BETA-HEMOLYTIC STREPTOCOCCAL SEPTICEMIAS IN CHILDHOOD LEUKEMIA

Abstract

During a 12-year period from 1955 to 1967, 13 episodes of beta-hemolytic streptococcal septicemia have occurred in 12 children with leukemia; 4 of these episodes occurred within 6 months prior to this report. Based on a review of septicemia in childhood leukemia from 1953 to 1963 at this same hospital, the frequency of septicemia caused by beta-hemolytic streptococci was 6.3%. An estimated frequency during the period covered by this report is between 5 and 10%, a percentage that is much higher than has been reported elsewhere. Beta-hemolytic streptococcal septicemia occurred during all stages of the leukemic process, but only in four instances could the septicemia have been related to the child's death. Eleven children had acute lymphatic leukemia, and one had acute promyelocytic leukemia. Although the clinical and laboratory findings associated with septicemia were similar in most instances (spiking fever, anorexia, lethargy, severe leukopenia, anemia, and so forth), the source of the infection which led to the septicemia was obvious only in one child who had cellulitis and thrombophlebitis. Despite the lack of clinical findings commonly associated with beta-hemolytic streptococcal infections, 8 of 12 patients who had routine throat cultures taken at the onset of septicemia had positive cultures for beta-hemolytic streptococci. Further identification of the organisms suggested that the same organism found in the blood was also present in the throat of these individuals. Grouping and typing of the beta-hemolytic streptococci isolated from these children revealed that nine of the septicemias were caused by a proven or presumptive group A streptococcus, whereas only four were caused by non-group A streptococci. The latter organisms may produce disease in man but their role in human disease is more often like that of other opportunistic pathogens. The greater number of group A streptococcal septicemias in these children may simply reflect the fact that this organism commonly produces upper respiratory disease in childhood. Nine of these leukemic children recovered from the septicemia. This finding plus the frequency with which beta-hemolytic streptococcal septicemias are reported in these patients should increase the awareness of physicians to this relatively easily diagnosed and treated infectious complication of childhood leukemia.