Questions to cover in the history | What answers may indicate |
Age | |
Ethnicity | |
Infection history | |
Have they been admitted to hospital before? | Neonatal infections, previous admissions, previous need for antibiotics are features of SCN: 50% children with SCN have an infection as a neonate, and 90% have had an infection by 6 months. |
Have they required antibiotics before? | |
Have infections been severe or life-threatening? | |
How old were they when infections began? | |
Specific questions:
| |
If they have frequent infective symptoms, do these occur in any kind of cyclical pattern? | In cyclical neutropenia the cycle may range from 14 days to 36 days; typically 21 days. |
Growth and development | |
Have there been concerns about their growth? | May be present in any causes of SCN—lack of growth problems do not rule these out. |
Do they have fatty stools that are hard to flush? | Seen in Shwachman Diamond syndrome, Pearson syndrome. |
Are they fully immunised? | Children with frequent infections may have missed immunisation. |
Drug history | |
Are they on any medicines? | Always consider drug causes. |
Have they had any over-the-counter medicines or herbal or ‘natural’ remedies? | |
Family history | |
Does anyone in the family have recurrent infections, especially mouth ulcers? | Often seen in cyclical neutropenia. |
Has anyone else been found to be neutropenic? | Seen in familial neutropenia and in syndromic causes. |
Are there any autoimmune disorders in the family? | Not very specific, but seen more with autoimmune neutropenia. |
Social history | |
How many days of school/nursery are missed through infection? | This gives an idea of the burden of illness, and may be helpful to gauge indication for granulocyte colony stimulating factor treatment. |
SCN, severe chronic neutropenia.