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Infectious complications in children with acute lymphoblastic leukemia treated in low-middle-income countries
Miguela A Caniza1, Carla Odio, Sheena Mukkada
1a 1 Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA.
Insights
Infections are a major cause of death in children with acute lymphoblastic leukemia (ALL), especially in low- and middle-income countries (LMIC). This review offers practical strategies to prevent and manage infections in these vulnerable pediatric patients.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Global Health
Background:
- Infections represent the primary cause of morbidity and mortality in pediatric patients undergoing treatment for acute lymphoblastic leukemia (ALL).
- Infection-related mortality rates are significantly higher, up to tenfold, in low- and middle-income countries (LMIC) compared to high-income nations.
- Children with ALL in LMIC face heightened risks due to factors like malnutrition, prevalent community-acquired pathogens, nosocomial multidrug-resistant organisms, and opportunistic infections.
Purpose of the Study:
- To summarize the key challenges in managing major infection categories in children with ALL in LMIC.
- To provide updated, practical recommendations for the prevention and management of infectious complications in this population.
- To address the specific difficulties faced in LMIC, including resource limitations and infrastructure challenges.
Main Methods:
- This study is a review of existing literature and clinical guidelines.
- It synthesizes information on infection challenges and management strategies pertinent to pediatric ALL patients in resource-limited settings.
- The review focuses on practical, actionable recommendations.
Main Results:
- Managing infections in children with ALL in LMIC is complicated by socioeconomic factors, limited resources (personnel, diagnostics, supplies), and inadequate healthcare infrastructure.
- Children with ALL in LMIC are disproportionately affected by a range of pathogens, increasing their susceptibility to severe infections.
- The review consolidates current knowledge to offer a framework for improved infection control.
Conclusions:
- Effective prevention and management of infections are critical to reducing mortality in children with ALL, particularly in LMIC.
- Addressing the unique challenges in LMIC requires tailored strategies and resource optimization.
- Implementing practical recommendations can significantly improve outcomes for pediatric ALL patients facing infectious complications.
Abstract:
Infections are the most important cause of morbidity and mortality in children treated for acute lymphoblastic leukemia (ALL). The rates of infection-associated mortality are up to 10-times higher in low- and middle-income countries (LMIC) than in high-income countries. The prevention, early recognition and management of infectious complications is especially challenging in LMIC because of disease and poverty-related factors, as well as the shortage of trained personnel, supplies, diagnostic tools and adequate organizational infrastructure. Children in LMIC with ALL, who are frequently underweight, are at increased risk of community-acquired pathogens, nosocomial multidrug-resistant pathogens and opportunistic microorganisms. This review summarizes the challenges of managing the major categories of infections in children receiving treatment for ALL and provides updated practical recommendations for preventing and managing these infections in LMIC.
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