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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
"interstitial pneumonitis"
symptom
inclusion body myositis
lymphangioleiomyomatosis
systemic capillary leak syndrome
This symptom has already been validated