Lower Peripheral White Blood Cell Research Articles

Distinguishing clinical characteristics of central nervous system tuberculosis in immunodeficient and non-immunodeficient individuals: a 12-year retrospective study

BackgroundCentral nervous system tuberculosis (CNS TB) is a severe Mycobacterium tuberculosis (MTB) infection. It is unclear whether a patient’s immune status alters the clinical manifestations and treatment outcomes of CNS TB.MethodsBetween January 2007–December 2018, chart reviews of CNS TB, including tuberculous meningitis (TBM), tuberculoma/abscess, and TB myelitis, were made. Subjects were categorized as immunodeficient (ID) and non-immunodeficient (NID).ResultsOf 310 subjects, 160 (51.6%) were in the ID group—132 (42.6%) had HIV and 28 (9.0%) had another ID, and 150 (48.4%) were in the NID group. The mean age was 43.64 ± 16.76 years, and 188 (60.6%) were male. There were 285 (91.9%) TBM, 16 (5.2%) tuberculoma/abscess, and 9 (2.9%) myelitis cases. The TBM characteristics in the ID group were younger age (p = 0.003), deep subcortical location of tuberculoma (p = 0.030), lower hemoglobin level (p < 0.001), and lower peripheral white blood cell count (p < 0.001). Only HIV individuals with TBM had an infection by multidrug-resistant MTB (p = 0.013). TBM mortality was varied by immune status —HIV 22.8%, other ID 29.6%, and NID 14.8% (p < 0.001). Factors significantly associated with unfavorable outcomes in TBM also differed between the HIV and NID groups.ConclusionsTBM is the most significant proportion of CNS TB. Some of the clinical characteristics of TBM, such as age, radiographic findings, hematological derangement, and mortality, including factors associated with unfavorable outcomes, differed between ID and non-ID patients.

Leukopenia in autosomal dominant polycystic kidney disease: a single-center cohort of kidney transplant candidates with post-transplantation follow-up.

Autosomal dominant polycystic kidney disease (ADPKD) has occasionally been associated with lower peripheral white blood cell (WBC) counts. This study aimed to investigate the peripheral blood cell counts in a large cohort of kidney transplant recipients before and after kidney transplantation and its potential impact on post-transplant outcomes. This was a retrospective study with long-term follow-up data of 2090 patients who underwent a first kidney transplantation in the Leuven University Hospitals, of whom 392 had ADPKD. In total, 2090 patients who underwent a first kidney transplantation in the Leuven University Hospitals were included, of whom 392 had ADPKD. Both pre- and post-transplantation, ADPKD patients had significantly lower total WBC counts, and more specifically lower neutrophil, lymphocyte and eosinophil counts compared with the non-ADPKD patients. This observation was independent of potential confounders such as level of inflammation, smoking habit, vitamins and pre-transplant medication. Overall survival and kidney transplant survival were significantly better in ADPKD vs non-ADPKD transplant recipients and a longer time to first infection was observed. However, no association between blood cell counts and outcome differences was found. In conclusion, this large single-center study reports a strong and independent association between ADPKD and lower peripheral WBC counts both before and after kidney transplantation. Considering the role of inflammation in disease progression, further investigation into the role of WBC in ADPKD is needed.

Analysis of factors influencing radiation-induced liver injury caused by stereotactic radiotherapy in patients with primary hepatocellular carcinoma

Objective: To analyze the factors influencing radiation-induced liver injury after receiving Cyberknife stereotactic radiotherapy in patients with primary hepatocellular carcinoma. Methods: 278 cases with primary hepatocellular carcinoma from July 2016 to April 2019 were prospectively enrolled. Stereotactic radiosurgery with a prescription dose of 48-55gy/5-8 times were given. Liver function, coagulation function, Child-Pugh score, and liver imaging changes were dynamically observed before and after treatment to evaluate the occurrence of radiation-induced liver injury. Logistic regression model was used to analyze the factors influencing radiation-induced liver injury. Results: Among 278 cases, 3 cases of tumor progression were excluded, and a total of 275 cases were included for analysis. The overall survival rate after 8 months of treatment was 100%. Among them, 22 cases were diagnosed as radiation-induced liver injury, with an incidence rate of 8%, and all cases were recovered after symptomatic treatment. Multivariate analysis result suggested that the peripheral white blood cell count was factors influencing the occurrence of radiation-induced liver injury. Conclusion: Cyberknife stereotactic radiotherapy has a low incidence of radiation-induced liver injury in patients with liver cancer, and it is a relatively safe treatment method. Patients with low peripheral white blood cell counts before treatment should be closely monitored for early detection and treatment.

Association among daily fish intake, white blood cell count, and healthy lifestyle behaviors in an apparently healthy Japanese population: implication for the anti-atherosclerotic effect of fish consumption.

Higher fish consumption has been reported to be associated with a lower incidence of coronary artery disease. We hypothesized that a higher frequency of fish intake may be associated with lower peripheral white blood cell (WBC) counts, a marker of chronic inflammation, which is known to be involved in the development of atherosclerotic cardiovascular disease (ASCVD), and a healthy lifestyle. This cross-sectional study was conducted between April 2018 and August 2018 at the Health Planning Center of Nihon University Hospital in a cohort of 4105 apparently healthy subjects. The average frequency of fish intake was 2.3 ± 1.3days per week. The WBC count decreased significantly as the frequency of fish intake (0-2days, 3-4days, or 5-7days per week) increased (s < 0.0001). Multivariate linear regression analysis identified higher weekly frequency of fish intake as a significant independent determinant of a lower WBC count (β = - 0.051, p = 0.001). Furthermore, as the weekly frequency of fish intake increased, the proportion of habitual cigarette smokers decreased (p = 0.021), that of subjects engaging in habitual aerobic exercises increased (p < 0.0001), and the weekly alcohol intake frequency increased (p < 0.0001). Moreover, the above-mentioned lifestyle behaviors were also independent determinants of the WBC count. These results suggest that a high frequency of fish intake might be associated with healthier lifestyle behaviors as well as lower WBC counts, and thus may both exert beneficial anti-inflammatory effects and represent a component of healthier lifestyle behaviors associated with a lower risk of ASCVD in Japanese. This association may be partially related to the preventive effects of a higher fish intake on ASCVD events. CLINICAL TRIAL REGISTRATION: UMIN ( http://www.umin.ac.jp/ ) Study ID: UMIN000039197 retrospectively registered 1 February 2020.

Cerebrospinal fluid features in adults with enteroviral nervous system infection

ObjectivesThe aim of this study was to investigate the clinical and laboratory features of adults with nervous system infections caused by enteroviruses, with special emphasis on cerebrospinal fluid (CSF). MethodsThe data of 46 patients who were PCR-positive for enteroviruses in the CSF between 2002 and 2017 were evaluated. ResultsMeningitis was the most common clinical manifestation (89%), followed by encephalitis (7%) and isolated cranial nerve involvement (4%). Twenty percent of patients reported a sudden onset of severe headache that led to the initial suspected diagnosis of subarachnoid haemorrhage. General signs of infection, such as fever, elevated C-reactive protein, and an elevated white blood cell count, were found in only 61%. Most patients exhibited consistent inflammatory CSF changes, with elevated cell counts (85%) and blood–CSF barrier dysfunction (83%). Patients with normal CSF cell counts were significantly older, less frequently presented with meningitis, and exhibited lower peripheral white blood cell counts. Sequencing revealed species Enterovirus B in all patients, with most sequences related to echovirus 30. ConclusionsThe absence of CSF pleocytosis, isolated cranial nerve involvement, and only infrequent general signs of infection may impede the diagnosis of enteroviral nervous system infections. A thorough CSF analysis including PCR is essential for a reliable diagnosis.

Bone marrow architecture reconstitution after hematopoietic grafting: A cross-sectional study

Abstract Objective Changes in bone marrow (BM) architecture and its remodeling after hematopoietic stem cell transplantation (HSCT) following a reduced-intensity conditioning regimen for treating malignant hematologic diseases are poorly documented. We assessed these changes and their correlation with the clinical course to investigate the dynamics of this process. Material and methods Hematology patients who received a reduced intensity conditioning (RIC) were followed after successful allogeneic or autologous HSCT. Patients had at least 100 days after hematopoietic grafting. Post-transplant BM architecture was assessed by expert examination of a trephine biopsy using age-adjusted scores and histopathology results were contrasted with clinical post-transplant evolution to determine meaningful associations. Results Twenty-seven HSCT recipients, 19 allogeneic and 8 autologous, were studied at a median 155 (100–721) days post-transplant. Eleven (40.7%) had hypocellular biopsies with around 50% of the expected cell composition for a normal individual at that age. Patients with increased fibrosis had lower peripheral white blood cell counts compared to those with normal reticulin distribution (p = 0.015). A decrease in overall survival (OS) was documented in the group with more severe myelofibrosis at a median 813 days of follow-up. Infectious complications were more frequent in patients receiving an allogeneic (n = 6) compared with the recipients of an autologous transplant (n = 0). Conclusions Despite normal peripheral blood count and composition, significant post-transplant hypocellularity, revealing incomplete bone marrow reconstitution, was documented after HSCT in patients conditioned with a RIC regimen. Severe BM fibrosis was associated to decrease OS.

Abstract 2750: Modulation of BRCA1 expression as a preventative method for BRCA1-associated breast cancer

Abstract Background: Women who inherited a BRCA1 mutation face a high lifetime risk of developing breast cancer estimated at 80% vs. 11% in the general population. Current prevention options are limited to prophylactic surgery and chemoprevention with tamoxifen. It is believed that a haploinsufficient state is responsible for the predisposition to cancer among BRCA1 mutation carriers. BRCA1 helps maintain genomic integrity through participating in the cellular response to DNA damage, specifically in the repair of double-stranded DNA breaks. Thus, factors which increase the physiologic expression of the normal gene and normalize protein levels may mitigate the effect of the mutation and decrease cancer risk. Objectives: The objectives of this study are: 1) to determine whether BRCA1 mRNA expression from peripheral blood lymphocytes (as well as the corresponding protein levels) differ in women with and without a BRCA1 mutation; 2) to correlate BRCA1 mRNA and protein levels with various factors, including reproductive, hormonal, and anthropometric factors as well as mutation type; and 3) to identify a minimal classifier gene set that predicts BRCA1 mutation status in the general population. Methodology: We enrolled 14 women with and 36 without a BRCA1 mutation. All participants completed a research questionnaire and standardized procedures were used to collect anthropometric measurements. Blood samples were collected for white blood cell isolation. BRCA1 mRNA was quantified using the Nanostring nCounter Analysis System and the Human Cancer Reference Kit, a panel of 230 cancer-associated genes. The gene expression data set will be used to identify a minimal gene classifier that predicts BRCA1 mutation status. BRCA1 protein levels will be determined using Western blot. Results: Mean BRCA1 expression was significantly lower for mutation carriers vs. non-carriers (139 vs. 157 counts; P = 0.02). Western blot experiments and analyses of predictors of expression are underway. Conclusions and Significance: These results provide important preliminary evidence that BRCA1 mutation carriers have lower peripheral white blood cell BRCA1 mRNA expression compared to non-carriers. Future studies can utilize peripheral blood samples from BRCA1 mutation carriers to evaluate whether lifestyle factors, such as diet and physical activity, may modulate BRCA1 levels and potentially modify disease risk. Our findings contribute to a program of research aimed at providing evidence-based lifestyle prevention strategies for high-risk women. Citation Format: Rania Chehade, Rachael Pettapiece-Phillips, Mohammad Akbari, Leonardo Salmena, Steven Narod, Joanne Kotsopoulos. Modulation of BRCA1 expression as a preventative method for BRCA1-associated breast cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 2750. doi:10.1158/1538-7445.AM2015-2750

Clinical features and predictive factors of recurrent fever observed during the treatment of bacterial meningitis in children

Recurrent fever often occurs during the treatment of bacterial meningitis in children. Few studies have focused on the difference between the patients with and without recurrent fever. The pathogenesis and clinical significance of recurrent fever remain to be elucidated. The objectives of this study were to clarify the clinical features of the patients with recurrent fever, and to identify the predictive factors for recurrent fever in childhood bacterial meningitis. We conducted a hospital-based retrospective chart review and confirmed 52 cases of bacterial meningitis. Recurrent fever was observed in 27 of 52 (52%) patients overall, and 27 of 47 (57%) patients with dexamethasone (DEX) therapy. All patients with recurrent fever received DEX therapy. The mean date of recurrent fever occurrence was 6.2 +/- 2.0 days after admission. The median duration of recurrent fever was 5 days (range 1-19 days). The proportion of patients < 2 years of age was higher in patients with recurrent fever than those without recurrent fever (p = 0.041). Initial peripheral white blood cell count was lower in patients with recurrent fever (p = 0.008). Of the 52 children, 10 (19%) showed neurological sequelae. Neurological sequelae were more frequent in patients with recurrent fever than those without recurrent fever, although this was not statistically significant (p = 0.078). Univariate and multivariate logistic regression analysis showed that the most powerful predictive factor for recurrent fever in patients with DEX therapy was young age (< 2 years) (adjusted odds ratio, 5.1; 95% confidence interval, 1.3-20.7). These results suggest that recurrent fever is related to the two known factors for sequelae, low peripheral white blood cell count and young age. Recurrent fever should be recognized as a possible risk factor for neurological sequelae.

Evaluation of the body fluid mode of automated hematology analyzer XN‐series for extremely low peripheral white blood cell counts

Evaluation of the body fluid mode of automated hematology analyzer <scp>XN</scp>‐series for extremely low peripheral white blood cell counts

Characteristics of Young Infants in Whom Human Parechovirus, Enterovirus or Neither Were Detected in Cerebrospinal Fluid During Sepsis Evaluations

Human parechovirus (HPeV) causes central nervous system (CNS) infection in infants. To further understand HPeV CNS infection, we describe its clinical, laboratory and epidemiologic characteristics from a Midwestern US tertiary care center. Because HPeV CNS infections have appeared clinically and seasonally similar to enterovirus (EV) infections, we retrospectively compared characteristics of young infants undergoing sepsis evaluations in whom HPeV, EV or neither were detected in cerebrospinal fluid (CSF). HPeV real-time reverse-transcription polymerase chain reaction (RT-PCR) assay was performed on frozen nucleic acid extracts of CSF specimens submitted for EV RT-PCR assay from children seen at our hospital in 2009. HPeV genotyping was performed by sequencing of the viral protein 1 region. Clinical data were abstracted from medical records retrospectively for EV-positive, HPeV-positive and age-matched controls in whom neither virus was detected from CSF testing. HPeV was detected in 66 of the 388 (17%) CSF specimens whereas EV was detected in 54 of the 388 (14%) from June through October 2009. Genotyping identified HPeV3 in 51 of the 66 (77%) positive CSF specimens. Males predominated (61%) with the most common presenting symptoms (91%) being fever and irritability. All HPeV-positive patients were <5 months of age. Eight required admission to the pediatric intensive care unit. In multivariate analysis, lower peripheral white blood cell counts with lower absolute lymphocyte count values, higher maximum temperatures, longer fever duration, absence of pleocytosis and longer hospitalization were independently associated with HPeV patients compared with patients with EV or patients negative for both HPeV and EV. Our data indicate that HPeV3, an emerging CNS pathogen of infants in the United States, should be considered in sepsis-like presentation even without CSF pleocytosis. Addition of HPeV RT-PCR to EV RT-PCR assay for CSF specimens of patients <6 months of age could reduce hospital stay and costs while improving clinical management.

Enteroviral meningitis without pleocytosis in children

ObjectivesThis study aims to describe the clinical characteristics of enteroviral meningitis in association with the absence of cerebrospinal fluid (CSF) pleocytosis.DesignThis was a retrospective analysis of databases of patients diagnosed...

The Effect of Rara Haploinsufficiency in a Mouse Model of Acute Promyelocytic Leukemia.

Abstract 3475 Poster Board III-412 Acute promyelocytic leukemia (APL) is characterized by the t(15;17) translocation, which leads to expression of the fusion protein that initiates this disease (PML-RARA), the creation of a small and inconsistently expressed RARA-PML fusion protein, and haploinsufficiency for both RARA and PML. While alternative translocations and fusion proteins have been associated with APL, RARA appears to be a necessary member of each (e.g. PLZF-RARA, NPM-RARA, STAT5b-RARA, NuMA-RARA). Furthermore, RARA activity is important for myeloid maturation. We have therefore explored the effect of RARA haploinsufficiency in the murine Cathepsin-G PML-RARA (mCG-PR) model of APL. We crossed RARA+/− mice with mCG-PR mice, all on a C57/B6 background. Both mCG-PR and the mutant RARA allele were observed at normal Mendelian ratios. At 8 weeks, mCG-PR x RARA+/− mice exhibited normal peripheral blood counts, spleen sizes and total bone marrow cells. Bone marrow cells from 8-week old mCG-PR x RARA+/− and mCG-PR mice both exhibited increased self-renewal in methylcellulose replating assays, with increased average cells per colony in mCG-PR x RARA+/− and mCG-PR colonies compared to wild type (28,470 ± 6,000 and 15,400 ± 2,375 vs 7,700 ± 630, p = 0.0001 and 0.0003 following the initial plating). Five months after bone marrow transplantation at a 1:9 ratio with competitor Ly5.1 bone marrow cells, mCG-PR derived cells have engrafted and expanded in four recipients to 10%, 12.4%, 13.8% and 15.2% of peripheral blood cells, while mCG-PR x RARA+/− derived cells have more robustly expanded to 8.7%, 20.2%, 24.5%, and 30.3% of peripheral blood cells. A cohort of 29 mCG-PR x RARA+/− and 20 mCG-PR mice was subjected to a tumor watch. With an average follow up of 10 months, we have observed AML arise in 9 mCG-PR x RARA+/− mice and 11 mCG-PR mice (an additional 20 and 9 mice in each respective cohort remain at risk of leukemia and will be subsequently evaluated). Leukemia arising from mCG-PR mice exhibited leukocytosis, splenomegaly and variable myeloid differentiation arrest in the peripheral blood and spleen, as measured by manual differential counts and cKit/CD11b expression in the Gr1+ compartment. Leukemia from two mice had marked promyelocytic maturation arrest, but 5 others retained differentiation, with 30-60% bands and ring-formed neutrophils in the spleen, which correlated with similar percentages of Gr1+/cKit-/CD11b+ cells (4 mice died with splenomegaly noted during necropsy and were not further characterized). AML arising in mCG-PR x RARA+/− mice displayed similar variability in maturation arrest, but these mice had a trend towards lower peripheral blood WBC counts compared to mCG-PR AML (mean WBC 28,000/mcl ± 26,000 vs 82,000/mcl ± 71,000/mcl, p = 0.06) and larger spleen size (mean 1,425 mg ± 475 mg vs 1,017 mg ± 193 mg, p = 0.03). In addition, 6/9 mCG-PR x RARA+/− mice with AML had marked cervical lymphadenopathy caused by infiltrating AML cells. Only 1/11 mCG-PR mice with AML displayed lymphadenopathy, which previously has been observed only rarely with this mouse model (Westervelt et al, Blood 2003). Both mCG-PR x RARA+/− and mCG-PR AML cells responded to ATRA with increased maturation in vitro and in vivo, a shift from cKit+/CD11b- to cKit-/CD11b+ expression, a loss of self renewal capacity, and improved survival compared to untreated controls, as expected. In sum, mCG-PR x RARA+/− mice are different from mice with mCG-PR alone. RARA haploinsufficiency further perturbs hematopoiesis in mCG-PR mice, accelerating an early competitive advantage conferred by PR expression, and possibly altering the pattern of homing and peripheralization of AML cells. Lower peripheral white blood cell counts in these animals more accurately reproduce the relatively low white counts of most patients with APL. These data strongly suggest that RARA haploinsufficiency contributes to the overall phenotype of APL initiated by PML-RARA, and thus is a relevant mutation created by the t(15;17) translocation. Disclosures: Welch: Cephalon: Research Funding; Eisai: Research Funding.

Intraperitoneal chemotherapy with hydroxycamptothecin reduces peritoneal carcinomatosis: results of an experimental study

We studied the efficacy and safety of intraperitoneal chemotherapy with hydroxycamptothecin (HCPT) for the treatment of peritoneal carcinomatosis in animal model. Highly metastatic human hepatocellular carcinoma (HCC) cell line HCCLM3 was injected into the peritoneal cavity of 30 nude mice to construct a model of intraperitoneal carcinomatosis, which were randomized into a treatment group and a control group of 15 mice in each group. The former received intraperitoneal injections of HCPT at the dose of 2 mg/kg body weight for 7 days every other week, on weeks 2, 4 and 6; and the latter received the same dose schedule treatment of 0.9% sodium chloride solution. The mice were observed for 8 weeks. Body weight changes, intraperitoneal carcinomatosis, hematological and biochemical parameters were evaluated. On day 56, 14 mice in the treatment group were still alive, compared against 5 in the control group, and the mean survival time was 55 +/- 1 days [95% confidence interval (CI) 54-57 days] versus 43 +/- 4 days (95% CI 34-51 days) (P = 0.002). The tumor weight in the treatment group (0.8 +/- 0.8 g) was significantly smaller than the control group (2.0 +/- 0.8 g) (P = 0.00028). No bloody ascites or diffuse peritoneal carcinomatosis were observed in the treatment group, as compared with 4 mice (26.7%) that developed bloody ascites and 6 mice (40%) which developed diffuse peritoneal carcinomatosis in the control group (P < 0.001). The treatment group had a significantly lower peripheral white blood cell count [(3.18 +/- 1.72) x 10(9) l(-1)] than the control group [(5.08 +/- 2.03) x 10(9 )l(-1)] (P < 0.05), significantly lower serum alpha fetoprotein level (101.22 +/- 20.12 microg/l) than the control group (244.87 +/- 30.24 microg/l) (P < 0.05), and significantly lower serum gamma glutamyl transpeptidase level (12.45 +/- 2.26 U/l) than the control group (20.75 +/- 3.87 U/l) (P < 0.05). No obvious treatment related toxicities were observed. Intraperitoneal injection of HCPT could inhibit tumor progression, reduce the extent of peritoneal carcinomatosis and improve survival of tumor bearing mice.

CAUSES OF COMMUNITY-ACQUIRED BACTEREMIA AND PATTERNS OF ANTIMICROBIAL RESISTANCE IN VIENTIANE, LAOS

There is no published information on the causes of bacteremia in the Lao PDR (Laos). Between 2000 and 2004, 4512 blood culture pairs were taken from patients admitted to Mahosot Hospital, Vientiane, Laos, with suspected community-acquired bacteremia; 483 (10.7%) cultures grew a clinically significant community-acquired organism, most commonly Salmonella enterica serovar typhi (50.9%), Staphylococcus aureus (19.0%), and Escherichia coli (12.4%). S. aureus bacteremia was common among infants (69.2%), while children 1-5 years had a high frequency of typhoid (44%). Multi-drug-resistant S. Typhi was rare (6%). On multiple logistic regression analysis, typhoid was associated with younger age, longer illness, diarrhea, higher admission temperature, and lower peripheral white blood cell count than non-typhoidal bacteremia. Empirical parenteral ampicillin and gentamicin would have some activity against approximately 88% of clinically significant isolates at a cost of US $1.4/day, an important exception being B. pseudomallei. Bacteremic infants in this setting require an anti-staphylococcal antibiotic.

A Low Peripheral Blood White Blood Cell Count in Infants Younger than 90 Days Increases the Odds of Acute Bacterial Meningitis Relative to Bacteremia

In relying on the peripheral blood white blood cell (WBC) count to identify infants at high risk for acute bacterial meningitis and bacteremia, to the best of the authors' knowledge, it has not been reported previously whether high and low values of the test have similar implications for predicting these separate infections. To analyze the relationship between the peripheral WBC count and the odds of acute bacterial meningitis relative to bacteremia among sick infants aged 3 to 89 days. Areas under the receiver operating characteristic curve (AUCs) and likelihood ratios at various intervals of the total peripheral blood WBC count were computed. A pathogen was isolated from blood or cerebrospinal fluid (CSF) from 72 infants aged 3 to 89 days. Fifty-two infants had growth of a pathogen from the blood only, and 20 had growth from the CSF. The most common bacteria isolated were Escherichia coli (32) and group B streptococci (32). The AUC for the peripheral WBC count when differentiating between acute bacterial meningitis and bacteremia was 0.75 (95% CI = 0.63 to 0.88). The odds of acute bacterial meningitis relative to bacteremia were sevenfold higher for a peripheral WBC cutoff below 5,000 cells/mm(3) and threefold lower for a peripheral WBC cutoff at or above 15,000 cells/mm(3). In young infants, the peripheral blood WBC count is useful for estimating the odds of acute bacterial meningitis relative to isolated bacteremia. A low peripheral blood WBC count should be considered a much more worrisome laboratory finding because it is associated with a relatively high risk for acute bacterial meningitis relative to the potential for bacteremia.

A Low Peripheral Blood White Blood Cell Count in Infants Younger than 90 Days Increases the Odds of Acute Bacterial Meningitis Relative to Bacteremia

A Low Peripheral Blood White Blood Cell Count in Infants Younger than 90 Days Increases the Odds of Acute Bacterial Meningitis Relative to Bacteremia

Clinical features and rapid viral diagnosis of human disease associated with avian influenza A H5N1 virus

Human infection with an avian influenza A virus (subtype H5N1) was reported recently in Hong Kong. We describe the clinical presentation of the first 12 patients and options for rapid viral diagnosis. Case notes of 12 patients with virus-culture-confirmed influenza A H5N1 infection were analysed. The clinical presentation and risk factors associated with severe disease were defined and the results of methods for rapid virus diagnosis were compared. Patients ranged from 1 to 60 years of age. Clinical presentation was that of an influenza-like illness with evidence of pneumonia in seven patients. All seven patients older than 13 years had severe disease (four deaths), whereas children 5 years or younger had mild symptoms with the exception of one who died with Reye's syndrome associated with intake of aspirin. Gastrointestinal manifestations, raised liver enzymes, renal failure unrelated to rhabdomyolysis, and pancytopenia were unusually prominent. Factors associated with severe disease included older age, delay in hospitalisation, lower-respiratory-tract involvement, and a low total peripheral white blood cell count or lymphopenia at admission. An H5-specific reverse-transcription PCR assay (RT-PCR) was useful for rapid detection of virus directly in respiratory specimens. A commercially available enzyme immunoassay was more sensitive than direct immunofluorescence for rapid viral diagnosis. Direct immunofluorescence with an H5-specific monoclonal antibody pool was useful for rapid exclusion of H5-subtype infection. Avian Influenza A H5N1 virus causes human influenza-like illness with a high rate of complications in adults admitted to hospital. Rapid H5-subtype-specific laboratory diagnosis can be made by RT-PCR applied directly to clinical specimens.

Benign acute childhood myositis in Kuwait.

Ten children, three girls and seven boys, aged 4-10 years, were admitted with benign acute childhood myositis during spring and winter months (March 1988 to March 1990). They presented with an acute onset of symmetrical calf muscle pain and tenderness, weakness and inability to walk a few days after a flu-like illness. All had raised serum creatine kinase and a normal erythrocyte sedimentation rate, and the majority had low peripheral white blood cell counts with relative lymphocytosis. Serum aspartate aminotransferase, alanine aminotransferase and lactate dehydrogenase were found to be raised in four patients. Virological studies performed in six children gave negative results. Full clinical recovery was achieved within 1-7 days. One child developed a second episode. These ten cases of benign acute childhood myositis are the first to be reported from this region.

Subdural Effusion and Its Relationship With Neurologic Sequelae of Bacterial Meningitis in Infancy: A Prospective Study

One hundred thirteen infants, aged 1 to 18 months, were screened systematically and serially using transillumination for the presence of subdural effusion during acute bacterial meningitis due to Haemophilus influenzae type b, Streptococcus pneumoniae, or Neisseria meningitidis. Effusion developed in 44 (39%) of the patients during the course of treatment. Young age, rapid onset of illness, low peripheral white blood cell count, and high cerebrospinal fluid levels of protein and bacterial antigen were associated with a higher likelihood of developing effusion. Although patients with effusion were more likely to have neurologic abnormalities both at the time of admission and at completion of therapy, and were more likely to have seizures during the course of treatment, there was no greater incidence of seizures, hearing loss, neurologic deficits, or developmental delay on longterm follow-up (median follow-up interval 5.5 years) in patients with effusion. Specific invasive therapy is not indicated in infants with meningitis and subdural effusion who are otherwise improving.

PSEUDOMONAS AERUGINOSA (PA) OSTEOMYELITIS IN CHILDREN: SIGNIFICANCE AND CLINICAL CHARACTERISTICS

PA is usually regarded as an infrequent cause of childhood osteomyelitis. The records of 144 children below 19 years of age and hospitalized between 1972 and 1981 were retrospectively reviewed. Osteomyelitis was defined as signs of localized infection and radiographic or radioisotopic demonstration of an osseous lesion. 104 patients fulfilled these criteria. S. aureus, no etiologic agent, and PA occurred in 60.5%, 15.4%, and 10.6% of the cases respectively. Compared to all other cases, children with PA osteomyelitis were significantly older (mean 8.0 yrs. vs 13.4 yrs. p <.001), lacked fever at admission (60.9% vs 18%, p <.02), and lacked bacteremia (60% vs 0%, p <.03). The relationship between penetrating trauma or cutaneous drainage and PA infection was highly significant (p <.005). Although statistical significance was not achieved, at the time of presentation children with PA osteomyelitis had lower erythrocyte sedimentation rates, lower peripheral white blood cell counts, and longer duration of symptoms when compared with other causes of osseous infection. PA is a significant cause of adolescent osteomyelitis and is characterized by signs of local, rather than systemic infection.