免疫功能正常的住院患儿中性粒细胞减少症的感染性和非感染性病因、临床表现和转归。
The Infectious and Noninfectious Etiology, Clinical Picture and Outcome of Neutropenia in Immunocompetent Hospitalized Children.
机构信息
From the Pediatric Hematology/Oncology Department.
Soroka University Medical Center, Beer-Sheva, Israel.
出版信息
Pediatr Infect Dis J. 2018 Jun;37(6):570-575. doi: 10.1097/INF.0000000000001893.
BACKGROUND
Acquired neutropenia in immunocompetent children is common, and its differential diagnosis ranges from benign causes to life-threatening diseases. We described the etiology, clinical picture and outcome of new-onset neutropenia in immunocompetent children assessed in the emergency department and hospitalized at our medical center.
METHODS
Previously healthy children admitted with neutropenia (absolute neutrophil count <1.5 × 10(9)/L) were included. Serious bacterial infections were defined as culture-positive blood, urine, cerebrospinal fluid, articular fluid or stool infections, pneumonia, Brucellosis and Rickettsiosis.
RESULTS
A total of 601 patients (5 days-202 months old) were enrolled; 3 (0.5%), 48 (8%), 165 (27.5%) and 385 (64%) had absolute neutrophil counts <0.2, 0.2-0.5, 0.5-1.0 and 1.0-1.5 × 10(9)/L, respectively. Associated leukopenia and thrombocytopenia were diagnosed in 186 (39%) and 71 (11.8%) patients. Three hundred sixteen of 601 (52.6%) and 519 of 601 (86.4%) were <2 or 36 months of age, respectively. Fever at admission was present in 27.6% patients. Serious bacterial infections were diagnosed in 106 (17.6%) patients. Brucellosis and rickettsiosis were diagnosed in 8 of 52 (15.4%) and 9 of 39 (23.1%) tests obtained. Respiratory syncytial virus was diagnosed in 17 of 33 (51.5%) nasal washes. An infectious etiology was determined in 171 (28.5%) patients. Acute leukemia was diagnosed in 6 patients. A significant correlation was found between resolution of neutropenia and patient age, infectious etiology and severity of neutropenia.
CONCLUSIONS
(1) Severe neutropenia was rare; (2) More than half of patients were <2 months of age; (3) An infectious etiology was diagnosed in a high number of patients, and serious bacterial infections were frequent and (4) Brucella spp. and rickettsial infections were frequent etiologies associated with neutropenia in our setting.
背景
免疫功能正常的儿童中获得性中性粒细胞减少症很常见，其鉴别诊断范围从良性病因到危及生命的疾病。我们描述了在我们的医疗中心急诊就诊和住院的免疫功能正常的新发中性粒细胞减少症儿童的病因、临床表现和转归。
方法
纳入了中性粒细胞减少症（绝对中性粒细胞计数＜1.5×10（9）/L）入院的既往健康儿童。严重细菌感染定义为培养阳性的血液、尿液、脑脊液、关节液或粪便感染、肺炎、布鲁氏菌病和立克次体病。
结果
共纳入 601 例患儿（5 天-202 个月龄）；3（0.5%）、48（8%）、165（27.5%）和 385（64%）例患儿的绝对中性粒细胞计数分别＜0.2、0.2-0.5、0.5-1.0 和 1.0-1.5×10（9）/L。186（39%）和 71（11.8%）例患儿同时存在联合的白细胞减少和血小板减少。306/601（52.6%）和 519/601（86.4%）例患儿＜2 岁或 36 个月，分别为 32.6%和 86.4%。入院时发热的患儿占 27.6%。106（17.6%）例患儿诊断为严重细菌感染。52 例患儿中诊断出布鲁氏菌病和立克次体病 8 例（15.4%）和 9 例（23.1%），33 例患儿的鼻洗液中诊断出呼吸道合胞病毒 17 例（51.5%）。171（28.5%）例患儿确定了感染病因。6 例患儿诊断为急性白血病。中性粒细胞减少症的缓解与患者年龄、感染病因和中性粒细胞减少症严重程度呈显著相关。
结论
（1）严重中性粒细胞减少症罕见；（2）半数以上患儿＜2 个月龄；（3）许多患儿诊断为感染性病因，严重细菌感染频繁发生，（4）在我们的研究中，布鲁氏菌属和立克次体感染是与中性粒细胞减少症相关的常见病因。
Zotero 插件