CLINICAL OQBERVATIONG ABD TRRATMENT
tical of gramuinrrvtapenia was indicative of sane
granulocyte regeneration.
White counts were repeated at 3 to 4 day in-
tervals om ail of the exponed individuals and
more frequently on the with the lowest counts.
Individuals with svmptonm or elevated tem-
peratures were treated only after an attempt to
eatablinh a diagnosin was made, even if a peried of observation was necewary. During the
observation pertod, the patients were examined
at frequent intervals and the temperatures
checked every few hours,
Twenty-seven individuals had total leukocyte
counts of 4000 or below or absolute neutrophile
counts of 2500 or less at some time during the
period of observation. Of thesr 27, 15 de-
veloped symptoms of disease that required
evaluation for possible antibiotic therapy. The
13 instances in which it was necessary to consider the use of antibiotic therapy in neutropenic individuals are summarized below:
Fight neutropenic individuals had symtoms
of upper vespiratory infection (URI) char-
acterized by malaise. sore throat, nasal dis-
charge. and temperatures bet ween 1) and 114°
F. The temperatures returned to normal
within 24 hours. Since the response of this
group to URE appeared identical with that of
other individuals with URE without neutropenia. no special therapy was given.
Two individuals developed) symptoms of
marked talaise, headache. abdominal pain,
nuisen and diarrhea. Doth were children, one
nye 1, the other age 2.
In both instances, the
symptoms were out of proportion to the plysical findings, which were negative except for
evidence of heed cotds and pharyngeal injection, The ¢-vear old child had an oral tempernture of 10.6" F. when first seen and 4 hours
later, it was 14° FE.) The two-year ald child
had an initial axillary temperature of 1O1.8° F.
which rose to 1O4.5° Flin 4 hours. Both were
given S00.000 nnits of procaine penicillin intra-
musculariy when the sharp rise in temperature
occurred, and both were
day. Asecond mnjyection
at this time, and therapy
spite of the fuct that the
afebrile the following
of penicillin was given
was discontinued. In
neutrophiles remained
-
;4
depresad in hoth cases long after the fever had
pamed. both rndividuals recovered and had no
further lines. In Figure 2.1 the leukocyte and
platelet counts of the Z-vear old patie und the
time of the orcurrenve of the febrile lines are
illustrated.
AU one-vear-okd boy had had symptoms of
mild upper respiratory infection for several
lays aud was brought to the clinic when be
developed a hacking cough. When he was seen,
his axillary temperature was 100.8° FL He
had signs of URI, there was pharyngeal injeetion, and numerous coarse rhonchi were heard
throughout the chest. A diagnosis of upper
respiratory infection with associated bronchitis was made and the child was given a single
intramuscular injection of 200000 units procame penicillin. On the following day his tem-
perature was 8° F., no rales er rhonchi were
heurd, and he recovered without further
treatment.
A 30-year-old man came to the clinic com-
piaining of weaknem, nervousness, mild xb-
dominal pain and shooting pam in the upper
anterior chest bilateraliy of several hours duration, He appeared moderately dl, his temper-
ature was 10.6° F.. and the only positive physical fituling Was moderate tenagerness in the eight
upper quadrant of the abdomen. Within a
10-hour pertad the temperature rose to 101.6°
F.. following which it fell gradually to normal. The abdominal tenderness continued for
24 hours and then gradually disappesred during the subsequent 2 davs. A tentative dingnosis of cholecystitis was made. No specttic
therapy was given. in Figure 2.2 his white
blood cell and platelet counts in relation to the
uppearance of svmptoms are shown,
A female, age 35, developed generalized urtt-
earis, fever, and headache.
No cause for the
urficaria was found and the symptoms subsided
within & hours without any Cherapy.
AL individduaads in Groups Tand Ff that received antibiotics are listed in Table 2.1. Of
the individuals treated with antibiotics, only
the first three recerved itut atime when thetr
teutrophile count was low, These casen are