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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Acute and chronic starvation is often associated with childhood cancer. Total parenteral nutrition (TPN) with 20% glucose and 3.0% amino acids, and minerals and vitamins was instituted to treat or prevent malnutrition in 41 children with cancer, ages three months to 18 years. TPN was required for anorexia, vomiting and diarrhea associated with anti-cancer therapy in 33 patients for intestinal complications or surgery in nine, and for preoperative correction of malnutrition in two. During TPN, general nutrition and appearance improved in all patients. Weight gain was noted in most. Despite gastrointestinal complications which usually require the interruption of chemotherapy and irradiation, in 21 children treatment could be continued at full dose with nutritional support by TPN. TPN was discontinued in six patients when blood cultures became positive. Sepsis was treated successfully by removal of the central venous catheter in all six and administration of antibiotics in three. No metabolic complications were noted. TPN appears to be a safe and effective means of combating the malnutrition which may occur with cancer and its therapy.
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PMID:Parenteral nutritional support in children with cancer. 40 34

Forty-two episodes of culture-proved salmonellosis were found retrospectively among 2,262 patients treated for malignant diseases at St Jude Children's Research Hospital, Memphis. These cases were reviewed in an effort to determine whether Salmonella infections in childhood cancer patients are associated with an increased frequency of septicemia and death, as has been reported for adults with cancer. Septicemia occurred in only 10% of the patients studied, consistent with the frequency established in general populations. There were no deaths attributable to Salmonella infection. Most of the patients (57%) with salmonellosis had gastroenteritis, and the clinical course of this syndrome was no more severe or prolonged than that seen in otherwise normal children. We recommend that management of Salmonella infections in children with cancer follow presently accepted guidelines for normal hosts.
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PMID:Salmonellosis in children with cancer: review of 42 cases. 42 44

Seventy episodes of Staphylococcus aureus sepsis occurring over a nine-year period in pediatric cancer patients are reviewed. Prominent findings at the time of diagnosis included fever, granulocytopenia, and active malignancy. Probable or suspected sites of primary infection were present in 40 episodes (57%). Serious direct complications of staphylococcal sepsis included only three cases of pneumonia and one of myositis. However, second infections by other organisms developed in 16 episodes (24%), resulting in nine nonstaphylococcal infectious deaths during therapy. Endocarditis and osteomyelitis never occurred in this group of patients. The median duration of antistaphylococcal therapy was 15 days.
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PMID:Staphylococcus aureus sepsis in children with cancer. 63 75

Of 6,099 children treated for malignancy, 16 (ages 3.5 to 18 years) developed acute appendicitis between 1962 and 1989. Fourteen had leukemia (ALL 10, AML 4). One each had rhabdomyosarcoma and Ewing's sarcoma. Active malignancy at diagnosis was noted in 10, 4 of whom had severe neutropenia (absolute neutrophil count less than 500/mm3). Of all the leukemics (2,794/6,099), abdominal pain during induction was a frequent complaint. The incidence of appendicitis, however, was low (0.5%). Nine of the 16 patients presented classically, facilitating prompt diagnosis and treatment. Six diagnoses were delayed. Three of these patients presented atypically with vague, nonlocalized pain, abdominal distention, lack of abdominal guarding, fever, dehydration, diarrhea, and unusual symptoms such as upper gastrointestinal bleeding. In each of these 6 patients the appendix was ruptured. Delays led to complications and deaths. Three patients required perioperative transfusions to treat excessive bleeding and two patients with ruptured appendicitis developed wound abscesses. Two patients died; in one, ruptured appendix was diagnosed only at autopsy. The other patient died of uncontrolled sepsis. Typhlitis occurring during induction chemotherapy may present similarly and is the main differential diagnosis. Typhlitis will usually improve with medical treatment alone. Nausea and vomiting (13/16), right lower quadrant pain (13/16), guarding (14/16), tachycardia (12/16), fever (10/16), and rebound tenderness (10/16) were the most frequent signs and symptoms of appendicitis. Persistent localized abdominal pain and guarding, lack of improvement with medical treatment, clinical deterioration, and the development of a mass were our indications for laparotomy. Despite major improvements in therapy, there is still a 37.5% error rate in our ability to accurately diagnose appendicitis in pediatric cancer patients.
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PMID:Acute appendicitis in children with leukemia and other malignancies: still a diagnostic dilemma. 152 62

To study the value of intensive care in childhood cancer, we evaluated the clinical course and outcome of all such children admitted to our intensive care unit (ICU) (n = 183) during the five-year period from 1984-1988. Excluding those admitted for postoperative observation, there were a total of 63 admissions for complications of malignancy. Of these, admissions for sepsis, pulmonary parenchymal disease, or coma were associated with poor outcome. Thirty-six percent of patients requiring mechanical ventilation for respiratory failure and 27% requiring inotropic support survived longer than six months. Physiologic Stability Index and Therapeutic Intervention Scores were significantly greater in nonsurvivors than survivors. Of those who survived their ICU stay, 50% went home functioning at their premorbid state. The duration of ICU stay was not different in survivors and nonsurvivors, suggesting that intensive care does not excessively prolong the dying process. We conclude that many life-threatening complications of cancer are potentially reversible. The extent of functional recovery of survivors warrants aggressive intensive support in this setting.
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PMID:The role of intensive care in managing childhood cancer. 195 Nov 73

Twenty-three pediatric cancer patients developed Pseudomonas aeruginosa septicemia during an 11-year period. Typically the patients had advanced neoplasia and were receiving immunosuppressive therapy. Severe myelosuppression was almost always present and antibiotic therapy during the prior 2-week period for proven or suspected sepsis was common. Disruption of the skin and mucosa in the anogenital regions was evident in the majority of patients, and the gastrointestinal tract represented the most common portal of entry. Patients who developed sepsis while relapsed had the highest case-fatality rate, and use of synergistic antibiotic combinations did not affect outcome in this group.
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PMID:Pseudomonas aeruginosa septicemia in childhood cancer patients. 717 13

Seventy-eight pediatric cancer patients were treated for gram-positive bacterial septicemia during a 10-year period (1968-1977). Sixty-one (78%) of the patients were granulocytopenic (PMNs less than 500/mm3) at the onset of the septic episode. All the patients whose granulocytopenia resolved (PMNs greater than 500/mm3) within one week of therapy recovered without sequelae. However, 7 of 15 patients (47%) who remained granulocytopenic for more than 7 days and who were treated with a single antibiotic developed a second sepsis with a gram-negative organism. In contrast, second infections were not observed in 24 patients with PMNs less than 500/mm3 for more than 7 days who were treated with broad spectrum antibiotics (p less than 0.002), suggesting that a broad-spectrum antibiotic regimen may be preferable when a cancer patient has prolonged granulocytopenia.
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PMID:Treatment of gram-positive septicemia in cancer patients. 735 Oct 4

The development of fever in neutropenic cancer patients is frequently an indication of infection. The response of these patients to antibiotic treatment is often poor, and the recent literature continues to document a substantial mortality rate in spite of the prompt treatment of these patients with multiple-agent antibiotic therapy. Because of limited available information regarding fever and neutropenia in pediatric cancer patients, we undertook an analysis of a group of such patients from a pediatric oncology center. The incidence of probable and documented infections was 39.2% in a group of these patients, representing 158 febrile episodes. The most frequent form of infection was bacterial sepsis; pulmonary infections were the next most frequent, followed by infections of skin and soft tissues. In leukemia patients with culture-proven infections, gram-negative organisms were isolated in 61.1% of episodes while gram-positive organisms were isolated in 41.7%. Escherichia coli and Staphylococcus aureus were the organisms most frequently isolated from these patients. In solid-tumor patients with bacterial infections, gram-positive organisms were isolated in 78% of cases. Patients having the highest incidence of documented infections were those with leukemia who had active disease (induction or relapse), and severe neutropenia (less than 200 granulocytes/microliter). Antibiotic therapy with cephalothin, gentamicin, and carbenicillin (CGC), was effective in 41 of 45 (91.1%) episodes of documented infection in the total group of patients.
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PMID:Fever and neutropenia in children with neoplastic disease: an analysis of 158 episodes. 735 Oct 24

In an open, prospective pilot study of pediatric cancer patients, 23 episodes of fever and neutropenia were treated with intravenous and then oral antibiotics. After 72 hours, patients were changed from intravenous to oral antibiotics if the following criteria were met: negative blood cultures, temperature 38.0 degrees C or lower for 24 hours, absolute neutrophil count less than 0.5 x 10(9)/L, and absence of clinical sepsis. Three patients (13%) had recurrent fever. Intravenous antibiotics were reinstituted in two of these three patients, and oral antibiotics were continued in the third. Fever was believed to be related to relapsed leukemia in one of the three patients. No focus of infection was defined in the other two, and both had good clinical outcomes. The study suggests that this approach to therapy is feasible and can be safely used for selected patients who are anticipated to have a short duration of neutropenia.
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PMID:Early discharge of pediatric febrile neutropenic cancer patients by substitution of oral for intravenous antibiotics. 794 14

Authors report their first experiences with the application of granulocyte-macrophage colony stimulating factor in 12 pediatric cancer patients (14 cases). The drug was given in a 5 micrograms/kg single daily dose subcutaneously. Patients were divided into three main indication groups: 1. Severe neutropenia (white blood cell count < 1.0 G/l) and sepsis (6 patients); 2. Prolonged neutropenia (white blood cell count: 1.0-2.0 G/l) and delay in treatment (3 patients); 3. Dose-escalation of chemotherapy in therapy-resistant cases (4 patients). Authors report that in all cases a substantial raise in white blood cell count could be achieved after 5-6 days of granulocyte-macrophage colony stimulating factor treatment. No side effects were detected except of a moderate local pain at the site of the injection. Authors suggest that in the above described dose and way of administration granulocyte-macrophage colony stimulating factor can be an effective agent in the treatment of chemotherapy-induced neutropenia in paediatric oncology.
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PMID:[First experience with the use of granulocyte-macrophage colony stimulating factor in pediatric oncology]. 835 Nov 31


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