Μελέτη μεταλοιμωδών κυταροπενειών σε παιδιά

Doctoral Dissertation uoadl:1307082 199 Read counter

Unit:
Τομέας Υγείας - Μητέρας - Παιδιού
Library of the School of Health Sciences
Deposit date:
2015-01-07
Year:
2014
Author:
Αλεξανδροπούλου Ουρανία
Dissertation committee:
Κωνσταντόπουλος Ανδρέας,Τσολιά Μαρίζα,Καραβανάκη Κυριακή
Original Title:
Μελέτη μεταλοιμωδών κυταροπενειών σε παιδιά
Languages:
Greek
Summary:
INTRODUCTION: The primary and acquired chronic cytopenias are rare and early
diagnosis and investigation lead to reduced morbidity and mortality. Acquired
cytopenias in children with febrile illness are common in paediatric practice
and usually occur during infectious diseases. Nevertheless, there is little
information on the epidemiology, the course and of course the outcome of
postinfectious cytopenias after a period of time. Various infectious agents
have been associated with acquired cytopenias such as viruses, bacteria and
parasites.
OBJECTIVE: To assess the etiology, duration and clinical outcome of febrile
cytopenias in hospitalized children. To study the incidence of transient
cytopenia compared with chronic cytopenia in childhood and finally, to evaluate
the cytopenia after one and two years.
PATIENTS AND METHODS: One hundred and seventeen children with febrile infection
and cytopenia with age (mean ± SD) 4.0 ± 3.8 years (range 0-14), were admitted
to a paediatric ward of a tertiary children’s hospital, during a two-year
period. They were evaluated using inflammatory markers, bacterial cultures and
serological screening tests.
RESULTS: In 52/117 (44.4%) cases a viral agent was identified. Among them 15/52
had neutropenia/leukopenia, 5/52 thrombocytopenia and the remaining 32 patients
exhibited bi- or trilineage cytopenia. In 13/117 (11.1%) cases a bacterial
agent was isolated (i.e.Salmonella spp, Shighella spp, Escherichia coli,
Mycoplasma pneumoniae). Three out of thirteen patients had
neutropenia/leukopenia, 2/13 had thrombocytopenia and 8/13 bilineage cytopenia.
In 9/117 children (7.7%) with pancytopenia, Leishmania spp was detected and
pancytopenia resolved within 26.1±23.5 days after treatment with Liposomal
Amphotericin B. In viral infections, neutropenia was transient and lasted for
41.3 ±67.7 days, thrombocytopenia lasted for 31.3±65.5 days, while in those
with 2 cell lines involvement, cytopenia lasted for 26.8 ±38.9 days. In
non-septic children with bacterial infections, cytopenia resolved within 34.9
±54.3 days .
In 84/117 cases (71.8%), cytopenia resolved within two months, in 12/117
(10.3%) it lasted for two-to-six months (transient cytopenia), while in 21/117
cases (17.9%) cytopenia lasted more than six months (chronic cytopenia).
Anti-neutrophil antibodies were detected in seven cases, three were diagnosed
having blood malignancies and one systemic lupus erythematosous. After two
years, only six patients were still cytopenic (two with autoimmune neutropenia
(AIN), three with chronic thrombocytopenia and one with chronic neutropenia).
In any of these six patients, an infectious agent was identified.
CONCLUSION: Cytopenia presenting in children during the course of a febrile
illness is usually transient and has a benign course, it resolves spontaneously
and is associated with common viral, bacterial or parasitic infections. However
occasionally, cytopenia during febrile illness may reveal coexistent chronic
autoimmune disease or haematologic malignancy.
Keywords:
Fever, Children, Cytaropenia, Infection, Neutropenia
Index:
No
Number of index pages:
0
Contains images:
Yes
Number of references:
288
Number of pages:
181
File:
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