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Abstract

ABSTRACT: INTRODUCTION: Infection is a common cause of morbidity and mortality in immunocompromised patients for *Central Public Health Laboratory-Ministry of Health. **Dep.College of Medicine University of Baghdad . whom diagnosis and management require scrupulous attention and continuing awareness of the microorganisms causing infection in a particular environment in different groups of patients , most are caused by recognized pathogen, although uncommon,some times THE IRAQI POSTGRADUATE MEDICAL JOURNAL VOL.12, NO 2 ,2013 BACK GROUND: Patients with neutropenia can be at low-or high-risk according to the duration of neutropenia, its differential count, the ANC (absolute neutrophil count) in addition to search for any causative agents to improve the diagnostic and therapeutic outcome. OBJECTIVE: This study focuses on the clinical and microbiological data in relation to the duration of neutropenia in a sample of immunocompromised Iraqi patients due to leukemia and aplastic anemia. INDIVIDUAL METHODS: 150 patients presented with pyrexia, marrow failure from oncology unit of the 7 floor of Medical City Hospital, National Center of Hematology-Iraq , Institute and Hospital of radiotherapy and nuclear medicine studied between 2008-2009 ,classified into three groups, fifty for each, with a plastic anemia, acute lymphoblastic leukemia(ALL), acute myelogenous leukemia(AML),all were investigated for WBC count, differential,ANC,Hb,Pcv,platelet count, RBC,Peripheral blood film for blast cells,ESR, specifically in those complaining from pyrexia of unknown origin. direct examination ,culture and sensitivity of the urine,stool,body fluids, sputum ,blood, tonsil and skin swab, Widal, rose Bengal tests, besides temperature recording was done for all patients with known site of infection. RESULTS : Neutropenia of a plastic anemia 5-70 days with a mean of 25 days is associated with a higher risk of infection particularly by the gram-negative enterobacter ,but with a mortality rate of 26%,while those suffered from ALL with a range of 11-40 day and a mean values of 16 days with a less mortality rate 22%.Unfortunatelly AML although gets a range of 7-35 day and a mean values 18 day and short lived neutropenia yet it was significantly have a higher mortality rate 52% presumably due to the combined effect of low neutropil count and chemo radiotherapy .However sever neutropenia (ANC < 500) is only found in 10 AA,6 AML,and 4 ALL patients, and moderate neutropenia (500 ≤ ANC < 1000) were explored in 7 AA,4 AML,10 ALL. The microbiological investigation shows that gram negative microorganism especially E.coli is positive in 19 different samples followed by Klebsiella 12 positive sample, then monilia takes place12 cases, followed by the remaining microorganisms. Lastly pyrexia of unknown origin were found to be the top problem facing immunocompromised patients with 20% AA,34%ALL,30%AML followed by chest infection 16%AA,22%ALL,15%AML, and then urinary tract infection17%AA,17%ALL,10%AML followed by other types of infections. CONCLUSION: Neutropenia is prolonged in a plastic anemia compared to acute leukemia with the risk of infection is directly related to it.G(-ve) enterobacter particularly E-coli is the commonest pathogen isolated.

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