripheral blood following an immunological challenge , substantiating the observed activation pattern of FPR2/ALX by ACT‐389949.…”

Clinical and Laboratory Features That Differentiate Dengue from Other Febrile Illnesses in an Endemic Area—Puerto Rico, 2007–2008

“…For example, subgroup analysis of our data shows that leukopenia, one of the manifestations of dengue listed in the current WHO case definition, is predictive of dengue early in the course of infection only among adults aged ≥ 20 years. Leukopenia is a common clinical finding in many viral childhood infections, 39 and as children have an average of 6 to 8 viral infections annually, 40,41 the finding that this is not a good early predictor for dengue among children could be anticipated. Although a previous study from Thailand did identify leukopenia as a good early predictor of dengue infection in children, 14 another study from Nicaragua found, similar to our results, that leukopenia was significantly associated with early dengue infection in adults but not in children.…”

Question 2: Unexpected neutropenia in a febrile, but immunocompetent, child

“…The risk of infectious complications (ie, developing a secondary SBI) during an episode of transient moderate neutropenia appears to be low;3 9 however, Alario and O'Shea1 found that 4 of the 36 children in their study (of the 191 patients who had neutropenia) who remained neutropenic for more than 30 days developed superficial skin or mucosal infections. None of the children in Alario's study developed invasive infections or bacteraemia.…”

“…The natural history of infection-induced neutropenia is that it is normally moderate, transient and self-resolving 2 8 9. The risk of infectious complications (ie, developing a secondary SBI) during an episode of transient moderate neutropenia appears to be low;3 9 however, Alario and O'Shea1 found that 4 of the 36 children in their study (of the 191 patients who had neutropenia) who remained neutropenic for more than 30 days developed superficial skin or mucosal infections.…”