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Pulmonary Infectious Complications in Children with Hematologic Malignancies and Chemotherapy-Induced Neutropenia

Infections frequently complicate the treatment course in children with hematologic malignancies undergoing chemotherapy. Febrile neutropenia (FN) remains a major cause of hospital admissions in this population, and respiratory tract is often proven to be the site of infection even without respirator...

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Autores principales: Voulgaridou, Aikaterini, Athanasiadou, Kleoniki I., Athanasiadou, Eftychia, Roilides, Emmanuel, Papakonstantinou, Evgenia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7564221/
https://www.ncbi.nlm.nih.gov/pubmed/32824956
http://dx.doi.org/10.3390/diseases8030032
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author Voulgaridou, Aikaterini
Athanasiadou, Kleoniki I.
Athanasiadou, Eftychia
Roilides, Emmanuel
Papakonstantinou, Evgenia
author_facet Voulgaridou, Aikaterini
Athanasiadou, Kleoniki I.
Athanasiadou, Eftychia
Roilides, Emmanuel
Papakonstantinou, Evgenia
author_sort Voulgaridou, Aikaterini
collection PubMed
description Infections frequently complicate the treatment course in children with hematologic malignancies undergoing chemotherapy. Febrile neutropenia (FN) remains a major cause of hospital admissions in this population, and respiratory tract is often proven to be the site of infection even without respiratory signs and symptoms. Clinical presentation may be subtle due to impaired inflammatory response. Common respiratory viruses and bacteria are widely identified in these patients, while fungi and, less commonly, bacteria are the causative agents in more severe cases. A detailed history, thorough clinical and basic laboratory examination along with a chest radiograph are the first steps in the evaluation of a child presenting signs of a pulmonary infection. After stratifying patient’s risk, prompt initiation of the appropriate empirical antimicrobial treatment is crucial and efficient for the majority of the patients. High-risk children should be treated with an intravenous antipseudomonal beta lactam agent, unless there is suspicion of multi-drug resistance when an antibiotic combination should be used. In unresponsive cases, more invasive procedures, including bronchoalveolar lavage (BAL), computed tomography (CT)-guided fine-needle aspiration or open lung biopsy (OLB), are recommended. Overall mortality rate can reach 20% with higher rates seen in cases unresponsive to initial therapy and those under mechanical ventilation.
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spelling pubmed-75642212020-10-26 Pulmonary Infectious Complications in Children with Hematologic Malignancies and Chemotherapy-Induced Neutropenia Voulgaridou, Aikaterini Athanasiadou, Kleoniki I. Athanasiadou, Eftychia Roilides, Emmanuel Papakonstantinou, Evgenia Diseases Review Infections frequently complicate the treatment course in children with hematologic malignancies undergoing chemotherapy. Febrile neutropenia (FN) remains a major cause of hospital admissions in this population, and respiratory tract is often proven to be the site of infection even without respiratory signs and symptoms. Clinical presentation may be subtle due to impaired inflammatory response. Common respiratory viruses and bacteria are widely identified in these patients, while fungi and, less commonly, bacteria are the causative agents in more severe cases. A detailed history, thorough clinical and basic laboratory examination along with a chest radiograph are the first steps in the evaluation of a child presenting signs of a pulmonary infection. After stratifying patient’s risk, prompt initiation of the appropriate empirical antimicrobial treatment is crucial and efficient for the majority of the patients. High-risk children should be treated with an intravenous antipseudomonal beta lactam agent, unless there is suspicion of multi-drug resistance when an antibiotic combination should be used. In unresponsive cases, more invasive procedures, including bronchoalveolar lavage (BAL), computed tomography (CT)-guided fine-needle aspiration or open lung biopsy (OLB), are recommended. Overall mortality rate can reach 20% with higher rates seen in cases unresponsive to initial therapy and those under mechanical ventilation. MDPI 2020-08-19 /pmc/articles/PMC7564221/ /pubmed/32824956 http://dx.doi.org/10.3390/diseases8030032 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Voulgaridou, Aikaterini
Athanasiadou, Kleoniki I.
Athanasiadou, Eftychia
Roilides, Emmanuel
Papakonstantinou, Evgenia
Pulmonary Infectious Complications in Children with Hematologic Malignancies and Chemotherapy-Induced Neutropenia
title Pulmonary Infectious Complications in Children with Hematologic Malignancies and Chemotherapy-Induced Neutropenia
title_full Pulmonary Infectious Complications in Children with Hematologic Malignancies and Chemotherapy-Induced Neutropenia
title_fullStr Pulmonary Infectious Complications in Children with Hematologic Malignancies and Chemotherapy-Induced Neutropenia
title_full_unstemmed Pulmonary Infectious Complications in Children with Hematologic Malignancies and Chemotherapy-Induced Neutropenia
title_short Pulmonary Infectious Complications in Children with Hematologic Malignancies and Chemotherapy-Induced Neutropenia
title_sort pulmonary infectious complications in children with hematologic malignancies and chemotherapy-induced neutropenia
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7564221/
https://www.ncbi.nlm.nih.gov/pubmed/32824956
http://dx.doi.org/10.3390/diseases8030032
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