Infectious Manifestations in Childhood Leukemia

ABSTRACT

PURPOSE: Infection is one of the major causes of morbidity and mortality in children during chemotherapy for leukemia and the development of fever in neutropenic cancer patients frequently indicates infection. The purpose of the present study is to evaluate infectious manifestations during the course of leukemia. METHODS: Seventy eight leukemic children who had one or more occasions of infection during hospitalization from January 1993 to December 1999 at Dong San Hospital, Keimyung University were analyzed. Infection was defined clinically as a single oral temperature of 38.5degrees C or higher or as three consequent oral temperature 38degrees C in a day. RESULTS: Two-hundred and four febrile episodes were studied. The cause of infection was detected in 136 episodes while in 68 episodes the cause was not detected. The causes of infection were 31 pneumonia, 24 sepsis, 16 urinary tract infections, 15 mucositis, and 14 wound infections. The etiologic pathogens were identified in 53 episodes. Sixty percent of the pathogens were gram negative organisms such as Escherichia coli, Enterobacter, Pseudomonas aeruginosa and Klebsiella. Both gram positive and fungal infections were 17.0%. Most sensitive antibiotics were vancomycin for gram positive organisms and ceftazidime and amikacin for gram negative organisms. Twenty-one patients died due to FUOs, sepsis, pneumonia and severe mucositis. CONCLUSION: Infection was the most frequent cause of death in leukemic patients and fungal infections have increased recently. The risk of infection was higher in patients with severe and prolonged neutropenia. Therefore immediate application of antibiotics and antifungal agents will be needed in the leukemic patient with neutropenia.