title: Infections in a pediatric patient cohort with acute lymphoblastic leukemia during the entire course of treatment.
abstract: OBJECTIVE
  To assess the type, frequency, severity, and outcome of all infectious episodes in a pediatric patient cohort with acute lymphoblastic leukemia (ALL) from a single institution during the entire length of leukemia treatment.
  
  
  METHODS
  Eighty-six patients were treated according to a modified ALL Berlin-Frankfurt-Munster protocol. Retrospective analysis of all types of infections according to the treatment phase and the degree of neutropenia is presented.
  
  
  RESULTS
  A total of 610 infectious episodes were recorded. Most infections were documented during maintenance (57%), followed by the induction phase (20.3%). During maintenance, 347 episodes were encountered, with nonspecific viral upper respiratory tract infections (URIs) being the commonest diagnosis (40.0%). Additionally, 38 of 58 total specific viral infections occurred during maintenance: 16 herpes simplex, 7 varicella, 10 herpes zoster infections [varicella-zoster virus (VZV), 45%]. The majority of bacteremia and fever of unknown origin occurred during induction (20%). The number of Gram-negative bacteremia was 50% of the total (26 of 52). The majority of the infections (59.5%) occurred without neutropenia [absolute neutrophil count (ANC) >1,000 microl(-1)]. Fewer infections (9.3%) were recorded with concurrent very severe neutropenia (ANC <100 microl(-1)), although 38.5% of positive blood cultures were documented with severe neutropenia. No infection-related fatality occurred.
  
  
  CONCLUSIONS
  Most of the severe infections occurred during induction. Gram-positive bacteremia and Gram-negative bacteremia were almost equal. URIs were the commonest infections during the entire treatment and during maintenance. Specific viral infections represented a smaller percentage of the total (VZV was the commonest pathogen). Infectious complications represented a significant morbidity factor, but notably, mortality was negligible.
authors.affiliation: Department of Pediatric Hematology--Oncology, Aghia Sophia Children's Hospital, Thivon & Livadias Ave, Goudi, Athens, 11527, Greece.
authors.forename: Katerina
authors.initials: K
authors.lastname: Katsimpardi
authors.forename: Vassilios
authors.initials: V
authors.lastname: Papadakis
authors.forename: Anastasia
authors.initials: A
authors.lastname: Pangalis
authors.forename: Agapi
authors.initials: A
authors.lastname: Parcharidou
authors.forename: John P
authors.initials: JP
authors.lastname: Panagiotou
authors.forename: Michael
authors.initials: M
authors.lastname: Soutis
authors.forename: Evangelos
authors.initials: E
authors.lastname: Papandreou
authors.forename: Sophia
authors.initials: S
authors.lastname: Polychronopoulou
authors.forename: Stavros
authors.initials: S
authors.lastname: Haidas
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007239:Infections / Q000145:classification / Q000453:epidemiology* / Q000821:virology; D007945:Leukemia, Lymphoid / Q000188:drug therapy*; D008297:Male; D010372:Pediatrics
chemical_list: D000970:Antineoplastic Agents