Viral Infections In Children Receiving Anticancer Chemotherapy

OBJECTIVE: To determine the presence of bacterial and viral infectious agents in children with fever during anticancer chemotherapy. DESIGN: Analysis of data obtained during a prospective cohort study. SETTING: The pediatric oncology unit of Tygerberg Children's Hospital; Cape Town. SUBJECTS: All patients up to the age of 15 years who deve- loped fever secondary to anticancer chemotherapy from February 9th 2000 to April 9th 2001. OUTCOME MEASURES: Viruses were isolated or antigens detected on venous blood samples; nasopharyngeal aspirates; throat swabs; urine and feces where possible. Blood for aerobic and anaerobic culture was obtained from an indwelling intravenous catheter and/or a peripheral vein. RESULTS: Thirty-four children were analyzed for a total of 102 febrile episodes. The absolute neutrophil count on admission was below 0.5*109/L in 57 (56) episodes and thus considered neutropenic. Thirty-five viral isolates were identified in 31 (30) febrile episodes: HSV-1 (n=14); HSV-2 (n=2); CMV (n=10); rotavirus (n=5); adenovirus (n=2); Para influenza type 3 (n=1) and hepatitis B (n=1). The blood culture was positive in 24 (24) febrile episodes. Within these; a combined viral and bacterial infection was demonstrated in 6 (6) episodes. Infections were more frequent in neutropenic compared to non-neutropenic episodes; however; this was not significant. CONCLUSIONS: Viral infections clearly are an important cause of fever in children receiving anticancer therapy and may occur together with a bacterial infection. Diagnostic tests for viral infections should be used more frequently and could be of considerable value in evaluating fever and establishing appropriate treatment in these patients

A Survey of the Management of Thrombocytopaenic Purpura in South Africa : do you need Guidelines for Developing Countries ?

AIM: To describe the management of idiopathic thrombocytopenic purpura (ITP) in South Africa. METHODS: A prospective survey was sent to 410 doctors in the country; including 4 different scenarios in children newly diagnosed with ITP; concerning the diagnosis and management. RESULTS: Steroids were the first line of choice in treating ITP. Anti-D immunoglobulin was not considered in the management and most of the practitioners would perform a bone marrow aspiration even if no treatment with steroids will be given. The vast majority of the patients will be treated in the hospital. CONCLUSIONS: This study is the first study done in South Africa (and in Africa) and it shows a great variation in the management practice of children with newly diagnosed ITP. Prospective studies in developing countries where various constraints to health care delivery exist are required to produce evidence based recommendations for this patient group