Does Extreme Leukocytosis Predict Serious Bacterial Infections in Infants in the Post-Pneumococcal Vaccine Era? The Experience of a Large, Tertiary Care Pediatric Hospital. Issue 6 (June 2015)

• Record Type: Journal Article
• Authors: Danino, Dana; Rimon, Ayelet; Scolnik, Dennis; Grisaru-Soen, Galia; Glatstein, Miguel
• Is Part Of: Pediatric emergency care. Volume 31:Issue 6(2015)
• Publication Date: 2015-06
• Subjects: extreme leukocytosis -- pneumonia -- severe bacterial infection -- bacteremia -- pneumococcal vaccine; Pediatric emergencies -- Periodicals; 618.92002505
• DOI: 10.1097/PEC.0000000000000454
• Languages: English
• ISSNs: 0749-5161

Abstract

Abstract : Background: Extreme leukocytosis, defined as a peripheral white blood cell count greater than 25, 000/mm 3, may alarm clinicians and prompt extensive evaluation in infants with fever, especially in the pediatric emergency department. Methods: We reviewed data from children aged 3 to 36 months with extreme leukocytosis, fever and the risk of serious bacterial infections (SBI) at our institution from July 2010 to December 2012, a period after the universal introduction of pneumococcal vaccine. Results: Serious bacterial infection was recorded in 57 (39%) of the 147 infants. The most common SBI were segmental or lobar pneumonia, in 28 (19%) patients, and urinary tract infection in 16 (10.9%) patients. Three patients had positive blood cultures, corresponding to a bacteremia rate of 2%. C-reactive protein was significantly higher in the SBI group than in the non-SBI group. Conclusions: All well-looking febrile infants with white blood cell greater than 25, 000/mm 3 should undergo a chest radiograph unless there are clear physical findings that indicate a different etiology. Urine culture should be considered in women. C-reactive protein can have an added value in the differential diagnosis.