Infección micótica profunda en niños con cáncer, neutropenia y fiebre, en Chile / Invasive fungal infections in children with cancer and febrile neutropenia, in Chile

Background: Invasive fungal infections (IFI) cause prolonged hospitalizations and increase the possibility of death among patients with cancer and febrile neutropenia (FN). Up to 10 percent of febrile neutropenic episodes may be caused by IFI. Aim: To estimate the incidence of IFI among a large group of Chilean children with cancer and FN. Patients and Methods: Clinical and laboratory information was collected from a data base provided by the "Programa Infantil Nacional de Drogas Antineoplásicas" (PINDA) that included 445 FN episodes occurring in five hospitals in Santiago, Chile. This information was used to identify children that presented with signs and symptoms compatible with an IFI. According to predefined criteria based on a literature review, IFI episodes were categorized as "proven", "probable" or "possible". Results: A total of 41/445 episodes (9.2 percent) were compatible with an IFI of which 4 (0.9 percent) were proven, 23 (5.2 percent) probable, and 14 (3.1 percent) possible. Hospitalization was longer (27 vs 8 days, p <.01), new infectious foci appeared with higher frequency (71 vs 38 percent, p <.01), and mortality was higher (10 vs 1.6 percent, p <.001) in children with IFI compatible episodes, when compared to children who did not have an IFI. Conclusions: The estimated incidence of IFI in Chilean children with cancer and FN ranged between 6-9 percent depending on the stringency of criteria selection used for classification. This estimate is similar to that reported by other studies. The low detection yield of clinically compatible IFI underscores the need of improved diagnosis of fungal infections in this population

Agentes causantes de infecciones del torrente circulatorio en niños con cáncer, en cinco hospitales de Santiago, 1994-1998 / Causative agents of bloodstream infections in Chilean pediatric patients with cancer

Background: Pediatric patients in treatment for cancer can have fatal bacterial infections. Thus, in the presence of fever or other signs infection, antimicrobials have to be prescribed empirically. Aim: To know the causative agents of bacteremia in children with cancer, their changes with time and between different hospitals and their patterns of susceptibility. Material and methods: We reviewed the blood cultores of children with cancer in five hospitals of Santiago, from 1994 at 1998. Results: During the study period, 707 agents were isolated. The most frequently isolated species or genus were coagulase negative Staphylococcus (43 percent), Staphylococcus aureus (16 percent), Escherichia coli (9 percent), Klebsiella spp. (8 percent), Pseudomonas spp. (5 percent) and Candida spp. (4 percent). Coagulase negative Staphylococcus was 55 percent resistant to meticilin and S. aureus was 44 percent resistant. Enterobacteriae had 15 percent resistance to gentamicin and amikacin, 2 percent to imipenem, 26 percent to ceftriaxone, 21 percent to cefotaxim and 20 percent to ceftazidim. Among non fermenting agents resistance was 6 percent for imipenem, 9 percent for amikacin 10 percent for ciprofloxacin, 19 percent for ceftazidim and 22 percent for cefoperazone. The resistance of Streptococcus spp. (non pneumoniae) to penicillin reached 50 percent and that of Enterococcus spp. was of 33 percent. Conclusions: Treatment for pediatric patients with cancer must be modified and new guidelines including more active medications for patients at risk for bacteremia, should be devised

Mejoría en el pronóstico de la leucemia linfoblástica aguda en niños de un país en desarrollo: resultados del protocolo nacional chileno PINDA 87 / Improved outcome for acute lymphoblastic leukemia in children of a developing country: results of the chilean national trial PINDA 87

Un grupo oncológico pediátrico nacional, PINDA, reporta el primer protocolo prospectivo, no randomizado, para tratamiento de la leucemia linfoblástica (LLA), usando una versión modificada del protocolo de Berlín-Frankfurt-Munster (LLA BFM 86). Los objetivos de este estudio fueron clasificar inmunofenotipos, disminuir radioterapia de cráneo y comprobar si este protocolo podía mejorar la sobrevida de nuestros pacientes. Procedimiento: desde junio 1987 a junio 1992 se registraron 444 pacientes, no seleccionados; de ellos 425 fueron evaluables. La terapia fue estratificada según riesgo: riesgo bajo (RB), riesgo alto (RA) y riesgo muy alto (RMA). Los pacientes en RB y RA recibieron inducción con protocolo I, consolidación con protocolo M (RMA usó protocolo E), reinducción con protocolo II y mantención. Todos recibieron tratamiento de prefase con prednisona oral y metotrexato (MTX) intratecal. Radioterapia de cráneo solo en RA y RMA (12-18 Gy). Los siguientes cambios se introdujeron al protocolo LLA BFM 86: en protocolo M 1 g/m² en vez de 5 g/m²; en protocolo E, 1 g/m² de citarabina en vez de 2 g/m², la mitoxantrona e ifosfamida fueron sustituidas por teniposido y ciclofosfamida. Resultados: inmunofenotipo: LLA común 67,4 por ciento, LLA proB 14 por ciento, LLA T 10 por ciento, LLA preB 4,3 por ciento. La frecuencia de sobrevida libre de eventos (SLE) global a 5 años fue 60 por ciento ñ 2 por ciento error standard; según riesgo fue: RB 75 por ciento, RA 62 por ciento, RMA 28 por ciento con una mediana de seguimiento de 6,5 años (rango 4,5 - 9,5 años). La incidencia acumulada de recaída en sistema nervioso central SNC fue 5,4 por ciento. Conclusión: hemos tenido éxito en realizar un estudio a nivel nacional. Nuestra estrategia para adaptar el protocolo BFM fue efectiva para mejorar la SLE. La distribución por fenotipos es similar a otras series

Infecciones asociadas al uso de catéteres totalmente implantables en niños con cáncer / Infections associated to the use of indwelling catheter in children with cancer

Los catéteres venoso totalmente implantables (CVTI) presentan ventajas operacionales y menos infecciones que los de acceso externo, por lo que serían preferibles en condiciones de pobreza o ruralidad. Nuestro objetivo fue analizar los episodios febriles (EF) asociados a su uso, en pacientes oncológicos de bajos recursos. Registros clínicos de 30 pacientes pedíatricos a quienes se les implantó un CVTI entre mayo de 1992 y junio de 1994. Se consideró bacteremia relacionada con el catéter (BRC) aquella con hemocultivo central positivo, o infección local y hemocultivo central o periférico positivo. La bacteremia, y especial la BRC, es la causa más importante de los episodios febriles en esta serie, lo que hace necesario el uso inicial de esquemas antimicrobianos de amplio espectro en estos pacientes, independientemente del recuento granulocitario. Gran parte de estos episodios pueden ser tratados con el dispositivo in situ, especialmente si el agente es Staphylococcus coagulasa negativa

Estudios citogenéticos en niños chilenos con leucemia linfoblástica aguda / Cytogenetic studies in chilean children with acute lymphoblastic leukemia

Acute lymphoblastic leukemia (ALL) is the most frequent childhood cancer. The leukemic cells of ALL patients show several well defined numeric and structural chromosomal abnormalities which are universally known for its prognostic implications. We studied a group of 44 children with ALL, to investigate the incidence of chromosome aberrations in ALL, its lymphocyte lineage and some clinical feature associations, ans the finding of non previously described aberrations. A high proportion of patients (79.5 per cent) showed chromosomal abnormalities. Most of them had a pseudodiploid karyotype (46 chromosomes), characterized mainly by a translocation. In relation to chromosome number, 27 percent of them were hyperdiploid with more than 50; 9 percent hyperdiploid between 47 - 50 and 7 percent hypodiploid (less than 46). Among structural aberrations found, were the following recurrent translocations: t(1;19), t(4;11), t(9;22) in 6.8 percent, 9.1 percent and 2.3 percent of cases respectively, all related to an early B immunophenotype. Other translocations found, compromised regions 7q22,9p21 -24. Two new translocations in ALL were found: 8(1;5)(q23;q33), apparently balanced and t(13;21)(q14;q22), unbalanced. Other recurrent structural changes found were: deletion (6q), (7q), (7q), (11q), (12q), inversion (3q), isochromosome (7q), maker chromosomes and double minutes. The distribution of chromosome abnormalities in this group of patients was in agreement with previous reports from other investigators

La anemia de la glomerulonefritis aguda post-estreptocócica / Anemia associated to acute post streptococcal glomerulonephritis

Thirty-three children with post-streptococcal acute glomerulonephritis, age x:8.3 years (range 6-12) were studied prospectively. Mean initial hematocrit (Hct) was 31.6 percent with 90 percent showing Hct under the normal lower limit for this age group. Reticulocyte index (RI) was <0.5 in half of the cases. Serum iron concentration, total iron binding capacity (TIBC) and percentaje of transferrin saturation were normal for this age group although 75 percent of the children had increased serum ferritin levels. At the time of discharge, Hct increased to 35.1 percent but 44 percent still had anemia. Hct increased spontaneously for 105 days stabilizing at 38 percent. Based on Hct changes, 3 groups were defined: Group I (3 individuals): normal upon discharge; Group II (19): partial recovery at discharge, slow recovery stabilizing after 105 days; Group III (11): lower Hct, slower recovery but with RI significantly higher than group II (0.96 vs 0.45 p<0.01). Our data suggest that although hemodilution is present in all, it may be considered the solely factor only in 3 cases (Group I). In group II, evidence of bone marrow depression was indicated by the low RI. On the other hand, the intense anemia that could not be justified only by hemodilution and marrow depression in group II, suggest other pathogenic factors