Lymphocytopenia as a marker for pandemic influenza A/H1N1 2009 virus infection in children.
Lymphocytopenia has been reported in adults with pandemic influenza A/H1N1 2009 infection, but data in children are inconclusive. Data from 76 children presented with flu-like symptoms between July and November 2009 and tested for pandemic influenza A/H1N1 2009 virus and white blood cell (WBC) counts were analyzed. Samples from 37 (48.7%) children resulted in a positive PCR assay for pandemic influenza A/H1N1 2009 virus. When comparing data from these children with data from 39 (51.3%) children with uncomplicated flu-like illness and negative PCR assay for pandemic influenza A/H1N1 2009 virus, no difference in disease duration, median age, red blood cell count, hemoglobin concentration, C reactive protein concentration, and absolute neutrophil count was observed, whereas significant differences were apparent when considering WBC count, relative and absolute lymphocyte count, absolute lymphocyte count z-score, and platelet count. Receiver operating characteristic curve analysis revealed that the best absolute lymphocyte count and absolute lymphocyte count z-score cut-points that simultaneously maximized sensitivity and specificity were 2,256 cells/µl and -0.89, respectively, sensitivity being 0.81 (95% CI: 0.68-0.94), specificity 0.87 (95% CI: 0.77-0.98), positive predictive value 0.85 (95% CI: 0.74-0.97), and negative predictive value 0.83 (95% CI: 0.71-0.94). In conclusion, lymphocytopenia is a marker for influenza A/H1N1 2009 virus infection in children. Absolute lymphocyte count <2,556 cells/µl or absolute lymphocyte count z-score < -0.89 may be useful cut-offs to discriminate against children at higher risk of infection during epidemics. Considering that the pandemic virus is highly likely to continue to circulate in the coming winter season, these findings provide direct and practical implications for the near future.
Department of Sciences for Woman and Child's Health, University of Florence, Florence, Italy.
Elena
E
Chiappini
Luisa
L
Galli
Alberta
A
Azzi
Massimo
M
Resti
Francesca
F
Bonsignori
Maurizio
M
de Martino
D000293:Adolescent; D015415:Biomarkers; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification* / Q000472:pathogenicity; D007251:Influenza, Human / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology / Q000821:virology*; D007958:Leukocyte Count; D008231:Lymphopenia / Q000175:diagnosis*; D008297:Male; D011237:Predictive Value of Tests; D012367:RNA, Viral / Q000235:genetics; D012372:ROC Curve; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012680:Sensitivity and Specificity
D015415:Biomarkers; D012367:RNA, Viral