title: Infectious complications in children with acute lymphoblastic leukemia treated in low-middle-income countries.
abstract: Infections are the most important cause of morbidity and mortality in children treated for acute lymphoblastic leukemia (ALL). The rates of infection-associated mortality are up to 10-times higher in low- and middle-income countries (LMIC) than in high-income countries. The prevention, early recognition and management of infectious complications is especially challenging in LMIC because of disease and poverty-related factors, as well as the shortage of trained personnel, supplies, diagnostic tools and adequate organizational infrastructure. Children in LMIC with ALL, who are frequently underweight, are at increased risk of community-acquired pathogens, nosocomial multidrug-resistant pathogens and opportunistic microorganisms. This review summarizes the challenges of managing the major categories of infections in children receiving treatment for ALL and provides updated practical recommendations for preventing and managing these infections in LMIC.
authors.affiliation: a 1 Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: Miguela A
authors.initials: MA
authors.lastname: Caniza
authors.forename: Carla
authors.initials: C
authors.lastname: Odio
authors.forename: Sheena
authors.initials: S
authors.lastname: Mukkada
authors.forename: Miriam
authors.initials: M
authors.lastname: Gonzalez
authors.forename: Francesco
authors.initials: F
authors.lastname: Ceppi
authors.forename: Sujittra
authors.initials: S
authors.lastname: Chaisavaneeyakorn
authors.forename: Nopporn
authors.initials: N
authors.lastname: Apiwattanakul
authors.forename: Scott C
authors.initials: SC
authors.lastname: Howard
authors.forename: Valentino
authors.initials: V
authors.lastname: Conter
authors.forename: Miguel
authors.initials: M
authors.lastname: Bonilla
mesh_terms: D000367:Age Factors; D019072:Antibiotic Prophylaxis; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D003906:Developing Countries; D019468:Disease Management; D064147:Febrile Neutropenia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007239:Infections / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000628:therapy; D014612:Vaccines / Q000008:administration & dosage
chemical_list: D014612:Vaccines
keywords: childhood acute lymphoblastic leukemia; febrile neutropenia; immune suppression; infections; low- and middle-income countries