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.