Mixed Bacterial-Viral Infections in Septic Children With Leukemia

Koskenvuo, Minna; Möttönen, Merja; Rahiala, Jaana; Saarinen‐Pihkala, Ulla M.; Riikonen, Pekka; Waris, Matti; Ziegler, Thedi; Uhari, Matti; Ruuskanen, Olli; Salmi, Toivo T.

doi:10.1097/inf.0b013e318146207c

Cited by 22 publications

(17 citation statements)

References 17 publications

(27 reference statements)

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“…The role of varicella zoster immunoglobulin (VZIG) in prophylaxis and treatment is still debated as regards severely immunocompromised children and adolescents 47. In our unit, children with cancer receiving conventional chemotherapy receive prophylactic acyclovir from day 7 after exposure for 7 days (1200 mg/m2/day po)49 Close clinical follow-up investigations are mandatory in these patients. If a breakthrough VZV infection occurs, the child is immediately hospitalised and treated with acyclovir intravenously.…”

Section: Varicella Zoster Virusmentioning

confidence: 99%

“…On the other hand, chronic persistence of replicating rhinovirus in the lung with fatal outcome has been reported in lung transplant recipients62 and severe lower RTIs have been attributed to rhinovirus infections in some prospective case series 2 3 63. One study from Greece investigated the clinical presentation, severity and outcome of EV infections in paediatric cancer patients 64.…”

Section: Rhinovirus and Enterovirusmentioning

confidence: 99%

“…In addition, atypical manifestations of viral infections may delay recognition of the viral aetiology of clinical symptoms and result in inadequate treatment due to delayed diagnosis. In a recent study performed in four Finnish university hospitals, Koskenvuo et al 2 investigated the concomitant presence of 16 viral pathogens in paediatric leukaemia patients with blood stream infection (BSI). Prospective evaluation of 156 febrile episodes in 51 children yielded 19 BSI (11%).…”

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confidence: 99%

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Viral infections in paediatric patients receiving conventional cancer chemotherapy

Simon

Schildgen²,

Schuster³

2008

Archives of Disease in Childhood

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In severely immunocompromised patients, the diagnosis of viral infections relies on PCR/RT-PCR based methods. The availability of these modern diagnostic tools facilitates timely diagnosis and contributes to our increasing knowledge of the epidemiology and clinical spectrum of common and emerging viral pathogens in this highly susceptible population. Viral infections may result in life threatening disease in paediatric cancer patients after stem cell transplantation and also during conventional chemotherapy. Often, clinical symptoms are a consequence of endogenous reactivation of latent viral infection. Many of these viruses are easily transmitted between patients, relatives and health care workers. As prolonged symptomatic and asymptomatic viral shedding is a common feature in paediatric cancer patients, it is necessary to implement strategies for the prevention and control of these communicable pathogens in the hospital setting and in the outpatient clinic. Although no randomised controlled studies on paediatric cancer patients are available, physicians should be aware of potential treatment options since early treatment may prevent a complicated or fatal outcome and shorten the period of contagiosity.

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Section: Varicella Zoster Virusmentioning

confidence: 99%

Section: Rhinovirus and Enterovirusmentioning

confidence: 99%

mentioning

confidence: 99%

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Viral infections in paediatric patients receiving conventional cancer chemotherapy

Simon

Schildgen²,

Schuster³

2008

Archives of Disease in Childhood

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“…Nevertheless, a more severe clinical course of mixed viral and bacterial infections in FN has been reported before. 17,18,20 …”

Section: Discussionmentioning

confidence: 99%

A Prospective Multicenter Study of Microbiologically Defined Infections in Pediatric Cancer Patients With Fever and Neutropenia

Agyeman¹,

Kontny²,

Nadal³

et al. 2014

Pediatric Infectious Disease Journal

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Background:Fever and neutropenia (FN) often complicate anticancer treatment and can be caused by potentially fatal infections. Knowledge of pathogen distribution is paramount for optimal patient management.Methods:Microbiologically defined infections (MDI) in pediatric cancer patients presenting with FN by nonmyeloablative chemotherapy enrolled in a prospective multicenter study were analyzed. Effectiveness of empiric antibiotic therapy in FN episodes with bacteremia was assessed taking into consideration recently published treatment guidelines for pediatric patients with FN.Results:MDI were identified in a minority (22%) of pediatric cancer patients with FN. In patients with, compared with patients without MDI, fever [median, 5 (interquartile range: 3–8) vs. 2 (interquartile range: 1–3) days, P < 0.001] and hospitalization [10 (6–14) vs. 5 (3–8) days, P < 0.001] lasted longer, transfer to the intensive care unit was more likely [13 of 95 (14%) vs. 7 of 346 (2.0%), P < 0.001], and antibiotics were given longer [10 (7–14) vs. 5 (4–7) days, P < 0.001]. Empiric antibiotic therapy in FN episodes with bacteremia was highly effective if not only intrinsic and reported antimicrobial susceptibilities were considered but also the purposeful omission of coverage for coagulase-negative staphylococci and enterococci was taken into account [81% (95% confidence interval: 68–90) vs. 96.6% (95% confidence interval: 87–99.4), P = 0.004].Conclusions:MDI were identified in a minority of FN episodes but they significantly affected management and the clinical course of pediatric cancer patients. Compliance with published guidelines was associated with effectiveness of empiric antibiotic therapy in FN episodes with bacteremia.

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“…Otro punto de interés en el que el uso de la PCR podría ser de gran utilidad sería conocer la frecuencia de infección viral asociada a infección bacteriana en niños oncológicos, la cual parece oscilar entre 9-13% de los episodios de fiebre y neutropenia 10,17,18,37 . El interés de estas infecciones mixtas en niños se justifica por la posibilidad de que cursen con una clínica más grave, una respuesta más lenta al tratamiento antibiótico, y unos valores más elevados de la proteína C reactiva, lo que puede conllevar un manejo más agresivo, con más cambios y asociaciones de antibióticos, más días de hospitalización y retrasos de quimioterapía, sin un beneficio en la evolución clínica 18 .…”

Section: Infección Dual Viral-bacterianaunclassified

Niños con cáncer e infección viral respiratoria: epidemiología, diagnóstico y posibles tratamientos

Saavedra-Lozano

Garrido

Catalán

et al. 2011

Enfermedades Infecciosas y Microbiología Clínica

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Community-adquired respiratory viral infection is the most common cause of febrile infection in children, and an important cause of infection to consider in children with cancer. Nevertheless, there are few well-designed, controlled studies in this population, which makes it difficult to understand the importance, behaviour and management of these viruses in immunocompromised children. New diagnostic techniques in PCR-based microbiology, could provide many opportunities for early diagnosis, preventing the spread of the virus and to implement the correct therapy. It is important to design appropriate prospective studies to assess these types of infections in children with cancer. In this review we analyse the main studies published in the literature, evaluating the epidemiology, diagnosis and management of children with cancer and respiratory viral infection.

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Mixed Bacterial-Viral Infections in Septic Children With Leukemia

Abstract: Our findings suggest that invasive bacterial infections are commonly associated with viral infections in children with leukemia.

Cited by 22 publications

References 17 publications

Viral infections in paediatric patients receiving conventional cancer chemotherapy

Viral infections in paediatric patients receiving conventional cancer chemotherapy

A Prospective Multicenter Study of Microbiologically Defined Infections in Pediatric Cancer Patients With Fever and Neutropenia

Niños con cáncer e infección viral respiratoria: epidemiología, diagnóstico y posibles tratamientos

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