Altered neutrophil counts at diagnosis of invasive meningococcal infection in children

Dawit E. Demissie, Sheldon L. Kaplan, Jose R. Romero, John A.D. Leake, William J. Barson, Natasha B. Halasa, Carrie L. Byington, Avinash K. Shetty, Tina Q. Tan, Jill A. Hoffman, Philana L. Lin, Kathryn M. Edwards, Edward O. Mason, Michael S. Cooperstock

Research output: Contribution to journalArticle

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Abstract

Background: Invasive meningococcal infections can be devastating. Substantial endotoxemia releases mature and immature neutrophils. Endothelial margination of mature neutrophils may increase the immature-to-total neutrophil ratio (ITR). These changes have not been previously well-described in invasive meningococcal disease. Methods: Using 2001 to 2011 data from the US Multicenter Meningococcal Surveillance Study, the diagnostic sensitivity and clinical correlates of white blood cell count, absolute neutrophil count (ANC), immature neutrophil count (INC) and ITR were evaluated alone and in combination at the time of diagnosis of invasive meningococcal disease. Results: Two hundred sixteen patients were evaluated: meningococcemia (65), meningitis (145) and other foci (6). ANC ≤1000/mm3 or ≥10,000/ mm3 was present in 137 (63%), INC ≥500/mm3 in 170 (79%) and ITR ≥0.20 in 139 (64%). One or more of these 3 criteria were met in 204 of the 216 (94%). Results were similar for meningococcemia and meningitis subgroups. All 13 cases with mildest disease met 1 or more of the 3 criteria. Eight children presented with ANCs <1000/mm3: 3 of them died and a fourth required partial amputation in all 4 limbs. Conclusions: Invasive meningococcal disease is characterized by striking abnormalities in ANC, INC and/or ITR. Neutropenia was associated with a poor prognosis. Notably, without INCs, 37% of cases would have been missed. Automated methods not measuring immature white blood cells should be avoided when assessing febrile children. Serious infection should be considered when counts meet any of the 3 criteria.

Original languageEnglish
Pages (from-to)1070-1072
Number of pages3
JournalPediatric Infectious Disease Journal
Volume32
Issue number10
DOIs
Publication statusPublished - 06-06-2013
Externally publishedYes

Fingerprint

Meningococcal Infections
Neutrophils
Meningitis
Endotoxemia
Neutropenia
Leukocyte Count
Amputation

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Demissie, D. E., Kaplan, S. L., Romero, J. R., Leake, J. A. D., Barson, W. J., Halasa, N. B., ... Cooperstock, M. S. (2013). Altered neutrophil counts at diagnosis of invasive meningococcal infection in children. Pediatric Infectious Disease Journal, 32(10), 1070-1072. https://doi.org/10.1097/INF.0b013e31829e31f1
Demissie, Dawit E. ; Kaplan, Sheldon L. ; Romero, Jose R. ; Leake, John A.D. ; Barson, William J. ; Halasa, Natasha B. ; Byington, Carrie L. ; Shetty, Avinash K. ; Tan, Tina Q. ; Hoffman, Jill A. ; Lin, Philana L. ; Edwards, Kathryn M. ; Mason, Edward O. ; Cooperstock, Michael S. / Altered neutrophil counts at diagnosis of invasive meningococcal infection in children. In: Pediatric Infectious Disease Journal. 2013 ; Vol. 32, No. 10. pp. 1070-1072.
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abstract = "Background: Invasive meningococcal infections can be devastating. Substantial endotoxemia releases mature and immature neutrophils. Endothelial margination of mature neutrophils may increase the immature-to-total neutrophil ratio (ITR). These changes have not been previously well-described in invasive meningococcal disease. Methods: Using 2001 to 2011 data from the US Multicenter Meningococcal Surveillance Study, the diagnostic sensitivity and clinical correlates of white blood cell count, absolute neutrophil count (ANC), immature neutrophil count (INC) and ITR were evaluated alone and in combination at the time of diagnosis of invasive meningococcal disease. Results: Two hundred sixteen patients were evaluated: meningococcemia (65), meningitis (145) and other foci (6). ANC ≤1000/mm3 or ≥10,000/ mm3 was present in 137 (63{\%}), INC ≥500/mm3 in 170 (79{\%}) and ITR ≥0.20 in 139 (64{\%}). One or more of these 3 criteria were met in 204 of the 216 (94{\%}). Results were similar for meningococcemia and meningitis subgroups. All 13 cases with mildest disease met 1 or more of the 3 criteria. Eight children presented with ANCs <1000/mm3: 3 of them died and a fourth required partial amputation in all 4 limbs. Conclusions: Invasive meningococcal disease is characterized by striking abnormalities in ANC, INC and/or ITR. Neutropenia was associated with a poor prognosis. Notably, without INCs, 37{\%} of cases would have been missed. Automated methods not measuring immature white blood cells should be avoided when assessing febrile children. Serious infection should be considered when counts meet any of the 3 criteria.",
author = "Demissie, {Dawit E.} and Kaplan, {Sheldon L.} and Romero, {Jose R.} and Leake, {John A.D.} and Barson, {William J.} and Halasa, {Natasha B.} and Byington, {Carrie L.} and Shetty, {Avinash K.} and Tan, {Tina Q.} and Hoffman, {Jill A.} and Lin, {Philana L.} and Edwards, {Kathryn M.} and Mason, {Edward O.} and Cooperstock, {Michael S.}",
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Demissie, DE, Kaplan, SL, Romero, JR, Leake, JAD, Barson, WJ, Halasa, NB, Byington, CL, Shetty, AK, Tan, TQ, Hoffman, JA, Lin, PL, Edwards, KM, Mason, EO & Cooperstock, MS 2013, 'Altered neutrophil counts at diagnosis of invasive meningococcal infection in children', Pediatric Infectious Disease Journal, vol. 32, no. 10, pp. 1070-1072. https://doi.org/10.1097/INF.0b013e31829e31f1

Altered neutrophil counts at diagnosis of invasive meningococcal infection in children. / Demissie, Dawit E.; Kaplan, Sheldon L.; Romero, Jose R.; Leake, John A.D.; Barson, William J.; Halasa, Natasha B.; Byington, Carrie L.; Shetty, Avinash K.; Tan, Tina Q.; Hoffman, Jill A.; Lin, Philana L.; Edwards, Kathryn M.; Mason, Edward O.; Cooperstock, Michael S.

In: Pediatric Infectious Disease Journal, Vol. 32, No. 10, 06.06.2013, p. 1070-1072.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Altered neutrophil counts at diagnosis of invasive meningococcal infection in children

AU - Demissie, Dawit E.

AU - Kaplan, Sheldon L.

AU - Romero, Jose R.

AU - Leake, John A.D.

AU - Barson, William J.

AU - Halasa, Natasha B.

AU - Byington, Carrie L.

AU - Shetty, Avinash K.

AU - Tan, Tina Q.

AU - Hoffman, Jill A.

AU - Lin, Philana L.

AU - Edwards, Kathryn M.

AU - Mason, Edward O.

AU - Cooperstock, Michael S.

PY - 2013/6/6

Y1 - 2013/6/6

N2 - Background: Invasive meningococcal infections can be devastating. Substantial endotoxemia releases mature and immature neutrophils. Endothelial margination of mature neutrophils may increase the immature-to-total neutrophil ratio (ITR). These changes have not been previously well-described in invasive meningococcal disease. Methods: Using 2001 to 2011 data from the US Multicenter Meningococcal Surveillance Study, the diagnostic sensitivity and clinical correlates of white blood cell count, absolute neutrophil count (ANC), immature neutrophil count (INC) and ITR were evaluated alone and in combination at the time of diagnosis of invasive meningococcal disease. Results: Two hundred sixteen patients were evaluated: meningococcemia (65), meningitis (145) and other foci (6). ANC ≤1000/mm3 or ≥10,000/ mm3 was present in 137 (63%), INC ≥500/mm3 in 170 (79%) and ITR ≥0.20 in 139 (64%). One or more of these 3 criteria were met in 204 of the 216 (94%). Results were similar for meningococcemia and meningitis subgroups. All 13 cases with mildest disease met 1 or more of the 3 criteria. Eight children presented with ANCs <1000/mm3: 3 of them died and a fourth required partial amputation in all 4 limbs. Conclusions: Invasive meningococcal disease is characterized by striking abnormalities in ANC, INC and/or ITR. Neutropenia was associated with a poor prognosis. Notably, without INCs, 37% of cases would have been missed. Automated methods not measuring immature white blood cells should be avoided when assessing febrile children. Serious infection should be considered when counts meet any of the 3 criteria.

AB - Background: Invasive meningococcal infections can be devastating. Substantial endotoxemia releases mature and immature neutrophils. Endothelial margination of mature neutrophils may increase the immature-to-total neutrophil ratio (ITR). These changes have not been previously well-described in invasive meningococcal disease. Methods: Using 2001 to 2011 data from the US Multicenter Meningococcal Surveillance Study, the diagnostic sensitivity and clinical correlates of white blood cell count, absolute neutrophil count (ANC), immature neutrophil count (INC) and ITR were evaluated alone and in combination at the time of diagnosis of invasive meningococcal disease. Results: Two hundred sixteen patients were evaluated: meningococcemia (65), meningitis (145) and other foci (6). ANC ≤1000/mm3 or ≥10,000/ mm3 was present in 137 (63%), INC ≥500/mm3 in 170 (79%) and ITR ≥0.20 in 139 (64%). One or more of these 3 criteria were met in 204 of the 216 (94%). Results were similar for meningococcemia and meningitis subgroups. All 13 cases with mildest disease met 1 or more of the 3 criteria. Eight children presented with ANCs <1000/mm3: 3 of them died and a fourth required partial amputation in all 4 limbs. Conclusions: Invasive meningococcal disease is characterized by striking abnormalities in ANC, INC and/or ITR. Neutropenia was associated with a poor prognosis. Notably, without INCs, 37% of cases would have been missed. Automated methods not measuring immature white blood cells should be avoided when assessing febrile children. Serious infection should be considered when counts meet any of the 3 criteria.

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SN - 0891-3668

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