Viridans streptococcal sepsis: clinical features and complications in childhood acute myeloid leukemia.
OBJECTIVE
Treatment of acute myeloid leukemia (AML) is associated with substantial adverse effects, including neutropenia and infection. Viridans streptococci (VS) are a primary cause of infection and pneumonia in patients with neutropenia. The authors determined the incidence, clinical features, and complications of VS sepsis in children receiving chemotherapy for AML.


METHODS
The authors retrospectively reviewed the records of 172 patients treated on their institutional protocols AML91 (n = 95) and AML97 (n = 77) and identified 36 patients who had VS sepsis.


RESULTS
The 1-year cumulative incidence of VS sepsis was significantly higher in AML97 than in AML91. Patients with favorable cytogenetic features (ie, t(9;11), t(8;21), or inv(16)) had a significantly higher incidence of infection than did other patients. VS sepsis developed at various times after chemotherapy was initiated, and patients remained febrile for a median of 15 days. Twelve patients (33%) experienced hypotension, 10 (28%) acute respiratory distress syndrome, and 6 (17%) fungal infection. Twenty-three patients (64%) required intensive care, 21 (58%), oxygen therapy, and 7 (19%), vasopressor medications. One patient died of pulmonary aspergillosis after VS sepsis. The 3-year cumulative incidence of aspergillosis was higher in patients with VS sepsis than in those without.


CONCLUSIONS
Although antibiotic therapy rapidly resolved VS sepsis, complications associated with this infection remained life-threatening in children receiving chemotherapy for AML.
Okamoto
Yasuhiro
Y
Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105-2794, USA.
Ribeiro
Raul C
RC
Srivastava
Deo Kumar
DK
Shenep
Jerry L
JL
Pui
Ching-Hon
CH
Razzouk
Bassem I
BI
D000208:Acute Disease; D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002869:Chromosome Aberrations; D003131:Combined Modality Therapy; D003561:Cytarabine / Q000008:administration & dosage; D003630:Daunorubicin / Q000008:administration & dosage; D003839:Deoxyadenosines / Q000008:administration & dosage; D004311:Double-Blind Method; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000008:administration & dosage; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007022:Hypotension / Q000209:etiology; D016867:Immunocompromised Host; D007951:Leukemia, Myeloid / Q000150:complications* / Q000188:drug therapy / Q000235:genetics / Q000628:therapy; D008297:Male; D009181:Mycoses / Q000150:complications; D009503:Neutropenia / Q000139:chemically induced / Q000150:complications; D016032:Randomized Controlled Trials as Topic; D012128:Respiratory Distress Syndrome / Q000209:etiology; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications / Q000382:microbiology*; D013290:Streptococcal Infections / Q000150:complications / Q000382:microbiology*; D034363:Viridans Streptococci
D003839:Deoxyadenosines; D003561:Cytarabine; D016179:Granulocyte Colony-Stimulating Factor; D005047:Etoposide; D016178:Granulocyte-Macrophage Colony-Stimulating Factor; D003630:Daunorubicin