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العنوان
Study of Diagnostic Criteria of Hemophagocytic Lymphohistiocytosis in Neonatal and Pediatric Sepsis /
المؤلف
Mohammed, Sara Mahfouz.
هيئة الاعداد
باحث / Sara Mahfouz Mohammed
مشرف / Mohsen Saleh Elalfy
مشرف / Iman Ahmed Ragab
مناقش / Nour El-din Abdel-Aal
تاريخ النشر
2018.
عدد الصفحات
173 P. :
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
طب الأطفال ، الفترة المحيطة بالولادة وصحة الطفل
تاريخ الإجازة
1/1/2018
مكان الإجازة
جامعة عين شمس - كلية الطب - قسم طب الاطفال
الفهرس
Only 14 pages are availabe for public view

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from 173

Abstract

H
emophagocytic lymphohistiocytosis (HLH) is a life-threatening condition characterized by uncontrolled inflammation and has common clinical and laboratory features with systemic inflammatory response syndrome (SIRS), sepsis and severe sepsis.
The aim of current study was to compare HLH by its known criteria among patients with neonatal sepsis admitted to NICU and childhood sepsis admitted to PICU.
1- Evaluate the determinants of HLH among both groups
a- Patients factors: age, sex, consanguineous parents
b- Microbial factor: Type of the detected microorganism, localization
2- Comparison of the outcome of patients with and without HLH criteria
3- The frequency of each criterion of HLH in each group
The study included 50 patients diagnosed with severe sepsis, who were recruited from pediatric intensive care unit of children’s hospital, neonatal intensive care unit, Faculty of Medicine, Ain-Shams University, with established diagnosis of severe sepsis. After enrollment, all patients were evaluated for the presence of HLH using the criteria set forth in 2004 by Pediatric HLH Study group of the Histiocyte Society.
Besides full history taking and detailed clinical examination, the following laboratory investigations were performed: CBC, CRP, Serum creatinine, AST, ALT, albumin, bilirubin, ferritin, fasting triglycerides, fibrinogen, prothrombin time (PT) and partial thromboplastin time (PTT).
In the current study we had 2 groups the neonatal and pediatric groups with median 39 days of age of neonatal group and with median of 1.6 years of age in pediatric group.
In our study, we observed that among 50 patients with severe sepsis, bronchopneumonia was the most frequent underlying infection in the neonatal group with 56%, followed by Non localized sepsis 36% then gastroenteritis in 8%, while CNS affection sepsis and the renal causes were the least commonly encountered in both groups while in pediatric group the most frequent underlying infection was bronchopneumonia with 64% followed by gastroenteritis in 20% of cases.
In our study 35% of the patients who fulfilled 2 criteria of HLH died while 31.2 % lived, patients who fulfilled 3 criteria zero% lived with 100% mortality, patients who fulfilled 4 criteria zero % lived with 100% mortality as well as patients who fulfilled 5 criteria zero% lived with 100% mortality.
In our study, Hepatomegaly was present in 38% of patients with sepsis. With 22% in neonatal group and in 16% in pediatric group and while splenomegaly is present in 20% of patients with sepsis with 16% in neonatal group and in 4% in pediatric group.
Concerning the peripheral blood counts of our studied patients total leukocytic count was ranging from 2(x 1,000/mm3) to22(x 1,000/mm3) in neonatal group with sepsis while in pediatric group ranging from 8.4 (x 1,000/mm3)to 44(x 1,000/mm3) which makes neonatal group shows leukopenia associated with sepsis more than leukocytosis which is more evident in the pediatric group, with also marked neutropenia in sepsis in the neonatal group reached 0.8(x 1,000/mm3) lowest range while in pediatric group reached 4.5(x 1,000/mm3) as lowest range Neutropenia in sepsis is more common in neonatal group with 56% than pediatric group with20% as a sign of sepsis with highly significant value in comparison between the two groups.
In our study, Fibrinogen level less than 100 mg/dl was found in 18% of cases of sepsis 14% in pediatric group and 4% in neonatal group. While it is more than 100 mg/dl in 82% of cases with sepsis 36%in pediatric group and 46% in neonatal group.
Fibrinogen level less than 100 mg/dl was found in 26.5% of the mortality group and more than 100 mg/dl in 73.5% in the mortality group.
There was significant correlation between elevated serum ferritin level and decreased serum fibrinogen level among patients with sepsis in our study.
In conclusion, some criteria of HLH were positive among patients with sepsis with no difference between pediatric and neonatal group. However, patients fulfilling 5 criteria of HLH were 4% in our study with no difference in mortality between those with 5 criteria positive and negative ones.