Outcomes of Febrile Children Presumed to be Immunocompetent Who Present with Leukopenia or Neutropenia to an Ambulatory Setting

Abstract

In the majority of patients, clinical judgment, physical findings, and review of all cell lines of the complete blood cell count identified those with significant disease.

Risk of Serious Bacterial Infection in Isolated and Unsuspected Neutropenia

“…Bonadio et al 9 found that in 68 children with neutropenia and fever, those who looked well on presentation had a negative blood culture, while 30% of the ill-appearing children had positive blood or CSF cultures. Three of these patients were less than 3 months of age, with two with group B streptococcal disease and one with Haemophilus influenzae type B, while the other two were less than 1 year of age with H. influenzae type B. Serwint et al 7 described 91 cases in children with leukopenia (<5,000 ⁄ lL) and ⁄ or neutropenia (ANC < 1,000 ⁄ lL). Of the five with positive blood cultures, one was clinically septic, one had leukemia, one did not have ANC performed, and those with an ANC of <1,000 ⁄ lL also had platelets counts of <150,000.…”

“…[4][5][6] The quantitative relationship of leukocytes to important infections among patients with leukemia has been well known since the mid 1960s, 4 but to date there have been very few studies regarding the risk of infection in neutropenic children without underlying disease. 7,8 These studies have had very few cases, and none of them have considered the presence of neutropenia on emergency department (ED) presentation, or many of the cases did not have neutropenia in the absence of other hematologic derangements. 7,8 The identification of neutropenia may represent the initial presentation of an underlying new immune-mediated or congenital neutropenia syndrome.…”

“…7,8 These studies have had very few cases, and none of them have considered the presence of neutropenia on emergency department (ED) presentation, or many of the cases did not have neutropenia in the absence of other hematologic derangements. 7,8 The identification of neutropenia may represent the initial presentation of an underlying new immune-mediated or congenital neutropenia syndrome. 9,10 Neutropenia may also occur as a result of consumption of neutrophils or depletion of bone marrow response in the child with severe sepsis or septic shock, especially in the neonate.…”

The epidemiology, clinical course and outcome of febrile cytopenia in children

“…To our knowledge, this is the first prospective study of the whole spectrum of febrile cytopenia in noncancer patients with a 2-year follow-up, with an extensive serological investigation towards multiple infectious agents. Most of the previous reports have been retrospective, focusing on isolated neutropenia with a limited number of patients (1,5,11). We should point out that the neutropenic subgroup of the present study, combined with patients admitted to another paediatric department during the same time period, has been previously reported (12).…”

Neutropenia in the Febrile Child

“…Limited studies have shown that febrile pediatric patients with transient moderate neutropenia who are otherwise well-appearing do not have increased risk of serious bacterial infection when compared with febrile patients without neutropenia. [12][13][14] However, comparative studies of treatment of these patients is limited, and many centers continue to treat these patients with antibiotics and hospital admission, absent either a known rapid response to G-CSF treatment, or an established history of no serious infections despite neutropenia.…”