Fever and Leucocytosis in Children in Clinical Practice in South East Nigeria: The Roles Played by Malaria and Bacterial Infection
AbstractObjective: The study was conducted with a view to determining the veracity of the assumption in clinical practice in the tropics that fever with a neutrophilic leucocytosis is more likely due to bacterial infection than to malaria.
Method: A retrospective analysis of case files of children aged over 3 months who had fever of >38.5 oC and leucocytosis with a final empirical therapeutic diagnosis of either malaria or bacterial infection, seen over a 3yr period in a paediatric private practice was done. A total of 186 patients comprising 118 treated for malaria and 68 treated for bacterial infection fitted the criteria and were analyzed.
Results: In all the patients with leucocytosis of 11 to 1 4x I09/l, malaria accounted for 81.7% and a further 60.5% of those with leucocytosis greater than14 to 17x109/1. Bacterial infection accounted for 52% and 53.2% of patients with leucocytosis of>17 to 20x109/1 and >20x109/1 respectively (X2=18.64, X23,0.05=7.81. P
Considering the neutrophils, malaria accounted for 77.9% of patients with neutrophils of <=75%, while bacterial infection accounted for 87.8% of patients with >75%. Again, 95.8% of all malaria patients had neutrophils of <=75% while 52.9% of those with bacterial infection had >75% neutrophil percent.
Further analysis showed that 78.9% of malaria patients with Hb <=5 gm/100ml had leucocytosis of >17x109/l (X2=35.4, X2 3,0.05=7.81 P<0.05).
Conclusion: Non-neutrophilic leucocytosis of moderate degree in febrile children in this environment is seen to be due mainly to malaria and this is more so if such patients are anaemic. Care should therefore be taken when interpreting such results.
Key Words: Fever, Febrile illness, children, tropics, leucocytosis
Orient Journal of Medicine Vol.15(1&2) 2003: 64-67