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Leukocyte counts in children with acute otitis media
Insights
Peripheral blood leukocyte counts in children with acute otitis media can be significantly altered. Leukopenia and neutropenia were common at follow-up, suggesting a link between infection and antibiotic treatment.
Area of Science:
- Pediatric Infectious Diseases
- Hematology
- Clinical Microbiology
Background:
- Acute otitis media (AOM) is a common childhood infection.
- Leukocyte counts are often used to assess infection severity.
- The impact of AOM and its treatment on peripheral blood counts requires further investigation.
Purpose of the Study:
- To investigate peripheral blood leukocyte counts in children diagnosed with acute otitis media.
- To determine the prevalence of leukocytosis at presentation and leukopenia/neutropenia at follow-up.
- To explore potential correlations between leukocyte count abnormalities, age, culture results, and antibiotic treatment.
Main Methods:
- Peripheral blood leukocyte counts were analyzed in 167 children with AOM undergoing myringotomy.
- Middle ear exudate cultures were performed.
- Leukocyte counts were assessed at initial presentation and 10–14 days post-treatment.
- Data were analyzed based on age, culture results, and antibiotic therapy (erythromycin-sulfisoxazole vs. amoxicillin).
Main Results:
- Markedly elevated leukocyte counts (>97th percentile) were observed in 28% of children at presentation.
- Leukocyte counts exceeded 20,000/microL in 9% of cases.
- Relative leukopenia (13% vs. 2%) and absolute neutropenia (10% vs. 2%) were significantly more common at follow-up than at initial presentation.
- No significant difference in leukocyte counts was found between culture-positive and culture-negative AOM.
- Children treated with erythromycin-sulfisoxazole showed a non-significant trend towards higher rates of neutropenia compared to amoxicillin.
Conclusions:
- Acute otitis media can cause significant transient alterations in peripheral blood leukocyte counts.
- Leukopenia and neutropenia are frequently observed at follow-up after AOM treatment.
- Antibiotic therapy, particularly the combination of erythromycin-sulfisoxazole, may influence peripheral blood counts, warranting further investigation.
Abstract:
Peripheral blood leukocyte counts were performed in 167 children with acute otitis media who underwent myringotomy with culture of the middle ear exudate. A markedly elevated (greater than 97th percentile for age) leukocyte count was noted at initial presentation among 28% of these children, and counts exceeded 20,000/microL among 9%. Children older than six years were more likely than younger children to have marked leukocyte (41 v 24%, P less than 0.1). Children with culture-positive and culture-negative acute otitis media had similar leukocyte counts. There was no difference in frequency of posttreatment leukocytosis between those children who had complete resolution of acute otitis media and those children who had persistent otitis media with effusion. At follow-up 10 to 14 days later, relative leukopenia was observed significantly more often than at initial presentation (13 v 2%, P less than 0.001), and was most common among children two to five years old. Absolute neutropenia was likewise more common at the follow-up than at initial presentation (10 v 2%, P less than 0.01). Children treated with the fixed combination of erythromycin ethyl succinate-sulfisoxazole acetyl were somewhat more likely to have absolute neutropenia than those children who were treated with amoxicillin, but this difference was not statistically significant (14 v 6%, P less than 0.1). Acute otitis media, and perhaps the specific antibiotic therapy prescribed for acute otitis media, may exert marked effects upon peripheral blood counts.(ABSTRACT TRUNCATED AT 250 WORDS)