Thesis (Ph.D.) - Cairo University - National Cancer Institute - Department of Pediatric Oncology

Background: Infections still remain a major cause of therapy-associated morbidity and mortality in children with acute lymphoblastic leukemia (ALL) especially during induction phase of chemotherapy. To improve supportive care measurements, detailed information on frequency and characteristic features of infectious complications is needed. Aim: To study the pattern and magnitude of the infections among pediatric cases of acute lymphoblastic leukemia during the induction therapy, morbidity and outcome of each infectious complications and the impact of various factors such as: age, gender, imunophenotyping and duration of neutropenia on susceptibility to various types of infections. Patients and Methods: This study included 89 newly diagnosed ALL pediatric patients treated at the National Cancer Institute, Cairo university during the period between 1st May 2012 and 30th April 2013. All patients received adopted protocol of St. Jude Children{u2019}s Research Hospital total study XV for low or standard/high risk ALL. Results: A total of 89 patients (54 males, 35 girls; median age 5.4 years) experienced 137 febrile episodes. Fever of unknown origin occurred in 10.1% of the patients and clinically and microbiologically documented infections in 89.1% and 70% of the patients, respectively. In all 96/137 Blood stream infection (BSI) reported, Gram-positive pathogens were isolated in 61 episodes (63.5%) of the total isolates, Gram-negative in 23 (23.9%) and mixed infections in 4 (4.1%). The common causative agents of blood stream infections in the present study were Staphylococcus aureus (29.3%) followed by Coagulase negative {u2013}Staph. aureus CONS (18.7%). Multidrug resistant organisms (MDR) were reported in 6/23(26%) of gram-ve organisms. Fungal infection was possible in 25/137(18.2%) and proven in 4/137 (2.9.5%) of the febrile episodes. In 49 out of the 137 of the febrile episodes (35.7%), pneumonia was radiologically diagnosed

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