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Infections in children with malignant disease in Argentina
Insights
Infections frequently cause illness in children with cancer. Bacterial infections, particularly from Staphylococcus aureus, Escherichia coli, and Streptococcus pyogenes, are the most common cause of fever, with a low mortality rate when managed effectively.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Hematology
Background:
- Children with malignant diseases are susceptible to infections.
- Fever is a common complication in this patient population.
- Understanding the etiology of fever is crucial for effective management.
Purpose of the Study:
- To prospectively evaluate febrile episodes in children with malignant diseases.
- To identify the common causes and pathogens of infection.
- To assess the outcomes and mortality associated with febrile episodes.
Main Methods:
- Prospective evaluation of 102 febrile episodes in 68 children with various cancers over six months.
- Microbiologic (bacterial, viral, fungal) and clinical assessments were performed.
- Analysis of common diagnoses, causative agents, and treatment responses.
Main Results:
- Bacterial infections were the most frequent cause (71% etiologically documented), with Staphylococcus aureus, Escherichia coli, and Streptococcus pyogenes as primary isolates.
- Pneumonia, cellulitis, pharyngitis, and varicella were common diagnoses.
- Severe neutropenia occurred in 39.2% of cases; overall mortality was 7%.
Conclusions:
- Infections are a significant cause of morbidity in pediatric cancer patients.
- Bacterial infections, particularly by S. aureus, E. coli, and S. pyogenes, are predominant.
- Effective management leads to favorable outcomes with low mortality.
Abstract:
During six-month period, 102 consecutive episodes of fever in 68 children (ranging from 1 month to 14 years of age) with malignant diseases were prospectively evaluated. Sixty-five had acute lymphoblastic leukemia, nine had acute myeloblastic leukemia, nine had malignant lymphoma (four Hodgkin and five non-Hodgkin), five had chronic myeloid leukemia, four had rhabdomyosarcoma, three had CNS tumors, two had neuroblastoma, one had Wilms, and four had other malignant tumors. Forty cases (39.2%) showed severe neutropenia (500 neutrophil/m3) during the episode. S. aureus, E. coli, and S. pyogenes were in 53% of the 75 microbiologic isolates. Twenty-two percent of the viral studies were positive. Mycologic studies were all negative, except one case with C. Albicans. Pneumonia (33 cases), cellulitis (15 cases), pharyngitis (12 cases), and varicella (11 cases) were the most common final diagnosis. Seventy-one percent of the episodes were etiologically documented (by bacterial isolate, characteristic serology, and/or typical clinic picture); 19% of the febrile episodes were probable infections, and 10% were fever of uncertain cause. Ninety percent of the cases responded well to therapy, and mortality of this series was 7%. Gentamicin, Carbenicillin, and Methicilin were the more common antibiotics employed. We conclude that in our population 1) infection is a frequent cause of morbidity in children with malignant diseases; 2) the most common cause of the febrile episodes is bacterial infection; 3) S. aureus, E. coli and S. pyrogenes are the most frequent bacterial isolates, and P. aeruginosa is infrequent; 4)viral infections are relatively frequent in this group of children; and 5) with adequate management, the mortality is low.