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

David, Odeya, MD*,†,‡; Fruchtman, Yariv, MD*,†,‡; Sergienko, Ruslan, PhD§,‡; Kapelushnik, Joseph, MD*,†,‡; Leibovitz, Eugene, MD¶,†,‡

The Pediatric Infectious Disease Journal: June 2018 - Volume 37 - Issue 6 - p 570–575
doi: 10.1097/INF.0000000000001893
Immunology Reports

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 × 109/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 × 109/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.

From the *Pediatric Hematology/Oncology Department

Soroka University Medical Center, Beer-Sheva, Israel

Ben-Gurion University of the Negev, Beer-Sheva, Israel

§Public Health Department

Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.

Accepted for publication July 14, 2017.

The authors have no funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com).

Author for correspondence: Eugene Leibovitz, MD, Pediatric Infectious Disease Unit, Soroka University Medical Center, P.O. Box 151, Beer-Sheva 84101, Israel. E-mail: eugenel@bgu.ac.il.

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