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A low peripheral blood white blood cell count in infants younger than 90 days increases the odds of acute bacterial meningitis relative to bacteremia.
Acad Emerg Med. 2004 Dec; 11(12):1297-301.AE

Abstract

In relying on the peripheral blood white blood cell (WBC) count to identify infants at high risk for acute bacterial meningitis and bacteremia, to the best of the authors' knowledge, it has not been reported previously whether high and low values of the test have similar implications for predicting these separate infections.

OBJECTIVE

To analyze the relationship between the peripheral WBC count and the odds of acute bacterial meningitis relative to bacteremia among sick infants aged 3 to 89 days.

METHODS

Areas under the receiver operating characteristic curve (AUCs) and likelihood ratios at various intervals of the total peripheral blood WBC count were computed.

RESULTS

A pathogen was isolated from blood or cerebrospinal fluid (CSF) from 72 infants aged 3 to 89 days. Fifty-two infants had growth of a pathogen from the blood only, and 20 had growth from the CSF. The most common bacteria isolated were Escherichia coli (32) and group B streptococci (32). The AUC for the peripheral WBC count when differentiating between acute bacterial meningitis and bacteremia was 0.75 (95% CI = 0.63 to 0.88). The odds of acute bacterial meningitis relative to bacteremia were sevenfold higher for a peripheral WBC cutoff below 5,000 cells/mm(3) and threefold lower for a peripheral WBC cutoff at or above 15,000 cells/mm(3).

CONCLUSIONS

In young infants, the peripheral blood WBC count is useful for estimating the odds of acute bacterial meningitis relative to isolated bacteremia. A low peripheral blood WBC count should be considered a much more worrisome laboratory finding because it is associated with a relatively high risk for acute bacterial meningitis relative to the potential for bacteremia.

Authors+Show Affiliations

Children's Hospital, Department of Medicine, Division of Emergency Medicine, 700 Children's Drive, Columbus, OH 43213, USA. bonsub@pediatrics.ohio-state.eduNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

15576520

Citation

Bonsu, Bema K., and Marvin B. Harper. "A Low Peripheral Blood White Blood Cell Count in Infants Younger Than 90 Days Increases the Odds of Acute Bacterial Meningitis Relative to Bacteremia." Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, vol. 11, no. 12, 2004, pp. 1297-301.
Bonsu BK, Harper MB. A low peripheral blood white blood cell count in infants younger than 90 days increases the odds of acute bacterial meningitis relative to bacteremia. Acad Emerg Med. 2004;11(12):1297-301.
Bonsu, B. K., & Harper, M. B. (2004). A low peripheral blood white blood cell count in infants younger than 90 days increases the odds of acute bacterial meningitis relative to bacteremia. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 11(12), 1297-301.
Bonsu BK, Harper MB. A Low Peripheral Blood White Blood Cell Count in Infants Younger Than 90 Days Increases the Odds of Acute Bacterial Meningitis Relative to Bacteremia. Acad Emerg Med. 2004;11(12):1297-301. PubMed PMID: 15576520.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A low peripheral blood white blood cell count in infants younger than 90 days increases the odds of acute bacterial meningitis relative to bacteremia. AU - Bonsu,Bema K, AU - Harper,Marvin B, PY - 2004/12/4/pubmed PY - 2005/1/26/medline PY - 2004/12/4/entrez SP - 1297 EP - 301 JF - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine JO - Acad Emerg Med VL - 11 IS - 12 N2 - UNLABELLED: In relying on the peripheral blood white blood cell (WBC) count to identify infants at high risk for acute bacterial meningitis and bacteremia, to the best of the authors' knowledge, it has not been reported previously whether high and low values of the test have similar implications for predicting these separate infections. OBJECTIVE: To analyze the relationship between the peripheral WBC count and the odds of acute bacterial meningitis relative to bacteremia among sick infants aged 3 to 89 days. METHODS: Areas under the receiver operating characteristic curve (AUCs) and likelihood ratios at various intervals of the total peripheral blood WBC count were computed. RESULTS: A pathogen was isolated from blood or cerebrospinal fluid (CSF) from 72 infants aged 3 to 89 days. Fifty-two infants had growth of a pathogen from the blood only, and 20 had growth from the CSF. The most common bacteria isolated were Escherichia coli (32) and group B streptococci (32). The AUC for the peripheral WBC count when differentiating between acute bacterial meningitis and bacteremia was 0.75 (95% CI = 0.63 to 0.88). The odds of acute bacterial meningitis relative to bacteremia were sevenfold higher for a peripheral WBC cutoff below 5,000 cells/mm(3) and threefold lower for a peripheral WBC cutoff at or above 15,000 cells/mm(3). CONCLUSIONS: In young infants, the peripheral blood WBC count is useful for estimating the odds of acute bacterial meningitis relative to isolated bacteremia. A low peripheral blood WBC count should be considered a much more worrisome laboratory finding because it is associated with a relatively high risk for acute bacterial meningitis relative to the potential for bacteremia. SN - 1069-6563 UR - https://www.unboundmedicine.com/medline/citation/15576520/A_low_peripheral_blood_white_blood_cell_count_in_infants_younger_than_90_days_increases_the_odds_of_acute_bacterial_meningitis_relative_to_bacteremia_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1069-6563&date=2004&volume=11&issue=12&spage=1297 DB - PRIME DP - Unbound Medicine ER -