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Frequency and Clinical Outcomes of Respiratory Infections in Children with Cancer Presenting with Febrile Illness
Arathi Srinivasan1, Ramya Manur Sekar2, Sara Chandy2
1Department of Pediatric Hemato-oncology, Kanchi Kamakoti CHILDS Trust Hospital (KKCTH), Nungambakkam, Chennai, Tamil Nadu, India.
Insights
Fever in pediatric cancer patients often lacks a clear source, with respiratory pathogens identified in 70% of cases. Molecular diagnostics can improve fever management and reduce unnecessary antibiotic use in these vulnerable children.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Molecular Diagnostics
Background:
- Fever is a common complication in pediatric cancer patients undergoing chemotherapy.
- Prompt antibiotic treatment is crucial, but fever sources remain unidentified in many cases.
- Molecular diagnostics offer potential for improved management and reduced antibiotic overuse.
Purpose of the Study:
- To evaluate the pathogenic etiology of febrile episodes in pediatric cancer patients.
- To analyze the clinical characteristics and outcomes of these febrile episodes.
- To assess the utility of molecular diagnostics in identifying fever sources.
Main Methods:
- Prospective observational study conducted from January 2019 to March 2020.
- Inclusion of pediatric cancer patients experiencing febrile episodes with or without neutropenia.
- Utilized nasopharyngeal swabs for pathogen detection.
Main Results:
- Forty febrile episodes were analyzed in 27 patients (mean age 5 years).
- Respiratory pathogens were detected in 70% of afebrile episodes without a clear focus.
- Rhinovirus was the most common isolate, followed by Streptococcus pneumoniae.
Conclusions:
- Respiratory pathogens are frequently identified in febrile episodes without a focus in pediatric cancer patients.
- Molecular diagnostics enhance sensitivity for pathogen detection.
- Individualized management of febrile illness in these children is facilitated by advanced diagnostics.
Objectives:
Fever is a known complication in pediatric cancer patients when on chemotherapy for which prompt initiation of empiric antibiotics is the single most important life-saving intervention. Nearly two-thirds of all children are treated without identifying the source of fever. Molecular diagnostics can improve management of febrile episodes and reduce unnecessary antibiotic use. The purpose of our study was to evaluate the pathogenic etiology of febrile episodes and analyze their clinical characteristics.
Materials And Methods:
We conducted a prospective observational study at our tertiary care institution from January 2019 to March 2020, to identify the etiology of febrile episodes with or without neutropenia in pediatric cancer patients and to study their clinical outcomes.
Results:
Forty febrile episodes were observed among 27 patients over a period of 15 months. The mean age group was 5 years. In 28 febrile episodes without a focus (70%), a respiratory organism (virus, bacteria, or coinfection) was detected. Rhinovirus was the most common single respiratory isolate (47.36%), followed by Streptococcus pneumoniae (21.05%) and six episodes had multiple viral isolates (21.42%). There was no prolonged hospitalization, need for intensive care unit or oxygen requirement, or mortality. The most common antibiotic used in empiric management was piperacillin-tazobactam. Aminoglycosides were added when there was a clinical suspicion of resistant organism.
Conclusion:
Around 70% of febrile episodes without a focus or documented infection in cancer children had a respiratory pathogen identified in nasopharyngeal swab. Molecular diagnostics greatly enhances diagnostic sensitivity and thereby individualizes the management of febrile illness in these children.
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