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The Infectious and Non-Infectious Etiology, Clinical Picture and Outcome of Neutropenia in Immunocompetent Hospitalized Children

David, Odeya, MD1,4,5; Fruchtman, Yariv, MD1,4,5; Sergienko, Ruslan, PhD2,5; Kapelushnik, Joseph, MD1,4,5; Leibovitz, Eugene, MD3,4,5

The Pediatric Infectious Disease Journal: January 9, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/INF.0000000000001893
Immunology Reports: PDF Only

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.

Patients and methods: Previously healthy children admitted with neutropenia (absolute neutrophil count [ANC] <1.5 x 109/L) were included. Serious bacterial infections (SBI) were defined as culture-positive blood, urine, CSF, articular fluid or stool infections, pneumonia, Brucellosis and Rickettsiosis.

Results: 601 patients (aged 5 days-202 months) were enrolled; 3 (0.5%), 48 (8%), 165 (27.5%) and 385 (64%) had ANCs <0.2, 0.2-0.5, 0.5-1.0 and 1.0-1.5 x 109/L, respectively. Associated leukopenia and thrombocytopenia were diagnosed in 186 (39%) and 71 (11.8%) patients. 316/601 (52.6%) and 519/601 (86.4%) were <2 or 36 months of age, respectively. Fever at admission was present in 27.6% patients. SBIs were diagnosed in 106 (17.6) patients. Brucellosis and rickettsiosis were diagnosed in 8/52 (15.4%) and 9/39 (23.1%) tests obtained. RSV was diagnosed in 17/33 (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 SBIs were frequent; 4. Brucella spp. and rickettsial infections were frequent etiologies associated with neutropenia in our setting.

1Pediatric Hematology/Oncology Department, 2Public Health Department, 3Pediatric Infectious Disease Unit, 4Soroka University Medical Center, 5Ben-Gurion University of the Negev, Beer-Sheva, Israel

Conflict of interest: none.

Author for Correspondence: Eugene Leibovitz, MD, Pediatric Infectious Disease Unit, Soroka University Medical Center, P.O.Box 151, Beer-Sheva 84101, Israel, Tel: (972-8) 640-0547, Fax: (972-8) 623-2334, Email: eugenel@bgu.ac.il

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