Abstract
Infections frequently complicate the treatment course in children with hematologic malignancies undergoing chemotherapy. Febrile neutropenia (FN) remains a major cause of hospital admissions in this population, and respiratory tract is often proven to be the site of infection even without respiratory signs and symptoms. Clinical presentation may be subtle due to impaired inflammatory response. Common respiratory viruses and bacteria are widely identified in these patients, while fungi and, less commonly, bacteria are the causative agents in more severe cases. A detailed history, thorough clinical and basic laboratory examination along with a chest radiograph are the first steps in the evaluation of a child presenting signs of a pulmonary infection. After stratifying patient’s risk, prompt initiation of the appropriate empirical antimicrobial treatment is crucial and efficient for the majority of the patients. High-risk children should be treated with an intravenous antipseudomonal beta lactam agent, unless there is suspicion of multi-drug resistance when an antibiotic combination should be used. In unresponsive cases, more invasive procedures, including bronchoalveolar lavage (BAL), computed tomography (CT)-guided fine-needle aspiration or open lung biopsy (OLB), are recommended. Overall mortality rate can reach 20% with higher rates seen in cases unresponsive to initial therapy and those under mechanical ventilation.
Highlights
Hematologic malignancies account for approximately 40% of all childhood malignancies [1]. the vast majority of children with blood cancer succeed in long-term survival, there are some factors associated with significant morbidity and mortality
Lu et al reported one case out of 171 children tested positive for SARS CoV-2 infection, who was under chemotherapy treatment for leukemia and required admission to Intensive Care Unit (ICU) with no other major events
While the frequency of Aspergillus spp. isolation in lung samples has been rising according to multiple studies [25,40,41], the incidence of Pneumocystis jirovecii pneumonia has dropped significantly since effective chemoprophylaxis with co-trimoxazole was established in children undergoing chemotherapy for hematologic malignancies [42,43]
Summary
Hematologic malignancies account for approximately 40% of all childhood malignancies [1]. The vast majority of children with blood cancer succeed in long-term survival, there are some factors associated with significant morbidity and mortality These factors are the nature of the disease and infiltrative bone marrow insufficiency, along with the intensity of the treatment protocols including chemotherapeutic drugs, use of corticosteroids, central lines or hematopoietic cell transplantation. In children with febrile neutropenia, respiratory infections can rapidly disseminate, leading to respiratory distress and pulmonary compromise [7,8]. For this reason, prompt diagnosis and management are of great importance, in order to reduce mortality rates [7,8].
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