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Infections in acute myeloid leukemia. Study of 184 febrile episodes
L Kumar1, V Kochupillai, R A Bhujwala
1Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi.
Abstract:
We analysed the case records of 75 patients with acute myeloid leukaemia treated at our institute from January 1984 to December 1988 to see the pattern and severity of infections and their relationship with granulocytopenia. A total of 184 febrile episodes (mean 2.45) were recorded; 153 (83.15%) were associated with granulocytopenia while 31 (16.84%) were without granulocytopenia. Among granulocytopenic patients, infections could be documented microbiologically in 58.2% and clinically in 30.0% of episodes. In the remaining 41.8% of episodes, no clinical, radiological or microbiological evidence could be found out. The various sites of infection were: septicaemia 21 (13.72%), disseminated fungal infections 4 (2.6%), upper respiratory tract 21 (13.7%), chest 58 (37.9%), gastrointestinal tract 8 (5.2%), genitourinary (7.2%), soft tissues 5 (3.2%) and skin cellulitis 7 (4.6%). Microbiologically, gram negative organisms (Klebsiella pneumoniae, E coli, Pseudomonas aeruginosa) were most common, followed by gram positive (Streptococcal faecalis, Staphylococcus aureus, Staph albus, Staph epidermidis). Four patients had disseminated fungal infection: candida 2, aspergillus *1, mucormycosis *1. Among non neutropenic febrile episodes, the sites infected were: septicemia 2 (6.4%), chest 9(29.0%), upper respiratory tract 1 (3.2%), gastrointestinal 1 (3.2%), soft tissue 1 (3.2%), drug fever 3 (9.6%) and fever of unknown origin 14 (45.2%).
Insights
Infections are common in acute myeloid leukemia (AML) patients, with most febrile episodes linked to granulocytopenia. Gram-negative bacteria were the most frequent cause of documented infections in these patients.
Area of Science:
- Hematology
- Infectious Diseases
- Oncology
Background:
- Acute myeloid leukemia (AML) patients often experience infections due to treatment-induced immunosuppression.
- Granulocytopenia is a significant risk factor for infection in AML.
- Understanding infection patterns is crucial for managing AML patients.
Purpose of the Study:
- To analyze the pattern and severity of infections in AML patients.
- To investigate the relationship between infections and granulocytopenia.
- To identify common pathogens and infection sites in this patient cohort.
Main Methods:
- Retrospective analysis of case records of 75 AML patients treated between 1984 and 1988.
- Detailed review of febrile episodes, documenting associated granulocytopenia, infection sites, and causative microorganisms.
- Categorization of infections based on clinical, radiological, and microbiological evidence.
Main Results:
- 184 febrile episodes were recorded, with 83.15% associated with granulocytopenia.
- The most common infection sites were the chest (37.9%) and upper respiratory tract (13.7%).
- Gram-negative organisms (Klebsiella pneumoniae, E. coli, Pseudomonas aeruginosa) were the predominant pathogens; disseminated fungal infections occurred in 4 patients.
Conclusions:
- Infections, particularly those associated with granulocytopenia, are a major complication in AML patients.
- Prompt identification and management of infections are essential for improving outcomes in AML.
- The study highlights the importance of monitoring for both bacterial and fungal infections in this vulnerable population.