title: Fever and bacteremia in children and adolescents with acute lymphoblastic leukemia.
abstract: The medical records of 318 children and adolescents with acute lymphoblastic leukemia (ALL) were reviewed to determine the relationship between the occurrence of fever, a positive blood culture, and the absolute neutrophil count (ANC) during induction, remission maintenance, and bone marrow relapse. On the day of diagnosis of ALL, almost one-third of the patients had a temperature higher than 38.5 degrees C, but only three (4.1%) had positive blood cultures. Following the initiation of induction chemotherapy, many patients had febrile episodes. Forty-six percent of the blood cultures obtained during this period were positive. Only patients with an absolute neutrophil count of 1000/mm3 or less were at risk of a positive blood culture during induction. Thirty-four percent of the admissions during remission maintenance for fever were associated with pneumonia. One-half of the episodes of pneumonia occurred during the first 150 days following the diagnosis of ALL. No patient with pneumonia during remission maintenance had a positive blood culture. Eighteen percent of the blood cultures obtained from patients admitted during periods of bone marrow relapse were positive. Gram-positive organisms predominated during induction, whereas gram-negative organisms predominated during periods of bone marrow relapse.
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000008:administration & dosage; D002648:Child; D004359:Drug Therapy, Combination; D005260:Female; D005334:Fever / Q000150:complications*; D006801:Humans; D007945:Leukemia, Lymphoid / Q000150:complications* / Q000188:drug therapy; D007958:Leukocyte Count; D008297:Male; D009504:Neutrophils; D011014:Pneumonia / Q000150:complications; D012306:Risk; D018805:Sepsis / Q000150:complications*
chemical_list: D000970:Antineoplastic Agents