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When my baby was 38 days he got meningitis. He was treated…

When my baby was 38...
When my baby was 38 days he got meningitis. He was treated with antibiotics and discharged. His neutrophils was before discharge 0.6 and during the first six months of his life it was 0.7 or 0.8. Then when he was 7 months old it got up and became 1.1. And then he was not tested again. I stopped taking him to labs.
Now he is 1 and a half years old. He had fever 38c. Coughing and runny nose. I took him to hospital and was given antibiotic. He took it for 5 days but still got fever from now and then. I took him back to hospital where they did cbc. Neutrophils was 0.4. And he is admitted to hospital.
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Answered in 10 minutes by:
1/18/2018
Dr. Su S.
Dr. Su S., Pediatrician
Category: Pediatrics
Satisfied Customers: 22,684
Experience: 20 years of experience in treating children.
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Greetings,
Thanks for your question.
I am Dr. Su S. I will try my best to help you.
I am reviewing the question now and will reply in a moment.

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How is he in hospital now?
What treatment is he getting?
Did doctor take any other test?

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Hello again,
I was waiting for response from you.
I am very sorry for his symptoms.
The decrease in neutrophil count can be relative.
In young children of his age, lymphocyte count is more.
In infections, lymphocyte count is raised further high.
This makes the neutrophil count relatively lower.
He is admitted into hospital for better monitoring & treatment.
With recovery from infection, the count will go back to previous level.
I hope this information will be helpful.
If you have any query, please feel free to ask.
If you are happy with my answer please click on the Excellent/Good rating.
Wish him healthy life.
Regards.

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Customer reply replied 4 months ago

He is taking antibiotic. He has neutropenia since 2 months old. He is now 1.5 years old. Nothing changed.

I am sorry.
I noticed you gave negative rating.
May I know the reason?

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Customer reply replied 4 months ago
Relist: Answer quality.
I paid for detailed answer. Beside my son has neutopina since 2 months old. He tells me when infection goes it will raise up. But it never beyond 1.1
Sumanth Amperayani
Sumanth Amperayani, Pediatrician
Category: Pediatrics
Satisfied Customers: 776
Experience: Consultant Pediatrician at Kanchi Kamakoti CHILDS Trust Hospital
Verified

Hi...Welcome to JustAnswer. I am Dr. Sumanth Amperayani from India. I have 13 years of experience in the field of Pediatrics at a tertiary care referral hospital in Chennai, India. I will do my level best to alleviate your health concern. I am currently reviewing your question. I will be back in a moment to guide you further.

Kind regards ***** ***** Sumanth Amperayani MBBS., DCH., DNB (PAEDIATRICS).,

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Hi... I understand your concern. I have seen the image of the blood test you have uploaded. The neutrophils are 10% and the total count is 4700, which means the % of neutrophils in differential count is 470, which is low and anything less than 500 should be evaluated. Another number which you are seeing down is segmented neutrophils which are suggestive of infection. Probably this is the reason why he was admitted.

I need more information before guiding you further.

1. What the date of birth?

2. What was his birth weight?

3. What are his current height and weight?

4. Now fever is 100.4F and how long has this fever been there?

5. How is his activity when the fever touches the base line?

6. What are the other symptoms other than fever/ cough/ runny nose he is having?

7. How is his appetite?

8. What antibiotic was given to him 5 days back?

9. Were any tests drawn before starting antibiotic (especially blood or urine cultures)?

Please revert back to me answers so that I can guide you better.

Regards ***** ***** Sumanth Amperayani MBBS., DCH., DNB (Paediatrics).,

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Customer reply replied 4 months ago

He was born june 2016

His birth weight is 3100

He was 11 kg but after he got flu he is now 10.5

He got fever last thu and was on adol when i stopped adol it went to 38 again. Now no fever no adol

He is usually acrive play but when he is sick he looks not on the mood

He is active now laughs and dance but refuse to eat

He was given amoclan antibiotic for 5 days

They did blood culture after two doses of antibiotic. I don't know why they were late,+÷ fault of nurses. The result is still not yet.

He was having cbc manually no blasts and wbc raised to 6.

Hello, thank you for getting back with the necessary requested information.Your son's birth weight and current weight in comparison to the birth weight and age or very good.I have calculated his percentile with respect to his age. He is falling between 15th to 25th centile which is normal. I did not get the opportunity to calculate the same for his height as it was not mentioned.Fever of 7 days duration along with cough and cold, on antibiotics is not to be worried about. It may be a viral illness or a simple bacterial infection. We can decide on that after we get the blood culture reports.Though his growth parameters have been normal and he has not been hospitalized recurrently for serious bacterial infections, low absolute neutrophil count is definitely a cause of concern.One more significant point is that he has been running fever since last Thursday which is 7 days now. But his total count and differential count in the neutrophils, which is called absolute neutrophil count is relatively less than compared to his duration of illness. This is what I feel is clinically significant and that is the reason why I have suggested that he needs work up for neutropenia.I suggest that you request the doctors who are treating him there to work him up for neutropenia and send a flow cytometry analysis of T cell, B cell and NK cell markers. That would be conclusive.One more small piece of suggestion is that, please do not start antibiotic even orally without blood or urine culture next time. This is even more important as your son has neutropenia.Hope what I have told you helps. Please get back to me if you have any more further queries regarding this. Happy to help any time.Kind regards ***** ***** Sumanth Amperayani MBBS., DCH., DNB (Pediatrics).,
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Customer reply replied 4 months ago

Is T cell, B cell and NK cell markers all what we need?

When he was 7 month his neutrophils were 1.1. Is he still may have congenital neutropenia

Hi.... I agree with you. It may be congenital neutropenia but usually if it is congenital neutropenia which is severe, there would have been severe bacterial infections warranting hospitalization in infancy itself that is less than 1 year of age.Which is not so here.I suggested to go with peripheral blood flow cytometry because it is less invasive procedure.Flow cytometry is completely normal then we need to go ahead with bone marrow study along with cytogenetic evaluation.In medical field the workup of any case is always in a stepwise manner. This is the reason why I had suggested flow cytometry initially.Please get back to me if there are any further queries. I am happy to help.Regards ***** ***** Sumanth Amperayani
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Customer reply replied 4 months ago
Relist: Answer quality.

Hi... I understand your concern.

I accept that my interaction was not helpful for you and could not alleviate your concerns and you are not satisfied or happy with my suggestions.

I request you to make me aware of the reason why I got a negative rating so that I may stand corrected in future or I can suggest you the other possible alternatives.

Kind regards ***** ***** Sumanth Amperayani MBBS., DCH., DNB (PAEDIATRICS).,

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Customer reply replied 4 months ago

My son ANC was 6.9 when he was admitted to hospital diagnosed meningitis at age of 38 days. After 2 weeks in hospital the day before discharged it was 0.6

What does that mean?

Meningitis damaged bone marrow

Heredity neutropenia

Hi.. I am sorry that my previous interaction was not up to your expectations. I will try my level best to clear your queries.

1. At the age of 38 days the usual response of the body is to have more of lymphocytes rather than neutrophils. That is the reason why when your baby had a serious bacterial infection like meningitis the neutrophils rose to tackle the situation and after the cure they had returned back to their normal. But this was at 38 days. What I mean to say is that this response of the ANC was age appropriate at that time.

2. I would like to know if the medical records then (if you have them in hand please see and tell me) have any documentation about the cause for meningitis? Was it bacterial or viral? If so was any organism identified?

I need this information to answer your first query about the causative organism for meningitis causing bone marrow suppression.

3. Coming to the issue of hereditary neutropenia - I am afraid I may lean towards the diagnosis with the information in hand. But at the same time I am open to options and hence I requested you for additional information on the cause for meningitis. I asked this information because some viruses may cause bone marrow suppression.

4. Now coming to the current issue of low ANC, I am sorry to say that I am still concerned and that is the reason why I analyzed in my first interaction about the age appropriate ANC and suggested you to go ahead with further evaluation in a step wise manner which is definitely indicated please.

But at the same time I can reassure you that even though your son has got low ANC which is probably there since long - he has not needed medical attention or further lab testing, which itself indicates that, it is not severe. I am just trying to ease your mind here. But this doesn't mean that he will not require further evaluation please.

If possible please try to upload all reports of hospitalization at 38 days of life and all the further CBC reports you have in hand in date wise chronological manner. This will give me a lot of insight in to the issue and I would be in able to help you out better.

Kind regards ***** ***** Sumanth Amperayani MBBS., DCH., DNB (Paediatrics).,

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Customer reply replied 4 months ago

Hello, Thank you for getting back.

I have gone through the notes images which you have provided. This is the admission notes when your boy was 38-40 days old and this suggests that he had been treated as Pyogenic meningitis or bacterial meningitis. They have not considered viral meningitis nor treated it as viral meningitis.

Bacterial meningitis as such does not cause bone marrow suppression and cause low ANC.

Only when a drug called Chloramphenicol is used, we use to see bone marrow suppression. This medicine has not been used for your baby. In modern medicine for the past 20 years medical field has stopped using Chloramphenicol as first line therapy for meningitis in pediatric population.

Now with facts in hand and analyzing everything, my suggestion for you will be that - your son needs evaluation for hereditary neutropenia or congenital neutropenia.

Please get back to me with further queries. I am happy to help anytime and will try to answer your queries and guide you please.

Kind regards ***** ***** Sumanth Amperayani MBBS., DCH., DNB (Paediatrics).,

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Customer reply replied 4 months ago

The culture was negative no bacteria found

Hi... I understand your query.

Only in 30% of the times, there will be positive cultures in bacterial meningitis. Whether is blood culture or CSF culture, the chance of a positive culture is 30%.

But treatment is imperative and that is what the doctors had done.

Though cultures were sterile, they have treated the baby.

May I know what is the CSF analysis of the baby at that time. I mean - CSF cytology report/ biochemistry report and Grams stain report please.

Kind regards ***** ***** Sumanth Amperayani MBBS., DCH., DNB (Paediatrics).,

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Customer reply replied 4 months ago

What are the test he should do now

Hello, Thank you for getting back.

I would suggest you to get a peripheral blood flow cytometry analysis for T-cell, B-cell and NK-cell markers done as the first step. This is the least invasive test and the primary step in your son's case please.

The results would be available within 3 - 7 days depending on the laboratory.

Right now this is the only test I would suggest.

Kind regards ***** ***** Sumanth Amperayani MBBS., DCH., DNB (Paediatrics).,

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Customer reply replied 4 months ago

This is the last test of today

Hi... Thank you for getting back with the latest report of CBC.This is a normal report as far as the absolute neutrophil count is concerned. Any value above 500 is normal and here it is 1150.Was there any reason for you to do the test or did you do it just to review the blood counts.I am asking this because we need to interpret the test always along with the clinical condition of the kid please.But the total count is slightly on the lower side of normal. But I can assure you that this is not an abnormal report as such.We have only two reports now where the absolute neutrophil count has been above 500. First report was when he was 38 day old baby and now again.You had mentioned that you did not go to labs to repeat the test, in between.But there have been instances where the absolute neutrophil count has been less when compared to the clinical condition.Please get back to me with the answer whether you have done this test latestly, only as a follow up test to see the blood counts or was there any particular reason like fever or any other infection. Based on your response I will guide you further.I will be waiting for your response please.Kind regards ***** ***** Sumanth Amperayani
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Customer reply replied 4 months ago

My son is admitted to hospital for neutropenia. This test was done to today to check neutrophils, if it is high we will be discharged. He was having fever 38c with sore throat when we first went there just to find out he has neutropenia.

Is this good?

There is no hematologist in the city where i live. Should I travel to another city to follow up or this is good now

Hello, thank you for getting back soon.The neutrophils now is in the appropriate range. So your son will be discharged.This is good and I am happy that when there is infection, his immunity is rising to the occasion and producing more neutrophils to find the infection.But as far as I have seen and from the history which you have quoted, I feel that his baseline neutrophils and his baseline absolute neutrophil count is less than 500 which definitely requires evaluation.But I again reiterate the fact that it may not be a severe a serious congenital neutropenia because of the fact that your son did not have any serious bacterial infections till now apart from the initial bacterial meningitis which is a probable bacterial meningitis.My suggestion is that, definitely your son will require evaluation for low absolute neutrophil count. If there is no hematologist in your city I suggest you travel to a city and get a paediatric hematologist opinion please. But I suggest you not to do this now, but after two weeks when the effect of this particular fever and sore throat settles down on his immune system.My goal is to give you the best experience possible!I hope I have earned a 5 star rating today!Please do remember to rate my service by selecting the 5 stars at the top of the screen. This is the only way we experts are credited and compensated for our time and professional work.Kind regards – Dr. Sumanth Amperayani MBBS., DCH., DNB (PAEDIATRICS).,
Sumanth Amperayani
Sumanth Amperayani, Pediatrician
Category: Pediatrics
Satisfied Customers: 776
Experience: Consultant Pediatrician at Kanchi Kamakoti CHILDS Trust Hospital
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Sumanth Amperayani
Sumanth Amperayani
Sumanth Amperayani, Pediatrician
Category: Pediatrics
Satisfied Customers: 776
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Experience: Consultant Pediatrician at Kanchi Kamakoti CHILDS Trust Hospital

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