Lymphocyte count as a sign of immunoparalysis and its correlation with nutritional status in pediatric intensive care patients with sepsis: A pilot study

OBJECTIVES: Developing malnutrition during hospitalization is well recognized worldwide, and children are at a relatively higher risk for malnutrition than adults. Malnutrition can lead to immune dysfunction, which is associated with a higher mortality rate due to sepsis, the most frequent cause of death in pediatric intensive care units (PICUs). The aim of this study was to investigate whether malnourished patients are more likely to have relative or absolute lymphopenia and, consequently, worse prognoses. METHODS: We enrolled 14 consecutive patients with sepsis whose legal representatives provided written informed consent. Patients were classified as normal or malnourished based on anthropometric measurements. As an additional evaluation of nutritional status, serum albumin and zinc were measured on the 1st and 7th days of hospitalization. Lymphocyte count was also measured on the 1st and 7th days. Clinicaltrials.gov: NCT02698683. RESULTS: Malnutrition prevalence rates were 33.3% and 42.8% based on weight and height, respectively. Laboratory analyses revealed a reduction of serum albumin in 100% of patients and reduction of zinc in 93.3% of patients. A total of 35% of patients had fewer than 500 lymphocytes/mm3 on their first day in the PICU. Lymphocyte counts and zinc concentrations significantly increased during hospitalization. CONCLUSIONS: Nutritional evaluations, including anthropometric measurements, were not correlated with lymphocyte counts. Lymphocyte counts concomitantly increased with zinc levels, suggesting that micronutrient supplementation benefits patients with sepsis.

Posterior fossa midline cryptococcoma in a patient with idiopathic CD4 lymphocytopenia.

Idiopathic CD4 lymphocytopenia (ICL) is a rare disorder which is often diagnosed as HIV-negative AIDS in the light of poor immunity and AIDS-defining illnesses. We present a case of a 50-year-old male who presented with a midline posterior fossa tumour with ICL diagnosed as cerebellar cryptococcoma.

Analysis of Patients with Positive Acid-fast Bacilli Culture and Negative T-SPOT.TB Results / 대한진단검사의학회지

BACKGROUND: T-SPOT.TB is a sensitive test that detects interferon-gamma producing T-cells in tuberculosis patients following stimulation with tuberculosis-specific antigens. Our study was aimed to investigate the possible causes of false negative results of the test by analyzing the patients with positive acid-fast bacilli (AFB) culture and negative T-SPOT.TB results. METHODS: We investigated 138 patients with positive AFB culture results reported between January 2009 and April 2010. Medical records of these patients were reviewed for the results of T-SPOT.TB test, AFB culture, PCR for Mycobacterium tuberculosis (TB-PCR), chest X-ray, drug treatment, etc. Diagnosis of tuberculosis was confirmed by positive TB-PCR or identification of Mycobacterium tuberculosis (MTB). Sensitivity of T-SPOT.TB test was calculated and the possible causes of AFB culture positive and T-SPOT.TB negative results were analyzed. RESULTS: T-SPOT.TB test was performed in 63 of the 138 patients with AFB culture positive results. Fifty-six (88.9%) were positive and 7 patients (11.1%) were negative on T-SPOT.TB test. Of these 7 negative cases, 4 were confirmed as nontuberculous mycobacteria (NTM), 2 were suspected as NTM and diagnosis could not be confirmed in 1. Six of these 7 patients were over 70 yr old and 6 patients had lymphocytopenia. T-SPOT.TB negative results were not observed in any of the 44 patients confirmed to have active tuberculosis (sensitivity 100%). CONCLUSIONS: Our results suggest that T-SPOT.TB test is very sensitive for diagnosing active tuberculosis. NTM may be the main cause of AFB culture positive and T-SPOT.TB negative results, but MTB infection in immunocompromised patients also has to be considered.

Estado hematológico a largo plazo en lupus eritematoso generalizado / Long-term hematologic status in systemic lupus erythematosus

Diversas alteraciones hematológicas puede ocurrir en el lupus eritematoso generalizado (LEG) y su severidad puede ser mayor al inicio de la enfermedad. De la cohorte de enfermos con LEG atendidos en nuestro servico estudiamos una muestra de 60 enfermos (1 varón y 54 mujeres) que al inicio de su padecimiento cursaron con éste tipo de manifestaciones y analizamos su evolución y estado actual. El tiempo de seguimiento de los enfermos fue 7.5 años; edad, 38.45 ñ 12.2 años; leucopenia actual en 3 (5 por ciento) y previa en 30 (p<0.005); leucocitosis en 11 (18.3 por ciento) y previa en 15 (p<0.05); cuenta linfocitos 2, 100 vs. 1,200 previa (p<0.005); plaquetas actual, 206 ñ 108 x 1000 vs. previa, 145 ñ 50 x 1000. Existió anemia hemolítica en siete pacientes al inicio del padecimiento; actualmente negativa a los parámetros clínicos y de laboratorio. Los tratamientos empleados fueron esteroides, ciclofosfamida y cloroquina. Aunque las alteraciones hematológicas son comunes al inicio del LEG, una vez establecido el tratamiento éstas tienden a disminuir o bien a desaparecer en un plazo mayor. Este es un estudio preliminar de la situación hematológica de nuestros enfermos con LEG