Diarrhea in neutropenic children with cancer: an Egyptian center experience, with emphasis on neutropenic enterocolitis

ABSTRACT

Diarrhea is a frequent complication in patients with cancer. It may be caused by several factors including conventional gastrointestinal pathogens, suppression of normal intestinal flora as well as noninfectious causes such as mucositis and bowel ischemia, with neutropenic enterocolitis [NE] being the most serious. To study diarrhea in neutropenic cancer patients in the pediatric age group, with its underlying etiologies and risk factors especially the bacterial causes with special concern on NE. The study was carried out at the Pediatric Hematology and Oncology Units, Zagazig University Hospitals, Egypt, from Januray 2009 to September 2010. Neutropenic cancer patients who developed diarrhea were grouped into 2 groups group [1], with NE, and group [2], with neutropenic diarrhea rather than NE, On the first day of diarrhea, patients were subjected to complete blood count, blood cultures [if febrile], stool microscopy [for red and white blood cells, ova and parasites], and stool culture [for specific pathogens]. Abdominal ultrasonography was carriad out within 3 days of the onset of diarrhea. A total of 200 children malignancies with a total of 180 neutropenic episodes were followed. Diarrhea was observed in 100 episodes [55.5%], NE constituted 16% of these diarrheal episodes. Acute lymphoblastic leukemia was the most prevalent in neutropenic cancer patients with diarrhea [66.7%], while acute myeloid leukemia dominated in patients with NE [50%]. Most of diarrheal episodes occurred during the induction phase of chemotherapy [42%]. All patients with NE had significantly more severe neutropenia and of longer duration than the other group. All patients with NE were febrile with 100% positive blood culture, while only 38% of the other group was febrile of which only 37.5%, had positive blood culture. Stool analysis diagnosed giardiasis in 4.8% of non NE patients while stool culture was positive in 75% of NE patients compared to 40.5% of the other group with Klebsiella oxytoca and Candida being the most commonly isolated in NE patients, compared to E coli in the other group. Methotrexate and mitoxantrone were the most implicated chemotherapeutic agents both group. Diarrhea is a common complication in neutropenic cancer children. Gram negative bacteria and Candida are the most incriminated pathogens. Duration and severity of neutropenia carry a great risk for development of neutropenic enterocolitis