Neonatal neutropenia

Introduction Peripheral blood leukocytes often increase in patients with sclerotin, mainly neutrophils. Clinical manifestations vary widely, the main clinical types are purulent meningoencephalitis, sepsis and perinatal infection, leading to miscarriage or neonatal sclerotia. It is characterized by difficulty in breathing, hepatosplenomegaly, dark red rash, leukopenia, and thrombocytopenia. Blood, urine, gastric juice, bronchial secretions, amniotic fluid, meconium culture can often be isolated from pathogenic bacteria, but cerebrospinal fluid culture is often negative. Late onset sclerotiasis is seen in infants 3 to 13 days after birth or later, with meningoencephalitis as the main manifestation, fever, susceptibility to stimulation, and refusal to eat. Cerebrospinal fluid culture can often find monocytogenes of Listeria.

Cause

The disease has been found around the world. Monocytogenes of Listeria monocytogenes can be isolated from the surface of soil, water and vegetables, human and animal feces. People are infected by direct contact with the carrier animals and have a sporadic distribution. Infected people of this type of transmission are more common in butchers, abattoir workers and veterinarians, and have a certain professional relationship. Bacteria can also spread through the digestive tract by contaminating vegetables, milk and other foods, causing the outbreak of human litresosis. Bacteria can also cause nosocomial infections. Normal people have a certain natural immunity against Listeria monocytogenes infection. After infection, it only shows flu-like symptoms or mild meningoencephalitis. The course of the disease is often benign and self-limiting. When human immune function is low, especially when phagocytic function and cellular immune function are low, bacteria enter the local venules or lymphatic vessels through the intestinal mucosa or skin or mucous membrane, and then invade the blood circulation, causing sepsis. When bacteria invade tissues and organs, it can cause suppurative lesions of the corresponding tissues and organs, forming scattered small abscesses. Invading brain tissue and meninges cause purulent meningoencephalitis and even brain abscess. After infection in pregnant women, bacteria can cause embryo infection through the placenta, causing miscarriage or neostatitis.

an examination

Related inspection

Neutrophil count (NEUT) Neutrophil ratio (NEUT%) Neutrophil chemotaxis assay

Peripheral blood leukocytes often increase in patients with sclerotin, mainly neutrophils. Examination of cerebrospinal fluid in patients with meningoencephalitis showed that the protein content increased and the sugar drop was not obvious. Only half of the human cerebrospinal fluid sugar was less than 2mmol/l, and the number of white blood cells often increased, and the range fluctuated between (50-1000)×106/l. White blood cell classification is dominated by an increase in multinucleated cells. Since it is difficult to distinguish from other bacterial infections in the clinical situation, the diagnosis depends on bacterial culture. If the pathogen can be isolated, the diagnosis can be confirmed. However, the bacteria are easily confused with streptococcus and coryneform bacteria, so when there are unexplained infection patients, the possibility of the disease should be considered when separating the diphtheria-like or non-pathogenic bacteria from the infected specimen.

According to the morning and evening of the symptoms, it can be divided into early onset and late onset sputum. Early onset sclerotia is seen several hours after the birth of a newborn. It is characterized by difficulty breathing, pneumonia, hepatosplenomegaly, dark red rash, leukopenia, thrombocytopenia, etc. Blood, urine, gastric juice, bronchial secretions, amniotic fluid, meconium culture can often be isolated from pathogenic bacteria, but cerebrospinal fluid culture is often negative. Late onset sclerotiasis is seen in infants 3 to 13 days after birth or later, with meningoencephalitis as the main manifestation, fever, susceptibility to stimulation, and refusal to eat. Cerebrospinal fluid culture can often find monocytogenes of Listeria. Other rare lyrics have subacute endocarditis, endophthalmitis, peritonitis, pleurisy, osteomyelitis, lymphadenitis, cutaneous sclerotin, conjunctivitis, cholecystitis, liver, spleen abscess, soft tissue abscess, etc. . The prognosis of sclerotin depends on the age of the disease and the condition of the primary disease. The early onset neonatal sclerotia has a poor prognosis and a high mortality rate of 40% to 54%. Survivors also often have serious neurological sequelae. Late-onset neonates with cerevisiae meningoencephalitis have a good prognosis, but nearly half of patients may have residual neurological sequelae. The mortality rate of sepsis without central nervous system infection is about 11%, and the mortality rate of sepsis with meningoencephalitis is 30%.

Differential diagnosis

Symptoms of neonatal neutropenia need to be differentiated from the following symptoms.

1. Neutrophil leukemia reaction: There are primary diseases, such as infection, tumor, poisoning, acute hemolysis, etc., diagnosis is not difficult. If there are many immature cells in the peripheral blood and there are abnormalities in the morphology, they should be differentiated from leukemia.

2.Sweet syndrome: also known as acute febrile neutrophil dermatosis, its clinical features are facial, neck, limbs with asymmetrical, painful, edematous dark red erythema; erythema boundary is clear, hard There is tenderness; biopsy has a large amount of neutrophil infiltration on the surface and sees nuclear fragmentation; accompanied by fever, fatigue, and sore joints. Peripheral blood leukocytes (15 ~ 20) × 109 / L, neutrophils accounted for 80% ~ 90%. About 10% of the cases in this disease are associated with acute leukemia.

3. Benign idiopathic neutrophilia: the disease can be seen at any age. Generally no clinical symptoms, a few may have fatigue, dizziness. Peripheral blood leukocytes continue to be mild to moderately elevated, mainly neutrophils, no cell morphology abnormalities or toxic changes, sometimes granulocyte hyperplasia can be seen in the bone marrow. The course of the disease can last for several years, and the cause of neutrophil enlargement can not be found, and it does not change into acute or chronic myeloid leukemia.

4. Hereditary neutropenia: The disease is clinically similar to benign idiopathic neutropenia. The difference is that there is often a genetic history, and family members often have the same disease.

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