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Alpha-streptococcal septicemia in leukemic children treated with continuous or large dosage intermittent cytosine
S V Sotiropoulos1, M A Jackson, G M Woods
1Section of Infectious Diseases, University of Missouri-Kansas City School of Medicine.
Insights
Children with acute nonlymphocytic leukemia receiving intensive chemotherapy, particularly cytosine arabinoside, face a heightened risk of alpha-hemolytic streptococcal sepsis. Early empiric antibiotics are crucial for febrile, neutropenic patients.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Hematology
Background:
- Acute nonlymphocytic leukemia (ANLL) treatment often involves intensive chemotherapy.
- Chemotherapy can lead to neutropenia and increased susceptibility to infections.
- Alpha-hemolytic streptococci are opportunistic pathogens.
Purpose of the Study:
- To investigate the incidence of alpha-hemolytic streptococcal sepsis in children with ANLL undergoing intensive chemotherapy.
- To identify potential risk factors and treatment associations for streptococcal sepsis in this population.
Main Methods:
- Retrospective analysis of sepsis episodes in pediatric ANLL patients over a 2-year period.
- Correlation of sepsis occurrences with specific chemotherapeutic agents and treatment timing.
- Review of clinical complications and potential entry points for infection.
Main Results:
- Alpha-hemolytic streptococci caused 75% of sepsis episodes, a significant increase from previous years.
- Most cases (14/15) occurred following cytosine arabinoside therapy.
- Complications included shock, encephalopathy, pneumonia, and death.
- Oral mucosal lesions were suggested as a potential portal of entry.
Conclusions:
- Children with ANLL treated with continuous or high-dose intermittent cytosine arabinoside are at increased risk for alpha-hemolytic streptococcal sepsis.
- Empiric antimicrobial therapy for febrile, neutropenic ANLL patients should cover alpha-hemolytic streptococci.
Abstract:
During a 2-year period after the introduction of an intensive chemotherapeutic protocol, alpha-hemolytic streptococci accounted for 75% of all episodes of sepsis among children with acute nonlymphocytic leukemia at our institution. Only one case had occurred in the previous 8 years. Fourteen of 15 episodes of streptococcal sepsis occurred after therapy with either continuous or large dosage intermittent cytosine arabinoside. Eleven episodes occurred at two specific treatment points. Septic episodes were complicated by shock (2 of 15), encephalopathy (2 of 15), pneumonia (3 of 15) and death (1 of 15). Oral mucosal lesions may provide a portal of entry for alpha-hemolytic streptococci. These data suggest that children receiving continuous or large dosage intermittent cytosine arabinoside for treatment of acute nonlymphocytic leukemia may be at increased risk for alpha-hemolytic streptococcal sepsis. Empiric antimicrobial therapy in these children when febrile and neutropenic should include antibiotics effective against alpha-hemolytic streptococci.