Related Experiment Videos
High-dose cytosine arabinoside and viridans streptococcus sepsis in children with leukemia
F Rossetti1, S Cesaro, M C Putti
1Department of Pediatrics, Centro Leucemie Infantili, Padova, Italy.
Insights
Fulminant sepsis from viridans streptococci can be fatal in children with leukemia receiving high-dose cytosine arabinoside (Ara-C). Prompt treatment with glycopeptide antibiotics alongside standard therapy can reduce mortality in neutropenic patients.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Hematology
Background:
- High-dose cytosine arabinoside (Ara-C) therapy for leukemia can cause oropharyngeal mucositis.
- This mucositis creates an entry point for viridans streptococci into the bloodstream.
- Prophylactic antibiotic regimens targeting gram-negative bacteria may inadvertently increase the risk of gram-positive infections.
Observation:
- Three cases of fulminant sepsis caused by viridans streptococci are reported in leukemic children undergoing high-dose Ara-C treatment.
- Patients presented with severe neutropenia and oropharyngeal mucositis.
- These infections led to fatal outcomes in the observed cases.
Findings:
- Viridans streptococci sepsis is a significant risk in neutropenic children treated with high-dose Ara-C, particularly with mucositis.
- Early recognition and aggressive antibiotic intervention are crucial for managing this life-threatening condition.
- Adding a glycopeptide antibiotic to standard beta-lactam and aminoglycoside therapy may improve survival rates.
Implications:
- Healthcare providers should consider viridans streptococci as a potential pathogen in febrile neutropenic patients, especially those with mucositis.
- Prophylactic strategies may need re-evaluation to balance gram-negative and gram-positive bacterial coverage.
- Implementing a policy of adding anti-gram-positive antibiotics to empiric fever treatment in high-risk patients is recommended to decrease sepsis-related mortality.
Abstract:
We report three cases of fulminant sepsis due to viridans streptococci in leukemic children treated with high-dose cytosine arabinoside (Ara-C). The major predisposing factors to this occurrence are the presence of oropharingeal mucositis, which is the entry of streptococci into the bloodstream, and the use of antibiotic prophylactic regimens against gram-negative bacteria. In order to avoid fatal events during viridans streptococci sepsis, specific measures such as penicillin prophylaxis or early antibiotic treatment are needed. We suggest that the prompt empiric use of a glycopeptide antibiotic in addition to the conventional association of a beta-lactam plus an aminoglycoside may significantly decrease the mortality rate due to fulminant streptococci sepsis while the patient is severely neutropenic. In this regard, our current policy considers the addition of an anti-gram-positive antibiotic to the first-choice fever treatment in neutropenic patients who have received high-dose Ara-C.