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Clinical deterioration in community acquired infections associated with lymphocyte upsurge in immunocompetent hosts.
[systemic capillary leak syndrome]
Clinical
deterioration
during
the
course
of
community-acquired
infections
can
occur
as
a
result
of
an
exaggerated
immune
response
of
the
host
towards
the
inciting
pathogens
,
leading
to
immune-mediated
tissue
damage
.
Whether
a
surge
in
the
peripheral
lymphocyte
count
can
be
used
as
a
surrogate
marker
indicating
the
onset
of
immunopathological
tissue
damage
is
not
known
.
In
this
study
,
we
report
the
clinical
presentations
and
outcomes
of
a
cohort
of
immunocompetent
patients
with
non-tuberculous
community
acquired
infections
who
experienced
clinical
deterioration
during
hospital
stay
(
n
=
85
)
.
12
(
14
.
1
%
)
patients
had
a
surge
in
lymphocyte
count
preceding
their
clinical
deteriorations
,
and
their
diagnoses
included
viral
pneumonitis
,
viral
encephalitis
,
scrub
typhus
,
leptospirosis
,
brucellosis
,
and
dengue
haemorrhagic
fever
.
The
clinical
manifestations
during
deterioration
ranged
from
interstitial
pneumonitis
,
airway
obstruction
,
CNS
disturbances
,
and
systemic
capillary
leak
syndrome
,
all
of
which
were
thought
to
represent
immunopathological
tissue
damages
.
When
compared
with
patients
without
lymphocyte
surge
,
these
patients
were
more
likely
to
be
infected
with
fastidious
/
viral
pathogens
(
0
vs
12
;
p
<
0
.
05
)
,
in
addition
to
having
lower
mean
baseline
lymphocyte
counts
(
403
+
/
-
181
vs
1143
+
/
-
686
cells
/
microl
;
p
<
0
.
05
)
.
We
postulate
that
the
peripheral
lymphocyte
count
may
be
a
useful
surrogate
marker
indicating
the
presence
of
immunopathological
damage
during
clinical
deterioration
in
certain
infectious
diseases
.
Diseases
Validation
Diseases presenting
"fever"
symptom
22q11.2 deletion syndrome
acute rheumatic fever
alexander disease
allergic bronchopulmonary aspergillosis
canavan disease
carcinoma of the gallbladder
child syndrome
congenital toxoplasmosis
cushing syndrome
cystinuria
dracunculiasis
erdheim-chester disease
esophageal adenocarcinoma
esophageal carcinoma
familial mediterranean fever
focal myositis
hodgkin lymphoma, classical
lamellar ichthyosis
legionellosis
locked-in syndrome
malignant atrophic papulosis
neonatal adrenoleukodystrophy
neuralgic amyotrophy
oculocutaneous albinism
papillon-lefèvre syndrome
pyomyositis
pyruvate dehydrogenase deficiency
scrub typhus
severe combined immunodeficiency
sneddon syndrome
systemic capillary leak syndrome
triple a syndrome
typhoid
waldenström macroglobulinemia
wolf-hirschhorn syndrome
This symptom has already been validated