Table III.
Winthrop-University Hospital Infectious Disease Division's H1N1 pneumonia weighted diagnostic point score system for hospitalized in adults with ILIs, fever >102°F, negative RIDTs and a CXR with no focal/segmental lobar infiltrates
| Clinical Features | Point Scores | Swine Influenza (H1N1) Laboratory Diagnosed | Swine Influenza (H1N1) Clinically Diagnosed | ILIs not swine influenza (H1N1) | CMV CAP | Q Fever CAP | Legionella CAP |
|---|---|---|---|---|---|---|---|
| • Severe myalgias | +5 | +5 | +5 | 0 | 0 | 0 | 0 |
| • Relative lymphopenia (otherwise unexplained⁎) | +5 | +5 | +5 | 0 | +5 | +5 | +5 |
| • Elevated CPKs (otherwise unexplained) | +5 | +5 | +5 | 0 | 0 | 0 | +5 |
| • Elevated serum transaminases (SGOT/SGPT) | +2 | +2 | +2 | 0 | +2 | +2 | +2 |
| • Thrombocytopenia (otherwise unexplained) | +2 | +2 | +2 | 0 | +2 | +2 | 0 |
| Argues against diagnosis of (H1N1) pneumonia: | |||||||
| • Relative bradycardia (otherwise unexplained) | −5 | 0 | 0 | 0 | 0 | 0 | 0 |
| • Leukopenia alone (otherwise unexplained) | −2 | 0 | 0 | 0 | 0 | 0 | 0 |
| • Atypical lymphocytes | −1 | 0 | 0 | 0 | 0 | 0 | 0 |
| • Highly elevated serum ferritin levels (> 2 x n) | −5 | 0 | 0 | 0 | 0 | 0 | 0 |
| • Hypophosphatemia | −3 | 0 | 0 | 0 | 0 | 0 | 0 |
| Swine influenza H1N1 Point Score Total: | Total Points | 19 | 19 | 0 | 9 | 9 | 12 |
| Probable H1N1 pneumonia > 15 Possible H1N1 pneumonia 10–15 Unlikely H1N1 pneumonia < 10 | |||||||
Other causes of relative lymphopenia include infectious causes, i.e., CMV, HHV-6, HHV-8, HIV, miliary TB, legionella, typhoid fever, Q fever, brucellosis, SARS, malaria, babesiosis, influenza, avian influenza, RMSF, histoplasmosis, dengue fever, chikungunya fever, ehrlichiosis, parvovirus B19, HPS, WNE, and viral hepatitis (early); and noninfectious causes, i.e., cytoxic drugs, steroids, sarcoidosis, SLE, lymphoma, RA, radiation therapy , Wiskott-Aldrich syndrome, Whipple's disease, severe combine immunodeficiency disease, common variable immune deficiency, Di George syndrome, Nezelof syndrome, intestinal lymphgiectasia, constrictive pericarditis, tricuspid regurgitation, Kawasaki's disease, idiopathic CD4 cytopenia, Wegener's granulomatosis, acute/chronic renal failure, hemodialysis, myasthenia gravis, celiac disease, alcoholic cirrhosis, coronary bypass, CHF, acute pancreatitis, and carcinomas (terminal).