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Streptococcus mitis septicemia in leukemia patients; clinical features and outcome
Abstract:
The frequency of streptococcal infections has been reported to be increasing. To determine the significance of such infections complicating treatment of leukemia, we studied the incidence and clinical features of Streptococcus mitis septicemia among 51 leukemia patients in our department. During 166 consecutive treatment courses for leukemia, eight episodes of Streptococcus mitis septicemia were observed in 35 septicemic patients. In seven out of eight episodes (88%), severe mucositis developed after aggressive chemotherapy, suggesting that oral mucosa might be the site of entry for Streptococcus mitis. The isolates were sensitive to imipenam/cilastatin and cefuzonam, and were relatively resistant to amikacin. Although none of the patients died of Streptococcus mitis septicemia, life-threatening adult respiratory distress syndrome (ARDS) developed in two independent treatment courses. We should thus be aware of the risk of ARDS in patients with Streptococcus mitis septicemia.
Insights
Streptococcus mitis septicemia is an emerging risk for leukemia patients, often linked to chemotherapy-induced mucositis. Awareness of potential adult respiratory distress syndrome (ARDS) is crucial for patient management.
Area of Science:
- Infectious Diseases
- Hematology
- Oncology
Background:
- Increasing incidence of streptococcal infections noted.
- Leukemia treatment carries risks of complications from infections.
- Streptococcus mitis septicemia is a specific concern in immunocompromised patients.
Purpose of the Study:
- To investigate the incidence and clinical characteristics of Streptococcus mitis septicemia in leukemia patients.
- To identify potential entry sites and risk factors for Streptococcus mitis septicemia during leukemia treatment.
- To assess the clinical outcomes and antibiotic sensitivities associated with Streptococcus mitis septicemia.
Main Methods:
- Prospective study of 51 leukemia patients undergoing 166 treatment courses.
- Observation and documentation of Streptococcus mitis septicemia episodes.
- Analysis of clinical features, including mucositis and adult respiratory distress syndrome (ARDS).
- Antimicrobial susceptibility testing of Streptococcus mitis isolates.
Main Results:
- Eight episodes of Streptococcus mitis septicemia occurred in 35 septicemic patients.
- Severe mucositis preceded 88% of septicemia episodes, suggesting oral mucosa as an entry point.
- Isolates showed sensitivity to imipenem/cilastatin and cefuzonam, with relative resistance to amikacin.
- No deaths directly attributed to Streptococcus mitis septicemia, but two cases of ARDS developed.
Conclusions:
- Streptococcus mitis septicemia is a significant complication in leukemia patients, particularly following aggressive chemotherapy.
- Severe mucositis is a likely precursor, highlighting the importance of oral care.
- Clinicians must be vigilant for the risk of life-threatening adult respiratory distress syndrome (ARDS) in these patients.