The pattern of infections in children with haematological malignancies undergoing treatment at Kenyatta National Hospital.

Abstract

During a 9 month period, 106 consecutive episodes of fever in 50 children with haematological malignancies were prospectively evaluated. The distribution of the haematologic malignancies were as follows: 17 cases had acute lymphocytic leukaemia; 18 malignant lymphoma (8 Hodgkin1s , 8 Burkitt1s and 2 lymphocytic lymphoma); 3 chronic granulocytic leukaemia and 12 acute non-lymphocytic leukaemia. The common clinical diagnoses associated with febrile episode and positive isolates included septicemia (17 cases) pneumonia (11 cases), oral infections (11 cases) suppurative cutaneous lesions (7 cases) pharyngitis (9 cases) perianal infections (4 cases) and typhoid (3 cases). 62.3% of the episodes were aetiologically documented by bacterial isolates. Crystaline pencillin, Gentamicin and Co-trimoxazole were the most commonly employed antibiotics. Of the 80 bacterial isolates the most common were Staphylococcus aureus (28.8%) Klebsiella (20%), Streptococcus faecal is (15%) Staphylococcus albus (12.5%) and Escherichia coli (11.3%) There was one case of systemic candidiasis. Other isolates unrelated to fever were tinea (5 cases) and incidental findings of Hookworm and Trichuris trichuria in two specimens of stool. Viral infections diagnosed clinically included 4 cases of varicella, 2 of measles, 1 herpes labialis and 2 hepatitis. The mortality in this series was 52% (80% of those admitted in relapse had a fatal outcome). 61.5% of the deaths were due to infections. It may therefore be concluded from this study that in children with haematological malignancies (1) infection is a frequent cause of mortality (2) the most common cause of febrile

episodes is bacterial infection (3) Staphylococcus aureus, Klebsiella, Escherichia coli and Streptococcus faecalis are the most frequent bacterial isolates and Pseudomonas is infrequent. (4) viral infections are relatively frequent in this group of children and (5) with adequate management the mortality can be reduced.