Çocuklarda Malignite ve Ateş
Özet
Ateşi ve nötropenisi olan kanserli çocuklar için risk sınıflandırması önerilmektedir. Bu yaklaşımın genel etkisini ölçmek ve hangi çocukların erken antibiyotik uygulamasından ve antibiyotiğe dirençli organizmaları kapsayacak şekilde ampirik rejimlerde yapılacak değişikliklerden fayda sağlayacağını tam olarak belirlemek için daha fazla araştırma yapılması gerekmektedir. Febril nötropenik pediatrik hastanın tedavisine yaklaşım, yüksek ve düşük risk kriterlerinin tanımlanması ve geniş spektrumlu antibiyotiklerin geliştirilmesiyle önemli ölçüde değişmiştir. Her ne kadar bireysel değerlendirme ve yönetim stratejileri yerel epidemiyoloji, mikrobiyal direnç paternleri ve kurumsal uygulama standartlarına dayandırılsa da, bu hastalara genel yaklaşım aynıdır. Kritik veya septik nötropenik hastalara ileri yaşam desteği kılavuzlarına göre resüsitasyon uygulanmalı, kültürler alınmalı ve geniş spektrumlu antibiyotikler uygulanmalıdır. Kapsamlı onkolojik bakım, etkili tedaviler ve uzun vadeli sağ kalımın iyileşmesi sonucunda, pediatrik kanser hastaları kliniklere sıkça başvurabilmektedir. Sonuç olarak, kanser hastalarında FN, pediatri merkezleri dışında acil servis hekimleri tarafından yaygın olarak görülmektedir. Hızlı değerlendirme ve tedavi başlanması çocukların prognoz için oldukça önemlidir.
Referanslar
Lam CG, Howard SC, Bouffet E, Pritchard-Jones K. Science and health for all children with cancer. Science. 2019;363(6432):1182-1186.
Siegel DA, King JB, Lupo PJ, Durbin EB, Tai E, Mills K, Van Dyne E, Buchanan Lunsford N, Henley SJ, Wilson RJ. Counts, incidence rates, and trends of pediatric cancer in the United States, 2003-2019. J Natl Cancer Inst. 2023;115(11):1337-1354.
Fragkandrea I, Nixon JA, Panagopoulou P. Signs and symptoms of childhood cancer: a guide for early recognition. Am Fam Physician. 2013;88(3):185-192.
Morgan JE. Fifteen minute consultation: Fever in children being treated for cancer. Arch Dis Child Educ Pract Ed. 2019;104(3):124-128.
Adamczewska-Wawrzynowicz K, Wiącek A, Kozłowska A, et al. Modern treatment strategies in pediatric oncology and hematology. Discov Oncol. 2023;14(1):98.
Kaatsch P. Epidemiology of childhood cancer. Cancer Treat Rev. 2010; 36(4):277-285.
Steliarova-Foucher E, Stiller C, Kaatsch P, et al. Geographical patterns and time trends of cancer incidence and survival among children and adolescents in Europe since the 1970s (the ACCIS project): an epidemiological study. Lancet. 2004;364(9451):2097-2105.
Lanzkowsky PS, ed. Manual of Pediatric Hematology and Oncology. 5th ed. London, United Kingdom: Academic Press (Elsevier); 2010.
Malogolowkin M, Quinn J, Steuber C, et al. Clinical assessment and differential diagnosis of the child with suspected cancer. In: Pizzo PA,
Poplack DG, eds. Principles and Practice of Pediatric Oncology. 5th ed. Philadelphia, Pa.: Lippincott-Raven; 2006.
Pinkerton R, Plowman P, Pieters RS, eds. Paediatric Oncology. 3rd ed. London, United Kingdom: Hodder Arnold; 2004.
Neville KA, Steuber CP. Clinical assessment of the child with suspected cancer. UpToDate. http://www.uptodate.com/contents/clinical-assessment-of-the-child-with-suspected-cancer (subscription required). Literature review current through: Feb 2018.
Bernbeck B, Wüller D, Janssen G, et al. Symptoms of childhood acute lymphoblastic leukemia: red flags to recognize leukemia in Daily practice. Klin Padiatr. 2009;221(6):369-373.
National Health Service. Clinical guidelines CG27. Referral guide lines for suspected cancer. June 2005. National Institute for Healthand Clinical Excellence. http://www.nice.org.uk/CG027. Accessed January 18, 2012.
Leung AK, Robson WL. Childhood cervical lymphadenopathy. J Pediatr Health Care. 2004;18(1):3-7.
Nazemi KJ, Malempati S. Emergency department presentation of childhood cancer. Emerg Med Clin North Am. 2009;27(3):477-495.
Strain JD. ACR appropriateness criteria on headache–child. J Am Coll Radiol. 2007;4(1):18-23.
Malogolowkin M, Quinn J, Steuber C, et al. Clinical assessment and differential diagnosis of the child with suspected cancer. In: Pizzo PA, Poplack DG, eds. Principles and Practice of Pediatric Oncology. 5th ed. Philadelphia, Pa.: Lippincott-Raven; 2006.
Widhe B, Widhe T. Initial symptoms and clinical features in osteosarcoma and Ewing sarcoma. J Bone Joint Surg Am. 2000;82(5):667-67
McCarville MB. The child with bone pain: malignancies and mimickers. Cancer Imaging. 2009;9 Spec No A:S115-S121.
Hughes WT, Bodey GP, Bow EJ, et al. Guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 2002; 34:730–51.
Henry M, Sung L. Supportive care in pediatric oncology: oncologic emergencies and management of fever and neutropenia. Pediatr Clin North Am 2015; 62:27–46.
Mueller EL, Walkovich KJ, Mody R, et al. Hospital discharges for fever and neutropenia in pediatric cancer patients: United States. BMC Cancer 2015; 15:388.
Mueller EL, Sabbatini A, Gebremariam A, et al. Why pediatric patients with cancer visit the emergency department: United States. Pediatr Blood Cancer 2015; 62:490–495.
Henry M, Sung L. Supportive care in pediatric oncology: oncologic emergencies and management of fever and neutropenia. Pediatr Clin North Am 2015; 62:27–46.
Haeusler GM, Sung L, Ammann RA, Phillips B. Management of fever and neutropenia in paediatric cancer patients: room for improvement?. Curr Opin Infect Dis. 2015;28(6):532-538.
Auletta JJ, O’Riordan MA, Nieder ML. Infections in children with cancer: a continued need for the comprehensive physical examination. J Pediatr Hematol Oncol. 1999;21(6):501–8.
Basu SK, Fernandez ID, Fisher SG, Asselin BL, Lyman GH. Length of stay and mortality associated with febrile neutropenia among children with cancer. J Clin Oncol. 2005; 23(31):7958–66.
Bodey GP, WhitecarJr JP, Middleman E, Rodriguez V. Carbenicillint herapy for pseudomonas infections. JAMA. 1971;218(1):62–6.
Schimpff S, Satterlee W, Young VM, Serpick A. Empiric therapy with carbenicillin and gentamicin for febrile patients with cancer and granulocytopenia. N Engl J Med. 1971;284(19):1061–5.
Kurt B, Flynn P, Shenep JL, et al. Prophylactic antibiotics reduce morbidity due to septicemia duringin tensive treatment for pediatric acute myeloid leukemia. Cancer. 2008;113(2):376–82.
Egan G, Robinson PD, Martinez JPD, et al. Efficacy of antibiotic prophylaxis in patients with cancer and hematopoietic stem cell transplantation recipients: a systematic review of randomized trials. Cancer Med. 2019;8(10):4536–46.
Alexander S, Fisher BT, Gaur AH, et al. Effect of levofloxacin prophylaxis on bacteremia in children with acute leukemia or undergoing hematopoietic stem cell transplantation: a randomized clinical trial. JAMA. 2018; 320(10):995–1004.
Lucas KG, Brown AE, Armstrong D, Chapman D, Heller G. The identification of febrile, neutropenic children with neoplastic disease at low risk for bacteremia and complications of sepsis. Cancer. 1996;77(4):791–8.
Rackoff WR, Gonin R, Robinson C, Kreissman SG, Breitfeld PB. Predicting the risk of bacteremia in childen with fever and neutropenia. J Clin Oncol. 1996;14(3):919–24.
Hakim H, Flynn PM, Knapp KM, Srivastava DK, Gaur AH. Etiology and clinical course of febrile neutropenia in children with cancer. J Pediatr Hematol Oncol. 2009;31(9): 623–9.
Agyeman P, Kontny U, Nadal D, et al. A prospective multi center study of microbiologically defined infections in pediatric cancer patients with fever and neutropenia: Swiss Pediatric Oncology Group 2003 fever and neutropenia study. Pediatr Infect Dis J. 2014;33(9):e219–25.
Castagnola E, Fontana V, Caviglia I, et al. A prospective study on the epidemiology of febrile episodes during chemotherapy-induced neutropenia in children with cancer or after hemopoietic stem cell transplantation. Clin Infect Dis. 2007;45(10):1296–304.
Hunger SP, Lu X, Devidas M, et al. Improved survival for children and adolescents with acute lymphoblastic leukemia between 1990 and 2005: a report from the children’s oncology group. J Clin Oncol. 2012;30(14): 1663–9 10.
Aquino VM, Pappo A, Buchanan GR, Tkaczewski I, Mustafa MM. The changing epidemiology of bacteremia in neutropenic children with cancer. Pediatr Infect Dis J. 1995;14(2):140–3.
Viscoli C, Varnier O, Machetti M. Infections in patients with febrile neutropenia: epidemiology, microbiology, and risk stratification. Clin Infect Dis. 2005;40(Suppl. 4): S240–5.
Zinner SH. Changing epidemiology of infections in patients with neutropenia and cancer: emphasis on gram-positive and resistant bacteria. Clin Infect Dis. 1999;29 (3):490–4.
Yadegarynia D, Tarrand J, Raad I, Rolston K. Current spectrum of bacterial infections in patients with cancer. Clin Infect Dis. 2003;37(8):1144–5.
Boutati EI, Anaissie EJ. Fusarium, a significant emerging pathogen in patients with hematologic malignancy: ten years’ experience at a cancer center and implications for management. Blood. 1997;90(3):999–1008 199.
Walsh TJ, Pizzo PA. Nosocomial fungal infections: a classification for hospital-acquired fungal infections and mycoses arising from endogenous flora or reactivation. Annu Rev Microbiol. 1988; 42:517–45.
Pizzo PA, Walsh TJ. Fungal infections in the pediatric cancer patient. Semin Oncol. 1990;17(3 Suppl 6):6–9.
Katsimpardi K, Papadakis V, Pangalis A,et al. Infections in a pediatric patient cohort with acute lymphoblastic leukemia during the entire course of treatment. Support Care Cancer. 2006;14(3):277–84.
Lindblom A, Bhadri V, Söderhäll S, et al. Respiratory viruses, a common microbiological finding in neutropenic children with fever. J Clin Virol. 2010;47(3):234–7.
Torres JP, Labraña Y, Ibañez C, et al. Frequency and clinical outcome of respiratory viral infections and mixed viral-bacterial infections in children with cancer, fever and neutropenia. Pediatr Infect Dis J. 2012;31(9):889–93.
Suryadevara M, Tabarani CM, Bartholoma N, Rosenberg HF, Domachowske JB. Nasopharyngeal detection of respiratory viruses in febrile neutropenic children. Clin Pediatr (Phila). 2012;51(12):1164–7.
Ramphal R, Grant RM, Dzolganovski B, et al. Herpes simplex virus in febrile neutropenic children undergoing chemotherapy for cancer: a prospective cohort study. Pediatr Infect Dis J. 2007;26(8):700–4.
Pizzo PA, Robichaud KJ, Wesley R, Commers JR. Fever in the pediatric and young adult patient with cancer. A prospective study of 1001 episodes. Medicine (Baltimore). 1982;61(3):153–65.
Cleary JF. Fever andsweats: Including the immuno compromised hosts. In: Berger A, Portenoy RK, Weissman DE, editors. Principles and practice of supportive oncology. Philadelphia: Lippincott-Raven. Publishers; 1998. p. 119–31.
Mackowiak PA. Drugfever. In: Mackowiak PA, editor. Fever: Basic mechanisms and management. New York: Raven Press; 1991. p. 255–65.
Phillips B, Selwood K, Lane SM, et al. Variation in policies for the management of febrile neutropenia in United Kingdom children’s cancer study group centres. Arch Dis Child. 2007;92(6):495–8.
Walkovich K, Boxer LA. How to approach neutropenia in childhood. Pediatr Rev. 2013;34(4):173–84.
Zimmer AJ, Freifeld AG. Optimal management of neutropenic fever in patients with cancer. J Oncol Pract. 2019;15(1):19–24.
Zinter MS, Dvorak CC, Auletta JJ. How we treat fever and hypotension in pediatric hematopoietic cell transplant patients. Front Oncol. 2020;10:581447 16.
Groll AH, Pana D, Lanternier F, et al. 8th European Conference on Infections in Leukaemia: 2020 guidelines for the diagnosis, prevention, and treatment of invasive fungal diseases in paediatric patients with cancer or post-haematopoietic cell transplantation. Lancet Oncol. 2021;22(6): e254–69.
Lehrnbecher T, Averbuch D, Castagnola E, et al. 8th European Conference on Infections in Leukaemia: 2020 guidelines for the use of antibiotics in paediatric patients with cancer or post-haematopoietic cell transplantation. Lancet Oncol. 2021;22(6):e270–80.
Gerber JS, Newland JG, Coffin SE, et al. Variability in antibiotic use at children’s hospitals. Pediatrics. 2010;126(6):1067–73.
Fisher BT, Gerber JS, Leckerman KH, et al. Variation in hospital antibiotic prescribing practices for children with acute lymphoblastic leukemia. LeukLymphoma. 2013;54(8):1633–9.
Phillips RS, Lehrnbecher T, Alexander S, Sung L. Updated systematic review and meta-analysis of the performance of risk prediction rules in children and young people with febrile neutropenia. PLoS One. 2012;7(5):e38300.
Alexander SW, Wade KC, Hibberd PL, Parsons SK. Evaluation of risk prediction criteria for episodes of febrile neutropenia in children with cancer. J Pediatr Hematol Oncol. 2002;24(1):38–42.
Dommett R, Geary J, Freeman S, et al. Successful introduction and audit of a step-down oral antibiotic strategy for low risk paediatric febrile neutropaenia in a UK, multicentre, shared care setting. Eur J Cancer. 2009;45 (16):2843–9.
Pulcini CD, Lentz S, Saladino RA, et al. Emergency management of fever and neutropenia in children with cancer: A review. Am J Emerg Med. 2021;50:693-698.
Arif T, Phillips RS. Updated systematic review and meta-analysis of the predictive value of serum biomarkers in the assessment and management of fever during neutropenia in children with cancer. Pediatr Blood Cancer. 2019;66(10):e27887.
Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin Infect Dis. 2011;52(4):e56–93.
Kuderer NM, Dale DC, Crawford J, Cosler LE, Lyman GH. Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer. 2006;106 (10):2258–66.
Clarke V, Dunstan FD, Webb DK. Granulocyte colony-stimulating factor ameliorates toxicity of intensification chemotherapy for acute lymphoblastic leukemia. Med Pediatr Oncol. 1999;32(5):331–5.
Michon JM, Hartmann O, Bouffet E, et al. An open-label, multicentre, randomised phase 2 study of recombinant human granulocyte colony stimulating factor (filgrastim) as an adjunct to combination chemotherapy in paediatric patients with metastatic neuroblastoma. Eur J Cancer. 1998;34(7):1063–9.
Sung L, Nathan PC, Lange B, Beyene J, Buchanan GR. Prophylactic granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor decrease febrile neutropenia after chemotherapy in children with cancer: a meta analysis of randomized controlled trials. J Clin Oncol. 2004;22(16):3350–6.
Ozkaynak MF, Krailo M, Chen Z, Feusner J. Randomized comparison of antibiotics with and without granulocyte colony-stimulating factor in children with chemotherapy-induced febrile neutropenia: a report from the Children’s Oncology Group. Pediatr Blood Cancer. 2005;45(3):274–80.
Lehrnbecher T, Welte K. Haematopoietic growth factors in children with neutropenia. Br J Haematol. 2002;116(1):28–56.
Mhaskar R, Clark OA, Lyman G, et al. Colony-stimulating factors for chemotherapy-induced febrile neutropenia. Cochrane Database SystRev. 2014;10:CD003039.
Ariffin H, Navaratnam P, Lin HP. Surveillances tudy of bacteraemic episodes in febrile neutropenic children. Int J Clin Pract. 2002;56(4):237–40.
Lehrnbecher T, Varwig D, Kaiser J, et al. Infectious complications in pediatric acute myeloid leukemia: analysis of the prospective multi-institutional clinical trial AML-BFM 93. Leukemia. 2004;18(1):72–7.
Rondinelli PI, RibeiroKde C, de Camargo B. A proposed score for predicting severe infection complications in children with chemotherapy-induced febrile neutropenia. J Pediatr Hematol Oncol. 2006;28(10):665–70.
Santolaya ME, Alvarez AM, Avilés CL, et al. Admission clinical and laboratory factors associated with death in children with cancer during a febrile neutropenic episode. Pediatr Infect Dis J. 2007;26(9):794–8.
Klastersky J, Ameye L, Maertens J, et al. Bacteraemia in febrile neutropenic cancer patients. Int J Antimicrob Agents. 2007;30 (Suppl. 1): S51–9.
