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Pulmonary Infectious Complications in Children with Hematologic Malignancies and Chemotherapy-Induced Neutropenia
Aikaterini Voulgaridou1, Kleoniki I Athanasiadou2, Eftychia Athanasiadou3
1Department of Pediatrics, General Hospital of Kavala, Agios Syllas, GR-655 00 Kavala, Greece.
Insights
Febrile neutropenia (FN) in children with cancer is a common cause of hospitalization. Prompt evaluation and empirical antimicrobial treatment are crucial for managing respiratory infections, even without obvious symptoms.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Hematology
Background:
- Infections are a significant complication for children undergoing chemotherapy for hematologic malignancies.
- Febrile neutropenia (FN) frequently leads to hospital admissions in this vulnerable population.
- Respiratory tract infections are common, often presenting subtly due to an impaired inflammatory response.
Purpose of the Study:
- To outline the diagnostic and management strategies for pulmonary infections in children with hematologic malignancies and FN.
- To emphasize the importance of early and appropriate antimicrobial therapy.
- To discuss advanced diagnostic procedures and factors influencing mortality.
Main Methods:
- Initial evaluation includes detailed history, clinical examination, basic laboratory tests, and chest radiography.
- Risk stratification guides the choice of empirical antimicrobial treatment.
- Invasive procedures like bronchoalveolar lavage (BAL) or lung biopsy are considered for unresponsive cases.
Main Results:
- Empirical antimicrobial treatment is effective for most patients.
- High-risk children require specific intravenous antipseudomonal beta-lactam agents or antibiotic combinations for suspected multi-drug resistance.
- Mortality can reach 20%, particularly in cases unresponsive to initial therapy or requiring mechanical ventilation.
Conclusions:
- Early recognition and prompt, risk-stratified antimicrobial therapy are vital for managing pulmonary infections in pediatric cancer patients with FN.
- Advanced diagnostic tools are necessary for complex or refractory cases.
- Effective management can reduce the significant mortality associated with these infections.
Abstract:
Infections frequently complicate the treatment course in children with hematologic malignancies undergoing chemotherapy. Febrile neutropenia (FN) remains a major cause of hospital admissions in this population, and respiratory tract is often proven to be the site of infection even without respiratory signs and symptoms. Clinical presentation may be subtle due to impaired inflammatory response. Common respiratory viruses and bacteria are widely identified in these patients, while fungi and, less commonly, bacteria are the causative agents in more severe cases. A detailed history, thorough clinical and basic laboratory examination along with a chest radiograph are the first steps in the evaluation of a child presenting signs of a pulmonary infection. After stratifying patient's risk, prompt initiation of the appropriate empirical antimicrobial treatment is crucial and efficient for the majority of the patients. High-risk children should be treated with an intravenous antipseudomonal beta lactam agent, unless there is suspicion of multi-drug resistance when an antibiotic combination should be used. In unresponsive cases, more invasive procedures, including bronchoalveolar lavage (BAL), computed tomography (CT)-guided fine-needle aspiration or open lung biopsy (OLB), are recommended. Overall mortality rate can reach 20% with higher rates seen in cases unresponsive to initial therapy and those under mechanical ventilation.
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