Bacteremias due to Haemophilus influenzae and Streptococcus pneumoniae

Abstract

Nine Haemophilus influenzae and 24 Streptococcus pneumoniae bacteremias occurring in children with cancer during the years 1968 to 1977 were reviewed. The number of bacteremias due to these organisms remained relatively constant, in contrast with a sharp decrease in bacteremias caused by other organisms during this period. The highest incidence of bacteremia occurred in patients with acute leukemias and the lowest incidence in patients with solid tumors. Twenty-seven of 33 episodes occurred while patients were receiving chemotherapy. Nine bacteremias were fatal, but concurrent or superinfections contributed to death in six of these. Children with cancer who are receiving chemotherapy seem to be at higher risk of bacteremia and meningitis due to H influenzae and Strep pneumoniae than are normal children. New approaches to the prevention of these infections, such as the use of bacterial polysaccharide vaccines, deserve investigation.

Increased risk for invasive pneumococcal diseases in children with acute lymphoblastic leukaemia

“…Therefore, the absolute risk for IPD in children with ALL is probably twofold higher, reaching approximately one IPD episode per 180 ALL cases or 5AE6 IPD episodes per 1000 ALL cases. In this regard, our results compare well with data from the few prior studies analysing IPD in paediatric ALL patients in the early era of combination chemotherapy (Chilcote & Baehner, 1979;Siber, 1980;Allen & Weiner, 1981). Siber (1980) provided an absolute incidence rate of 13AE3 IPD cases per 1000 patient years in children with ALL treated between 1968 and 1977 in a large American paediatric cancer centre.…”

“…In this regard, our results compare well with data from the few prior studies analysing IPD in paediatric ALL patients in the early era of combination chemotherapy (Chilcote & Baehner, 1979;Siber, 1980;Allen & Weiner, 1981). Siber (1980) provided an absolute incidence rate of 13AE3 IPD cases per 1000 patient years in children with ALL treated between 1968 and 1977 in a large American paediatric cancer centre. Our report extended these observations to paediatric ALL patients treated according to current intensive therapy protocols and also showed that IPD episodes are equally likely to arise during neutropenia following intensive chemotherapy and non-neutropenic treatment phases i.e.…”

Preparation of human hyperimmune globulin to Haemophilus influenzae b, Streptococcus pneumoniae, and Neisseria meningitidis

“…VO'L. 45,1984 antibody levels achieved with each preparation would be ca. 1/10 of the concentrations of the 1% Cohn-Oncley fractions II in Table 3.…”

“…High-risk groups who are unable to respond to active immunization with currently available polysaccharide vaccines are the logical target population. Examples are children of less than 2 years of age with asplenia, sickle cell disease, or thalassemia (16,36,39), children on active chemotherapy for malignancy (45), splenectomized patients receiving immunosuppressive therapy for Hodgkin's disease (47) or renal transplantation (31), patients recovering from bone marrow transplantation (54), and patients with congenital immunodeficiencies, such as agammaglobulinemia (50), selective IgG2 deficiency (37), or Wiskott-Aldrich syndrome (9), or with acquired B-cell impairments due to multiple myeloma or chronic lymphocytic leukemia (42). In addition, certain populations such as Native American and Alaskan Eskimo infants who have an extremely high endemic incidence of invasive Hib as well as pneumococcal and meningococcal infections (19,52) are candidates for passive prophylaxis with BPIG during the first 12 to 18 months of life.…”

Immunodeficiency in children with acute lymphoblastic leukemia after completion of modern aggressive chemotherapeutic regimens

“…51 Considering the risk these child may have in acquiring serious infection as a consequence of this humoral defect, an increased risk of HIB and pneumococcal sepsis has been reported in pediatric oncology patients. 5,8,[52][53][54][55] The return of normal plasma cell numbers after the completion of chemotherapy in some children with ALL does not guarantee the expression of protective antibody responses after anamnestic vaccine challenge. 16 It is possible that a major reason why most children in remission for ALL do not commonly experience severe or life-threatening bacterial infections is the heightened surveillance by parents, pediatricians, and hematologists/ oncologists who quickly respond to any suspected infections with early intervention with antibiotics.…”