儿童侵袭性脑膜炎球菌感染时中性粒细胞计数的改变。
Altered neutrophil counts at diagnosis of invasive meningococcal infection in children.
机构信息
From the *University of Missouri School of Medicine, Columbia, MO; †Department of Pediatrics, Pediatric Infectious Disease Section, Baylor College of Medicine, Houston, TX; ‡Department of Pediatrics, University of Arkansas of Medical Sciences, Little Rock, AR; §Department of Pediatrics, Children's Hospital San Diego, San Diego, CA; ¶Department of Pediatrics, Ohio State University College of Medicine and Public Health, Columbus, OH; ‖Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN; **Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, UT; ††Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC; ‡‡Department of Pediatrics, Northwestern University Medical School, Chicago, IL; §§Department of Pediatrics, University of Southern California School of Medicine, Los Angeles, CA; ¶¶Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA; ‖‖Department of Pediatrics, Pediatric Infectious Disease Section, Baylor College of Medicine, Houston, TX; and ***Department of Child Health, Division of Infectious Disease and Rheumatology, University of Missouri School of Medicine, Columbia, MO.
出版信息
Pediatr Infect Dis J. 2013 Oct;32(10):1070-2. doi: 10.1097/INF.0b013e31829e31f1.
BACKGROUND
Invasive meningococcal infections can be devastating. Substantial endotoxemia releases mature and immature neutrophils. Endothelial margination of mature neutrophils may increase the immature-to-total neutrophil ratio (ITR). These changes have not been previously well-described in invasive meningococcal disease.
METHODS
Using 2001 to 2011 data from the US Multicenter Meningococcal Surveillance Study, the diagnostic sensitivity and clinical correlates of white blood cell count, absolute neutrophil count (ANC), immature neutrophil count (INC) and ITR were evaluated alone and in combination at the time of diagnosis of invasive meningococcal disease.
RESULTS
Two hundred sixteen patients were evaluated: meningococcemia (65), meningitis (145) and other foci (6). ANC ≤1000/mm(3) or ≥10,000/mm(3) was present in 137 (63%), INC ≥500/mm(3) in 170 (79%) and ITR ≥0.20 in 139 (64%). One or more of these 3 criteria were met in 204 of the 216 (94%). Results were similar for meningococcemia and meningitis subgroups. All 13 cases with mildest disease met 1 or more of the 3 criteria. Eight children presented with ANCs <1000/mm(3): 3 of them died and a fourth required partial amputation in all 4 limbs.
CONCLUSIONS
Invasive meningococcal disease is characterized by striking abnormalities in ANC, INC and/or ITR. Neutropenia was associated with a poor prognosis. Notably, without INCs, 37% of cases would have been missed. Automated methods not measuring immature white blood cells should be avoided when assessing febrile children. Serious infection should be considered when counts meet any of the 3 criteria.
背景
侵袭性脑膜炎球菌感染可能是毁灭性的。大量内毒素血症会释放成熟和不成熟的中性粒细胞。成熟中性粒细胞的内皮边缘可能会增加不成熟中性粒细胞与总中性粒细胞的比例（ITR）。这些变化在侵袭性脑膜炎球菌病中以前没有得到很好的描述。
方法
使用 2001 年至 2011 年美国多中心脑膜炎球菌监测研究的数据，评估白细胞计数、绝对中性粒细胞计数（ANC）、不成熟中性粒细胞计数（INC）和 ITR 在诊断侵袭性脑膜炎球菌病时的单独和组合的诊断灵敏度和临床相关性。
结果
评估了 216 例患者：脑膜炎球菌血症（65 例）、脑膜炎（145 例）和其他病灶（6 例）。ANC≤1000/mm3 或≥10000/mm3 存在于 137 例（63%），INC≥500/mm3 存在于 170 例（79%），ITR≥0.20 存在于 139 例（64%）。216 例中的 204 例符合 1 项或多项这 3 项标准。脑膜炎球菌血症和脑膜炎亚组的结果相似。最轻微疾病的 13 例均符合 1 项或多项 3 项标准。8 例儿童 ANC<1000/mm3：其中 3 例死亡，第四例四肢均需部分截肢。
结论
侵袭性脑膜炎球菌病的特征是 ANC、INC 和/或 ITR 显著异常。中性粒细胞减少与预后不良相关。值得注意的是，如果不测量 INC，37%的病例将被遗漏。评估发热儿童时，应避免使用不测量不成熟白细胞的自动方法。当计数符合 3 项标准中的任何一项时，应考虑严重感染。
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