Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Mary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University.
What are the clinical consequences of neutropenia?
Neutropenia results in an increased susceptibility to bacterial infections.
The degree of risk depends upon the cause and severity of the neutropenia, the
underlying medical condition of the patient, and the presence or absence of bone
marrow reserves for the production of neutrophils.
The most common type of infections seen in neutropenic
patients are caused by bacteria normally found on the skin (such as
Staphylococcus aureus) or from the gastrointestinal and urinary tract.
Fungal
infections are also more frequent in
patients with neutropenia. The infections may be limited to certain areas of the
body (commonly the oral cavity, genital area, and skin)
or may spread via the bloodstream to the lungs and other organs in severe, prolonged neutropenia.
What causes neutropenia?
Neutropenia can be present (though it is relatively
uncommon) in normal healthy individuals, notably in some persons of African or
Arabic descent and and Yemenite Jews. Neutropenia may arise as a result of
decreased production of neutrophils, destruction of neutrophils after they are
produced, or pooling of neutrophils (accumulation of the neutrophils out of the
circulation).
Neutropenia may arise as a result of numerous medical conditions:
Infections (more commonly viral infections, but also
bacterial or parasitic infections). Examples include:
HIV,
tuberculosis,
malaria,
Epstein Barr virus (EBV);
Medications that may damage the bone marrow or
neutrophils, including cancerchemotherapy;
Congenital (inborn) disorders of bone marrow function
or of neutrophil production, for example,
Kostmann syndrome;
Autoimmune destruction of neutrophils (either as a
primary condition or associated with another disease such as
Felty's syndrome)
or from drugs stimulating the immune system to attack the cells
Hypersplenism, which refers to the increased
sequestration and/or destruction of blood cells by the spleen
Infectious mononucleosis is a virus infection in which there is an increase of white blood cells
that are mononuclear (with a single nucleus) "Mono" and "kissing
disease" are popular terms for this very common illness caused by the
Epstein-Barr virus (EBV).
Staphylococcus or Staph is a group of bacteria that can cause a multitude of diseases. Staph infections can cause illness directly by infection or indirectly by the toxins they produce. Symptoms and signs of a Staph infection include redness, swelling, pain, and drainage of pus. Minor skin infections are treated with an antibiotic ointment, while more serious infections are treated with intravenous antibiotics.
Anemia is the condition of having less than the normal number of red blood cells or less than the normal quantity of hemoglobin in the blood. The oxygen-carrying capacity of the blood is, therefore, decreased.
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis bacteria. Symptoms include weakness, fever, weight loss, night sweats and in worse cases, chest pain, shortness of breath, and coughing up blood. A person with an active infection (a positive TB skin test, abnormal chest x-ray and TB bacteria in their sputum) requires treatment with izoniazid, rifampin, ethambutol and pyrazinaide.
Athlete's foot (tinea pedis) is a skin infection caused by the ringworm fungus. Symptoms include itching, burning, cracking, peeling, and bleeding feet. Treatment involves keeping the feet dry and clean, wearing shoes that can breathe, and using medicated powders to keep your feet dry.
Jock itch is an itchy red rash that appears in the groin area. The rash may be caused by a bacterial or fungal infection. People with diabetes and those who are obese are more susceptible to developing jock itch. Antifungal shampoos, creams, and pills may be needed to treat fungal jock itch. Bacterial jock itch may be treated with antibacterial soaps and topical and oral antibiotics.
Malaria is an infectious disease transmitted by the bite of an infected Anopheles mosquito. Symptoms of malaria include chills, pain, fever, and sweating. Though mild cases of malaria can be treated with oral medication, severe cases require intravenous drug treatment and fluids.
Cancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
Fungal nails (onychomycosis) may be caused by many species of fungi but the most common is Trichophyton rubrum. Distal subungal onychomycosis starts as a discolored area at the nail's corner and slowly spread toward the cuticle. In proximal subungal onychomycosis, the infection starts at the cuticle and spreads toward the nail tip. Yeast onychomycosis is caused by Candida and may be the most common cause of fungal fingernail.
Felty's syndrome is a complication of long-term rheumatoid arthritis. Felty's syndrome is defined by the presence of three conditions: rheumatoid arthritis, an enlarged spleen, and an abnormally low white blood count. Treatment of Felty's syndrome is not always required; however, treatment for patients with infections is available.
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