Wanahita Anna, Goldsmith Elizabeth A, Musher Daniel M
Infectious Disease Section, Medical Service, Veterans Affairs Medical Center, Houston, TX, 77030, USA.
Clin Infect Dis. 2002 Jun 15;34(12):1585-92. doi: 10.1086/340536. Epub 2002 May 23.
Few modern studies have enumerated the conditions associated with leukocytosis. Our clinical experience has implicated Clostridium difficile infection in a substantial proportion of patients with leukocytosis. In a prospective, observational study of 400 inpatients with WBC counts of >/=15,000 cells/mm(3), we documented >/=1 infection in 207 patients (53%). Of these 207 patients, 97 (47%) had pneumonia, 60 (29%) had urinary tract infection, 34 (16%) had soft-tissue infection, and 34 (16%) had C. difficile infection. C. difficile infection was present in 25% of patients with WBC counts of >30,000 cells/mm(3) who did not have hematological malignancy. Other causes of leukocytosis in the 400 patients included physiological stress, in 152 patients (38%); medications or drugs, in 42 (11%); hematological disease, in 22 (6%); and necrosis or inflammation, in 22 (6%). C. difficile infection is a prominent cause of leukocytosis and this diagnosis should be considered for patients with WBC counts of >/=15,000 cells/mm(3), even in the absence of diarrheal symptoms.
很少有现代研究列举过与白细胞增多相关的病症。我们的临床经验表明，艰难梭菌感染在相当一部分白细胞增多患者中存在。在一项针对400名白细胞计数≥15,000个细胞/mm³的住院患者的前瞻性观察研究中，我们记录到207名患者（53%）发生了≥1次感染。在这207名患者中，97名（47%）患有肺炎，60名（29%）患有尿路感染，34名（16%）患有软组织感染，34名（16%）患有艰难梭菌感染。在白细胞计数>30,000个细胞/mm³且无血液系统恶性肿瘤的患者中，25%存在艰难梭菌感染。400名患者中白细胞增多的其他原因包括生理应激，有152名患者（38%）；药物或毒品，42名（11%）；血液系统疾病，22名（6%）；坏死或炎症，22名（6%）。艰难梭菌感染是白细胞增多的一个重要原因，对于白细胞计数≥15,000个细胞/mm³的患者，即使没有腹泻症状，也应考虑这一诊断。
