will white blood cell count rise with local infection?

[applicant2002]

There a case study of a pregnany diabetic (type1) patient who has an elevation in WBC's (13,000 around). She also has frequent persistant candidal yeast vaginal infections, and also has condylomata accuminatans(sp?) due to HPV. Those are both local infections.

Would a local vaginal yeast infection cause a systemic rise in the WBC count? Would infection by HPV strains 6 or 11 causig condylomata cause a systemic rise in WBC count? Does it depend on the severity of the infection?

I looking either for the answer, or a source to look for for the answer.

I'm not sure if this is the right forum to post this question in either.

All responses are greatly appreciated.

Thanks for your help.

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[PACtoDOC]

My guess is that you are not a medical student, but all the same, the info you are looking for is easy to find in any medical textbook. Here are some starting points. First, see if you can determine in your reading whether 13,000 WBC count is always indicatative of being abnormal? It might not be Next, HPV is a viral pathogen, which is chronic, so would you really expect the WBC count to be changed? Maybe not If the patient is a type I diabetic, why are they more prone to developing vaginal yeast infections? And do you think this would alter the WBC as well? It could, but it might not

Start with the normal reference range for WBC counts
Then look up lab counts associated with viral and fungal infections

 

[applicant2002]

Dear PACtoDOC,

First, thanks for taking the time and trouble to answer (somewhat) my question.
I am actually a medical student, FYI. I don?t know what you keep assuming I am.

According to the lab that this bloodwork was done this was an elevated WBC. normal was 4800-10,800. To answer your question about normal WBC count, it is generally in this range, but it varies with different labs.

The white blood count is normally elevated in pregnancy, and rises progressively throughout pregnancy. In the third trimester, according to Gabbe:Obstetrics-Normal and Problem Pregnancies, 4th edition, the normal range is 5600-12,200. This patient is still slightly elevated beyond that. I don?t know at what point you can attribute that to normal variation. I?m haven?t developed enough of a clinical sense to judge.

Second, your point about HPV. According what I?ve read, viruses can cause leukocytosis, esp. lymphocytosis. This patient?s differentials included a low percentage of monocytes and lymphocytes. So that doesn?t really match.
I don?t know if I would expect the WBC count to be changed in a chronic viral infection. Should I?

But my initial question was this:

The HPV strains that cause condylomata are harbored in the epithelial cells, so wherever the condylomata are, that?s where the HPV is (I think). So my question is, this would be a local infection, right? That would trigger a local response, but would that cause a systemic elevation in wbc count?

That?s also my question about the candida. Would a local infection of fungal candida be enough to elevate the systemic WBC count?

To your question about why type 1 diabetics are more prone to developing vaginal yeast infections, it?s because of several factors, including increased blood sugar being a friendly environment for the Candida to grow in, increased AGE?s binding to leukocyte receptors, rendering the leukocytes more ineffective. That wouldn?t cause an increase in WBC?s to the best of my knowledge. Would it?

Also, since you seem to be knowledgeable about these topics, why does pregnancy and oral contraceptives cause people to be more prone to vaginal candida infections? What would be that mechanisms?

Thanks for your time and trouble.

P.S. If the answers to my questions can easily be found in any textbook, could you guide me as to what chapter of what textbook. Because I am at a loss as to where to look. Can I find it on a book on MD consult? Or a basic science text? What search terms should I use? All the sections I?ve read about candididis don?t mention CBC, and granted, I haven?t looked at HPV as much as I should have, but in the reading I came across about condylomata, it didn?t mention elevation in WBC?s.

 

[DocWagner]

Her count is 13,000? Without a fever or other signs/symptoms of infection...I would attribute the number to pregnancy and nothing else.
I have discharged patients (not pregnant) with counts of 13k without batting an eye.

 

[Castro Viejo]

But how did this become a patient who was pregnant?

And, for what it's worth, I agree with Dr. Wagner. If this patient has nothing but an elevated white count, no other associated symptoms, then I wouldn't worry so much about it. If she is pregnant then it can be very likely due to the pregnancy itself, as you pointed out.

How about more about the patient and her history (other than the HPV infection and vaginal candidiasis)?

 

[applicant2002]

History: 21 yo w female who is 34 weeks pregnant and comes in for evaluation/treatment till delivery. Compaints: tiredness, weakness. Moved here 3 weeks ago. Been with boyfriend for 3 years, been trying to get pregnant for three years. Has had 2 misscarriages previously. diabetes since age 7. sexual history: currently only relations with boyfriend, before this relationship, she had other relationships. smokes pck/day and has for 4 years. relatively well controlled diabetic but not been optimally controlled for pregnancy. social drinker: 3-4 drinks/wk. used to be more than that, but cut down b/c she was pregnant. tried to quit smoking but not been able to.

Her blood pressure when she began pregnancy was 140/86. then it lowered throughout pregnancy until around week 24, when it began to climb and it was around 140/86 again. currently, this is her blood pressure.

significant physical findings
ht murmur, mid systolic gradeII ejection murmur
2+ edema, pitting
chieolosis (sp?)
the physician's estimate was that the babe's around 7lbs, so pretty big already (macrosomia)

significant tests

2+ protienuria in urine

normal platelet count.

there were irregularities in her labwork consistent with pregnancy, though (physiologic anemia, i don't have it right in front of me or I would list it).

have not got blood smear yet(to check for hemolysis), will get that next class. also ultrasound will come next class period.

the 2+protien in her urine makes you start thinking preeclampsia. i don't the the 2+protien in her urine is because of just advanced diabetes, because she had no retinopathy, so the diabetes would probably not cause that much damage.

So the main clinical suspicion right now is that she is mildly preeclamptic. If her blood volume was decreased, that would explain mild leukocytosis, but it wouldn't explain why here monocytes and lymphocytes were low on the percentage count. (but it wasn't major, so I'm beginning to think that this leukocytosis is becuase of volume depletion). But none of her other lab values really suggest this at all. So that's a little confusing.


what also quite distressing is that this patient has all the risk factors for birth defects: smoking, drinking, apparent B vitamin deficiency (chieloisis), diabetes, not optimally controlled. I don't know what the ultrasound will show.

THis patient also has not had consistent medical care. She was seen around 3 months ago, and was upped on her insulin dose to adjust for the insulin resistance that is a normal part of prengancy. She is also on prenatal vitamins.


So from all your responses, I can conclude that local yeast infections will not generally cause a systemic elevation in WBC?

 

[Castro Viejo]

I don't believe yeast infections routinely produce an elevated white count, and her white count of 13,000 isn't terribly high anyway. It's not really clinically significant, and this is assuming that she's afebrile, and probably due to the pregnancy itself. Volume depletion would be reflected in a change in the platelet count as well, and since the platelet count was "normal" I think volume depletion is an incorrect assumption.

As for the 2+ proteinuria and its relation to diabetes, diabetes just doesn't produce a 2+ proteinuria in a 21 y/o type 1 diabetic who's "relatively well-controlled." I think most diabetics will have microalbuminuria, but not 2+ proteinuria. It is one of the criteria for preeclampsia, and her BP approaching the 140/90 cutoff for "mild" preeclampsia is troubling. But then her BP before pregnancy was 140/86, and for chronic hypertensives there's different criteria for establishing preeclampsia (like >30mm Hg SBP and >15mm Hg DBP over the baseline BP I believe).

Oh well... That's the best I can do with several beers in me. To summarize the white count isn't really troubling. Focus in on that BP and possible preeclampsia. Break out the mag-sulfate and bring the BP down. Any OBs on the board care to comment?

 

[DancingFajitas]

Hi, I saw your post on one of the other forums. I was just wondering, does an elevated WBC count indicate systemic infection or local infection or both? My question was involving a patient with an elevated WBC count and inc neutrophils, so I was assuming it is a bacterial infection likely from a superficial skin infection, but I was wondering, am I missing anything else like a more serious infection? And if so, how can I tell? Thanks

 

[J-Rad]

I'm guessing somewhere in this case it will be very important to get an HIV test.