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Early lymphopenia in burned children with and without the toxic shock syndrome
A N Brain1, J D Frame, M D Eve
1North-east Thames Regional Burns and Plastic Surgery Unit, St Andrews Hospital, Billericay, UK.
Insights
Toxic shock syndrome (TSS) in children postburn shows a distinct white cell count (WCC) pattern. A significantly lower WCC nadir and profound lymphocyte fall between days 2-4 aid in TSS diagnosis.
Area of Science:
- Pediatric Burn Care
- Immunology
- Infectious Diseases
Background:
- Thermal injury, or burns, can trigger significant physiological responses.
- Toxic shock syndrome (TSS) is a serious complication following various infections, including burns.
- Understanding immune markers like white cell count (WCC) is crucial for managing pediatric burn patients.
Purpose of the Study:
- To investigate the white cell count (WCC) kinetics in children during the first week post-thermal injury.
- To compare the WCC response in pediatric burn patients with and without toxic shock syndrome (TSS).
- To identify potential diagnostic markers for TSS in this patient group.
Main Methods:
- Prospective study of 33 pediatric burn patients.
- Analysis of white cell count (WCC) trends from day 2 to day 4 postburn.
- Comparison of WCC, granulocyte, and lymphocyte counts between non-TSS (control) and TSS groups.
Main Results:
- All patients exhibited an initial leukocytosis followed by a WCC nadir between days 2-4.
- The WCC nadir was significantly lower in the TSS group compared to controls.
- TSS patients showed a profound fall in lymphocytes by day 3, unlike controls.
Conclusions:
- Distinct WCC patterns, particularly a significant lymphocyte decrease, may aid in diagnosing TSS in pediatric burn patients.
- Monitoring WCC, granulocytes, and lymphocytes offers valuable insights into immune responses post-burn.
- Early identification of TSS through hematological markers can improve patient outcomes.
Abstract:
The white cell count (WCC) response to thermal injury in children in week 1 postburn has been investigated in a prospective study of 33 patients. Two of these patients developed the toxic shock syndrome (TSS) and, together with seven previously diagnosed cases of the TSS, were studied as a separate group. The WCC response in the non-TSS (control) patients was compared with the response observed in the TSS group. In all patients there was an initial leucocytosis followed by a fall in WCC to a nadir between days 2 and 4. The nadir was significantly lower in the TSS group than that observed in the control group. A rise in the WCC was observed over the following 3-4 days in both groups. In the control group the changes in the WCC were mainly attributable to changes in the granulocyte count with little change in the lymphocyte count. There were similar changes in the granulocyte count in the TSS group but, in contrast to the control group, the lymphocyte count fell, to below the normal range, on day 3. The lowest lymphocyte count observed in the TSS group was significantly lower than that seen in the control group. The observation of a profound fall in the total WCC, granulocytes, and in particular the lymphocytes, between days 2 and 4 are additional factors that may help with the diagnosis of TSS.