Table 2

Questions to cover in the history

Questions to cover in the historyWhat 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:

  • Umbilical stump infection

  • Recurrent mouth ulcers,

  • Recurrent respiratory infections,

  • Skin abscesses including perirectal abscesses

  • Meningitis.

 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.