Decrease in gamma delta T-cell with microbiologically proven infection in septic oncologic children

Abstract

© JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND. Objective: Predictors determining septic oncologic patients at high or low risk are helpful in guiding of antimicrobial management. As the number of γδ T-cells decreased in septic adult patients and the degree of change significantly associated with disease severity, the authors applied this concept and explored the association between the number of γδ T-cells and sepsis severity in oncologic children. The association of cell counts with microbiologically proven infection was also investigated. Materials and Methods: Pediatric oncologic patients admitted with sepsis were prospectively enrolled. T-cell subset numbers were performed by flow cytometry method. Each episode of sepsis was categorized as severe sepsis versus non-severe sepsis or microbiologically proven infection versus non-microbiologically proven infection. Comparison of white blood cell count, lymphocyte count, and lymphocyte subset count between groups was performed. Results: Forty-eight septic episodes were included. No association between the number of γδ T-cells and sepsis severity was noted. However, the percentage of γδ T-cell/total lymphocytes and absolute neutrophil count (ANC) were significantly lower in patients with microbiologically proven infection. A γδ T-cell greater than 3% of total lymphocytes and ANC greater than 100/uL are proposed as factors associated with non-microbiologically proven episodes in patients presenting with mild sepsis. Conclusion: The authors proposed that percentage of γδ T-cells in septic oncologic patients, along with ANC may be used as a guide for antibiotic management in septic oncologic children.