小児急性リンパ性白血病治療中の重症感染症の検討

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  • Infectious Complications in Children with Acute Lymphoblastic Leukemia during Chemotherapy

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We analyzed the complications of severe infectious episodes in 223 children with acute lymphoblastic leukemia (ALL) who were treated by the Japan Association of Childhood Leukemia Study (JACLS) ALL-02 protocol from June 2003 to May 2004. Sixty-two cases were complicated with bacterial or fungal infections. In 49of these patients, infectious episodes occurred during neutropenia (< 500/, u1 of peripheral neutrophil counts).Among causes of infection in the neutropenic patients, gram-negative bacteria accounted for 32.7%, gram-positive bacteria for 59.2%, and fungi for 8.2%. In the patients with complications of bacterial infections of gram-positive or gram-negative pathogens, infectious symptoms disappeared with initial empirical antibiotic therapy. On the other hand, thelesions of fungal infections in three children (two systemic Candidasis and one Aspergillus pneumoniae) did not disappear despite antifungal therapy, so the ALL-02 protocol was discontinued in these patients. In the treatment of ALL, it seemed that prevention and the treatment management of fungal infections were important as well as broad spectrum antibiotic empirical therapy.

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