Title: Clinical Profile of Febrile Neutropenia in Children with Acute Leukemia

Authors: Dr Soumya P C MD, Dr Ajit Kumar V T

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i2.61

Abstract

Introduction: Febrile neutropenia is the most common cause of morbidity and mortality in leukemic patients. These children mostly require parenteral antibiotics because an absolute neutrophil count <500 cells/mm3 conferred a high risk of bacteremia though their correlation with positive blood cultures were rarely proven. This study was undertaken with the sole aim of finding the clinical profile of febrile neutropenia in children with leukemia in our hospital and the various factors influencing its occurrence and its prognosis.

Materials and Methods: This hospital based descriptive study was conducted at IMCH Calicut between Jan2014-Dec2015 and included all leukemic children presenting with one or more febrile neutropenic episodes (fever >38.3 C or 101.5F & ANC <500).

Results: Total of 38 children with 53 febrile neutropenic episodes were encountered. Children above 5 years of age (n=8/18; CI 41.1%; p=0.004) and those with severe anemia (Hb<7g/dl) had statistically significant (n=8/19; CI 29.6%; p=0.012) correlation with mortality.

Conclusion: This study established correlation between the age, type of malignancy, severity of anemia and organisms grown in febrile neutropenic children and their risk of mortality.

Keywords: Neutropenia, Absolute Neutrophil Count, Leukemia.

References

  1. Coebergh J W et al. Leukaemia incidence and survival in children and adolescents in Europe during 1978–1997. Eur J Cancer 2006; 42: 2019–2036.
  2. Sharma A, Lokeshwar N. Febrile neutron-penia in haematological malignancies. J Postgrad Med 2005; 51(1): S42-8.
  3. Koll B S, Brown A E. The changing epidemiology of infections at cancer hospitals.Clin Infect Dis. 1993;17 Suppl 2: S322–S328.
  4. Ozer H, Armitage JO, Bennett CL et al. Update of recommendations for the use of hematopoietic colony-stimulating factors: evidence based, clinical practice guidelines. J Clin Oncol 2000;18: 3558–3585.
  5. Rolston KV. New trends in patient management: risk-based therapy for febrile patients with neutropenia.Clin Infect Dis 1999; 29: 515–521.
  6. Netea MG, Kullberg BJ, Van der Meer JW.  Circulating Cytokines as Mediators of Fever.  Clin Infect Dis.  2000; 31: S178-S184.
  7. Watts RG, Foerster J, Lukens J, et al.  Wintrobe's Clinical Hematology. 10thed; 1999:1862-1888.
  8. Swati M, Gita N,Sujata B et al. Microbial Etiology of Febrile Neutropenia. Indian J Hematol Blood Transfus.2010; 26(2): 49–55.
  9. Fevzi Özkaynak, Mark Krailo, Zhengjia Chen, James Feusner. Randomized comparison of antibiotics with and without granulocyte colony-stimulating factor in children with chemotherapy-induced febrile neutropenia: Ped B Cancer 2005;45(3):274-280.
  1. El-mahallawy H A,Attia I, Ali-el-din N H, Salem A E. A prospective study on fungal infection in children with cancer journal of medical microbiology.J Med Microbiol July 2002; 51(7): 601-673
  2. Pizzo PA, et al. Increasing incidence of Gram-positive sepsis in cancer patients. Med Pediatr Oncol 1978; 5(1): 241-4.
  3. Mullen CA, Buchanan GR. Early hospital discharge of children with cancer treated for fever and neutropenia: identification and management of the low-risk patient. J Clin Oncol  1990; 1998-2004.
  4. Ronald Feld, Marianne Paesmans, Alison G. Freifeld, Talcott et al. Methodology for Clinical Trials Involving Patients with Cancer Who Have Febrile Neutropenia: Updated Guidelines of the Immunocomp-romised Host Society/Multinational Association for Supportive Care in Cancer, with Emphasis on Outpatient Studies. Clin Infect Dis.(2002); 35(12): 1463-1468 doi:10.1086/344650
  5. Santolaya ME,Farfán MJ, De La Maza V et al. Diagnosis of bacteremia in febrile neutropenic episodes in children with cancer: microbiologic and molecular approach. Pediatr Infect Dis J2011; 30(11): 957-61.
  6. Santolaya M E, Alvarez A M, Becker A, Cofre J et al. Prospective, Multicenter Evaluation of Risk FactorsAssociated With Invasive Bacterial Infection in Children with Cancer, Neutropenia, and Fever. J Clin Oncol 2001;19:3415-3421.
  7. Timothy M, Bodkyn C. The outcome of febrile neutropenic episodes in paediatric oncology at the Wendy Fitzwilliam Paediatric Hospital. West Indian Med J 2011;60(2):153-7.
  8. Rackoff WR, Gonin R, Robinson C et al. Predicting the risk of bacteremia in children with fever and neutropenia. J Clin Oncol 1996;14:919-924.
  9. Aquino VM, Tkaezewski Y, Buchanan G. Early discharge of low-risk febrile neutropenic children and adolescents with cancer. Clin Infect Dis 1997;25:74-78.
  10. 19.        FreifeldAG, Bow EJ, Sepkowitz KA et al.  Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer: 2010 Update by the Infectious Diseases Society of America. Clin infect Dis 2011; 47:123-154.
  11. Hughes WT, Armstrong D, Bodey GP et al. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 2002; 34: 730–51.

Corresponding Author

Dr Ajit Kumar V T

Professor and Head, Department of Paediatrics,

Govt Medical College, Manjeri, Kerala