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Development of an IFN-γ ELISpot Assay to Assess Varicella-Zoster Virus-specific Cell-mediated Immunity Following Umbilical Cord Blood Transplantation
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Viridans Group Streptococcal Infections in Children After Chemotherapy or Stem Cell Transplantation: A 10-year Review

Maryke J Nielsen1, Sarah Claxton, Barry Pizer

  • 1From the Department of Oncology, Alder Hey Children's NHS Foundation Trust (MJN, BP); Institute of Infection and Global Health, University of Liverpool (SC, EDC, SP); Institute of Translational Medicine, University of Liverpool (SL, BP); Department of Microbiology, Alder Hey Children's NHS Foundation Trust (RPDC); and Department of Infectious Diseases, Alder Hey Children's NHS Foundation Trust (SP, EDC), Liverpool, UK.

Medicine
|March 6, 2016
PubMed

Insights

Viridans Group Streptococci bacteremia in children with cancer is dangerous, especially in relapsed acute lymphoblastic leukemia. Further research is needed for better treatment strategies.

Area of Science:

  • Pediatric Hematology-Oncology
  • Infectious Diseases
  • Microbiology

Background:

  • Viridans Group Streptococci (VGS) infections carry high mortality in febrile neutropenia.
  • Recent European pediatric data on VGS bacteremia (VGSB) and antimicrobial therapy are lacking.
  • Children undergoing cancer treatment or hematopoietic stem cell transplant are at risk.

Purpose of the Study:

  • To characterize VGSB in pediatric patients undergoing malignancy treatment or stem cell transplant.
  • To describe outcomes and antimicrobial resistance patterns of VGSB.
  • To inform empirical antimicrobial therapy in febrile neutropenia.

Main Methods:

  • Retrospective study of patients aged 0–18 years with VGSB.
  • Data collected from medical records at a tertiary pediatric hemato-oncology center (2003–2013).
  • Analysis of VGS characteristics, patient outcomes, and antimicrobial susceptibility.

Main Results:

  • 54 bacteremic episodes in 46 patients; most common diagnosis was relapsed acute lymphoblastic leukemia.
  • Streptococcus mitis was the most frequent organism; 30% of isolates resistant to penicillin, 100% sensitive to vancomycin.
  • 8 episodes (14.8%) of Viridans Group Streptococcal Shock Syndrome occurred, with 3 deaths.

Conclusions:

  • VGSB is a potentially fatal condition in pediatric cancer patients.
  • Relapsed acute lymphoblastic leukemia poses a high risk.
  • Risk-stratification scores are needed to guide empirical antimicrobial therapy for VGSB.

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