Does extreme leukocytosis predict serious bacterial infections in infants in the post-pneumococcal vaccine era? the experience of a large, tertiary care pediatric hospital

Dana Danino, Ayelet Rimon, Dennis Scolnik, Galia Grisaru-Soen, Miguel Glatstein

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Extreme leukocytosis, defined as a peripheral white blood cell count greater than 25,000/mm3, 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/mm3 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.

Original languageEnglish
Pages (from-to)391-394
Number of pages4
JournalPediatric Emergency Care
Volume31
Issue number6
DOIs
StatePublished - 13 Jun 2015
Externally publishedYes

Keywords

  • Extreme leukocytosis
  • bacteremia
  • pneumococcal vaccine
  • pneumonia
  • severe bacterial infection

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Emergency Medicine

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