Botryoid neutrophils in sepsis caused by influenzae virus A.

A 13-year-old patient was admitted to our hospital with severe respiratory distress, fever, and signs of meningeal infection. A positive result of swine flu was obtained by RT-PCR. All bacterial cultures were negative. Due to a worsening progression, the patient required mechanical ventilation. Leucocytosis with neutrophilia was observed with an absence of immature granulocytes and thrombocytopenia. A blood film was therefore examined, observing 85% of botryoid neutrophils, hypersegmented, and radially distributed nuclear lobs, and a large number of apoptotic cells. There was an elevated nucleus-cytoplasm ratio and neutrophils presented as slightly degranulated. The detection of botryoid nuclei in the neutrophils is a very infrequent finding and are usually found in cases of severe burns, hyperthermia, abuse of cocaine and methamphetamine, and encephalitis. Current studies also suggest that some morphometric measurements (cell population data [CPD]) can be altered in the case of sepsis and serious infection. In this particular case, [NE-SSC] = 159.9, [NE-FSC] = 94.6, and [NE-SFL] = 65.5, which correspond to measures of cellular complexity, size, and fluorescence and were above normal threshold values (performed by Sysmex XN20). Current studies directly relate the increase of NE-SSC > 149 in patients presenting with sepsis. The CPD and abnormal neutrophil morphology improved as the patient recovered. Results normalized by day 30 postdischarge.

Laboratorio clínico 2.0 / Laboratory Medicine 2.0

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Procalcitonin, C-reactive protein and leukocyte count in children with lower respiratory tract infection.

BACKGROUND: Lower respiratory tract infection is the most common infection leading to unnecessary antibiotic treatment in children. Etiologic diagnosis is not immediately achieved, and the pathogen remains unidentified in a large number of cases. Neither clinical nor laboratory factors allow for a rapid distinction between bacterial and viral etiology. The aim of our study was to evaluate the reliability of procalcitonin (PCT), C-reactive protein (CRP) and leukocyte count in distinguishing pneumococcal, atypical and viral lower respiratory tract infection. METHODS: PCT, CRP and leukocyte count were measured in children with microbiologically documented diagnoses of lower respiratory tract infection. The results were compared of children with pneumococcal, atypical and viral etiologies. RESULTS: PCT and CRP showed significant correlation with a bacterial etiology of lower respiratory tract infection. No significance was found for leukocyte count. Using a cutoff point of 2 ng/ml for PCT and 65 mg/l for CRP, the sensitivities and specificities for distinguishing bacterial from viral lower respiratory tract infections were 68.6 and 79.4% for PCT and 79.1 and 67.1% for CRP. The sensitivities and specificities for distinguishing pneumococcal from other etiologies were 90.3 and 74.1% for PCT and 90.3 and 60% for CRP, respectively. CONCLUSIONS: High PCT and CRP values show a significant correlation with the bacterial etiology of lower respiratory tract infection. PCT and CRP show good sensitivity for distinguishing pneumococcal from other etiologies. PCT shows higher specificity than CRP. PCT and CRP can help make decisions about antibiotic therapy in children with lower respiratory tract infections.

Elevated serum procalcitonin values correlate with renal scarring in children with urinary tract infection.

BACKGROUND: Urinary tract infection (UTI) in young children carries the risk of parenchymal damage and sequelae. The location of the infection within the urinary tract influences decisions regarding both therapeutics and follow-up. Because clinical features and laboratory markers of infection at an early age are not specific, it is difficult to make a distinction between lower UTI and acute pyelonephritis. Procalcitonin (PCT) has been studied as a marker of severe bacterial infection. The aim of this study was to test the usefulness of PCT concentration in serum to distinguish between uncomplicated UTI and severe acute pyelonephritis with renal scars. METHODS: PCT was measured by immunoluminometric assay in serum samples from children with microbiologically documented infection. Severe renal involvement was assessed by 99mTc-dimercaptosuccinic acid gammagraphy done 5 to 6 months after the episode to check for the presence of parenchymal scars. C-reactive protein (CRP) and leukocyte count were also measured. RESULTS: PCT at presentation showed a significant correlation (P < 0.001) with the presence of renal scars in children with UTI. Using a cutoff of 1 ng/ml for PCT and 20 mg/l for CRP, sensitivity and specificity in distinguishing between urinary tract infection with and without renal damage were 92.3 and 61.9%, respectively, for PCT and 92.3 and 34.4% for CRP. Positive and negative predictive values were 32 and 97.5%, respectively, for PCT and 23 and 95%, respectively, for CRP. CONCLUSIONS: A low PCT value at admission indicates a low risk of long term renal scarring. Increased PCT values at admission correlate with the presence of scars. PCT values have proved to be more specific than CRP and leukocyte count for identifying patients who might develop renal damage.