Comparison of the etiologic, microbiologic, clinical and outcome characteristics of febrile vs. non-febrile neutropenia in hospitalized immunocompetent children

Abstract

We compared the etiologic, microbiologic, clinical, and outcome picture among febrile and non-febrile immunocompetent children hospitalized during 2013–2015 with acute neutropenia (absolute neutrophil count < 1.5 × 10 9 /L). Serious bacterial infections (SBI) were defined as culture-positive blood, urine, cerebrospinal fluid, articular fluid or stool infections, pneumonia, brucellosis, and rickettsiosis. Overall, 664 children < 18 years of age were enrolled; 407 (62.2%) had fever > 38.0 °C and 247 (37.8%) were non-febrile at admission. There were 425 (64.0%), 125 (18.8%), 48 (7.2%), and 66 (9.9%) patients aged 0–24 months, 2-6, 7–12, and > 12 years, respectively. No differences were recorded in the distribution of febrile vs. non-febrile patients among the age groups nor among the 3 neutropenia severity groups (< 0.5, 0.5–1.0 and 1.0–1.5 × 10 9 /L). SBI infections were diagnosed in 98 (14.8%) patients, with higher rates among febrile patients vs. non-febrile patients (16.8% vs. 11.5%, P = 0.06). Brucellosis and rickettsiosis were diagnosed in 15.4% and 23.1% tests performed, respectively. 295/688 (42.9%) virologic examinations returned positive. Among patients < 24 months, more febrile ones had viral infectious compared with afebrile patients ( P = 0.025). Acute leukemia was diagnosed in 6 patients. Neutropenia resolved in 163/323 (50.5%) patients during a 1-month follow-up. No differences were recorded in neutropenia resolution between febrile and non-febrile children among all 3 severity groups. Severe neutropenia was rare and occurred mainly in very young patients. SBIs were more common among febrile patients compared with non-febrile patients, but there was no association between severity of neutropenia or its resolution and the presence or absence of fever at diagnosis.

Diagnosis and therapeutic decision-making for the neutropenic patient

“…25,26 Higher rates of bac te rial infec tions have been reported in stud ies focused on hos pi tal ized neutropenic patients (12.7%-14.9%, with 1 study dem on strat ing 0%), 27 which may have resulted from the admis sion of sicker patients and the infec tious envi ron ment of the pop u la tion, as bru cel losis and rick ett sia, bac te rial infec tions known to be asso ci ated with neutropenia, were reported eti ol o gies in 3 out of 4 of these inpa tient-only stud ies. [28][29][30][31] The con clu sion from these stud ies is that the risk of bac te rial infec tion in the out pa tient set ting for the well-appearing pediat ric patient with iso lated and unsus pected neutropenia is low and sim i lar to patients with nonneutropenic fever. Screening for bac te rial infec tion, includ ing a blood cul ture, a uri nal y sis with urine cul ture, and, for symp tom atic patients, a chest x-ray, is suggested, but aggres sive man age ment includ ing admis sion and empiric anti bi ot ics may not be nec es sary for all patients.…”

The Clinical and Laboratory Profiles of Immunocompetent Patients With Short-Duration Fever With Neutropenia in a Tertiary Care Hospital in Pune, India

“…Neutropenia has also been linked to miliary tuberculosis. Bone marrow dysfunction is occasionally observed in disseminated histoplasmosis, and it is uncommon in fungal infections [5].…”

Brucellosis: A Rare Cause of Febrile Neutropenia in a Child

“…9,11. Brucellosis and rickettsiosis, which affect up to 34% of patients, are the most common infections observed among SBIs. 9,[11][12][13]…”