High-dose cytosine arabinoside and viridans streptococcus sepsis in children with leukemia

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.