title: Alpha-streptococcal septicemia in leukemic children treated with continuous or large dosage intermittent cytosine arabinoside.
abstract: During a 2-year period after the introduction of an intensive chemotherapeutic protocol, alpha-hemolytic streptococci accounted for 75% of all episodes of sepsis among children with acute nonlymphocytic leukemia at our institution. Only one case had occurred in the previous 8 years. Fourteen of 15 episodes of streptococcal sepsis occurred after therapy with either continuous or large dosage intermittent cytosine arabinoside. Eleven episodes occurred at two specific treatment points. Septic episodes were complicated by shock (2 of 15), encephalopathy (2 of 15), pneumonia (3 of 15) and death (1 of 15). Oral mucosal lesions may provide a portal of entry for alpha-hemolytic streptococci. These data suggest that children receiving continuous or large dosage intermittent cytosine arabinoside for treatment of acute nonlymphocytic leukemia may be at increased risk for alpha-hemolytic streptococcal sepsis. Empiric antimicrobial therapy in these children when febrile and neutropenic should include antibiotics effective against alpha-hemolytic streptococci.
authors.affiliation: Section of Infectious Diseases, University of Missouri-Kansas City School of Medicine.
authors.forename: S V
authors.initials: SV
authors.lastname: Sotiropoulos
authors.forename: M A
authors.initials: MA
authors.lastname: Jackson
authors.forename: G M
authors.initials: GM
authors.lastname: Woods
authors.forename: R A
authors.initials: RA
authors.lastname: Hicks
authors.forename: J
authors.initials: J
authors.lastname: Cullen
authors.forename: A I
authors.initials: AI
authors.lastname: Freeman
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D003561:Cytarabine / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007108:Immune Tolerance; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000188:drug therapy; D011658:Pulmonary Fibrosis / Q000209:etiology; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications / Q000188:drug therapy / Q000209:etiology*; D012772:Shock, Septic / Q000209:etiology; D013290:Streptococcal Infections / Q000150:complications / Q000188:drug therapy / Q000209:etiology*
chemical_list: D000900:Anti-Bacterial Agents; D003561:Cytarabine