Vol 44 # 2 June 2012 - Kma.org.kw

June 2012
KUWAIT MEDICAL JOURNAL 158
Infectious Etiologies of Transient Neutropenia in
Previously-Healthy Children
Husain EH 1 , Mullah-Ali A 1 , Al-Sharidah S 2 , Azab AF, Adekile A 3
1
Department of Pediatrics, Faculty of Medicine 2 Department of Pediatrics, Mubarak Al-Kabeer Hospital
3
Departments of Pediatric Hematology & Oncology, Al-Sabah Hospital
Pediatr Infect Dis J 2012 Mar 12 [Epub ahead of print]
Background: Healthy children presenting with neutropenia are often hospitalized and treated empirically
with antibiotics without an evidence of infection. The objective of this study was to investigate the
infectious causes of isolated transient neutropenia in otherwise previously- healthy children.
Method: A two-year prospective study was conducted at a tertiary hospital in Kuwait. All previouslyhealthy
children (aged 1 month - 12 years) hospitalized with isolated neutropenia defined as absolute
neutrophil count (ANC) ≤ 1.5 x 10/L were enrolled in the study. Investigations to identify the infectious
causes included blood and urine culture for bacteria whereas for viruses, serology for EBV, CMV,
adenovirus, parvovirus and PCR for HHV6 and enterovirus were performed.
Results: Fifty five children were enrolled during the study. Children less than 2 years constituted 73% of
the sample. There were two peaks of presentation: March - May (33%) and September - November (38%).
Associated features were: congested throat (56%), runny nose (53%), and cervical lymphadenopathy
(20%). The median ANC on admission was 0.6 x 10/L. Associated infections were documented in 55% of
enrolled children and were as follows: HHV6 30%, enterovirus 23%, influenzaAH1N113%, parvovirus10%,
EBV10%, UTI (E.coli) 7%, and adenovirus 7%. No serious bacterial infection was identified and the mean
time for recovery of the ANC was 16.7 ± 15 days.
Conclusion: Neutropenia in previously-healthy children in Kuwait is caused by demonstrable infections
in 55% of cases. Majority of children will recover their ANC completely within one month without
significant infectious complications.
Genotypic Heterogeneity and Molecular Basis of 5-Flucytosine
Resistance among Candida Dubliniensis Isolates Recovered from
Clinical Specimens in Kuwait
Med Mycol 2012; 50:244-251
Ahmad S, Khan ZU, Joseph L, Asadzadeh M, Theyyathel A
Department of Microbiology, Kuwait University, Kuwait
There is a paucity of information about genotypic heterogeneity among Candida dubliniensis
isolates recovered from different geographic regions. This study explored genotypic heterogeneity
among 103 C. dubliniensis strains obtained over a six-year period from clinical specimens in Kuwait.
Genotype assignment was based on amplification with genotype-specific primers and sequencing of
rDNA. Susceptibility to 5-flucytosine was determined by means of the Etest. DNA sequencing of cytosine
deaminase was performed to determine the molecular basis of resistance to 5-flucytosine. DNA sequencing
of rDNA identified seven different genotypes, i.e., 68 (66%) isolates were found to belong to genotype 1, 25
to genotype 4, six to genotype 5 and one each to genotypes 6-9. Strains of genotype 2 or genotype 3 were
not detected. All isolates of genotype 4 but none of other genotypes were resistant to 5-flucytosine and the
resistant strains all contained S29L mutation. Isolates of all other genotypes contained wild-type codon 29
in cytosine deaminase. A simple, PCR-RFLP-based method has been developed to facilitate rapid detection
of S29L mutation in cytosine deaminase. A noteworthy observation of our study is the identification of
five new genotypes of C. dubliniensis isolates, recovered from oral/respiratory specimens from patients of
Middle Eastern origin. Furthermore, all 5-flucytosine resistant C. dubliniensis isolates in Kuwait belonged
to genotype 4 only.