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An outbreak of pneumocystis pneumonia in children with acute lymphocytic leukemia
Insights
A 1975 outbreak of pneumocystis pneumonia in children with acute lymphocytic leukemia (ALL) was linked to intense chemotherapy. Hospital staff showed higher antibody levels, suggesting pneumocystis transmission within the hospital.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Epidemiology
Background:
- Pneumocystis pneumonia is a serious opportunistic infection.
- Children undergoing chemotherapy for acute lymphocytic leukemia (ALL) are particularly vulnerable.
Purpose of the Study:
- To investigate a cluster of pneumocystis pneumonia cases in pediatric ALL patients.
- To identify potential risk factors and transmission routes for the infection.
Main Methods:
- Retrospective analysis of ten pediatric cases of pneumocystis pneumonia.
- Correlation of infection onset with chemotherapy intensity and timing.
- Serological testing (indirect immunofluorescence) for antipneumocystis antibodies in patients, staff, and parents.
Main Results:
- A cluster of ten cases occurred between January and October 1975.
- Infection risk correlated with chemotherapy intensity.
- Most cases developed 30-100 days post-therapy initiation, indicating a window of susceptibility.
- Elevated antipneumocystis antibody titers were found in 7/12 close-contact hospital staff, versus 2/22 other staff and 0/8 parents (P = .004 and P = .01, respectively).
Conclusions:
- Chemotherapy intensity is a risk factor for pneumocystis pneumonia in pediatric ALL.
- A specific period (30-100 days post-therapy) presents heightened susceptibility.
- Hospital staff may play a role in pneumocystis transmission within the healthcare setting.
Abstract:
Between Jan 1 and Oct 31, 1975, a cluster of ten cases of pneumocystis pneumonia occurred in children with acute lymphocytic leukemia (ALL) at the James Whitcomb Riley Hospital for Children in Indianapolis. The risk of infection appeared to be related to the intensity of chemotherapy. Furthermore, illness developed in nine of the ten patients between 30 and 100 days after initiation of therapy, suggesting a period of heightened susceptibility to infection. An indirect immunofluorescent test was used to detect antipneumocystis antibodies in serum samples collected from patients with pneumocystis pneumonia and their contacts. Members of the Riley Hospital staff who had close contact with infected children had a higher prevalence of elevated antibody titers (7/12) than other staff members (2/22; P = .004) or parents of infected patients (0/8; P = .01). This suggests that transmission of pneumocystis may occur within the hospital environment.