RESUMEN
Serum antibody response to a conjugated Haemophilus influenzae type b polyribosylribitol phosphate-diphtheria toxoid vaccine was assessed in nonvaccinated children aged 1 1/2 to 5 years receiving chemotherapy for solid tumors. Responses occurred in 21 (42%) of 50 children after first vaccination, and in 10 (45%) of 22 revaccinated children.
Asunto(s)
Anticuerpos Antivirales/sangre , Toxoide Diftérico/inmunología , Vacunas contra Haemophilus/inmunología , Haemophilus influenzae/inmunología , Huésped Inmunocomprometido , Vacunas Conjugadas/inmunología , Preescolar , Humanos , Lactante , Neoplasias/tratamiento farmacológico , Neoplasias/inmunologíaRESUMEN
Two children with cancer received azithromycin for Cryptosporidium-associated diarrhea that was unresponsive to supportive care. One child had choleriform diarrhea requiring daily fluid replacement of up to 65% of his total body weight; the other had protracted diarrhea and wasting. In both cases, administration of azithromycin was followed by prompt clinical improvement.
Asunto(s)
Criptosporidiosis/tratamiento farmacológico , Diarrea Infantil/tratamiento farmacológico , Diarrea/tratamiento farmacológico , Eritromicina/análogos & derivados , Neoplasias del Mediastino/complicaciones , Neuroblastoma/complicaciones , Infecciones Oportunistas/tratamiento farmacológico , Sarcoma/complicaciones , Administración Oral , Azitromicina , Preescolar , Terapia Combinada , Criptosporidiosis/etiología , Diarrea/etiología , Diarrea Infantil/etiología , Evaluación de Medicamentos , Eritromicina/administración & dosificación , Fluidoterapia , Humanos , Lactante , Masculino , Infecciones Oportunistas/etiologíaRESUMEN
We reviewed 60 consecutive flexible bronchoscopies done during a 36-month period in 48 pediatric cancer patients with undiagnosed pulmonary infiltrates. Diagnostic procedures during bronchoscopy included 40 brushings, 50 bronchoalveolar lavages, and 6 transbronchial and mucosal biopsies. A total of 16 specific diagnoses were made by bronchoscopy (27% diagnostic yield), including infection (12), pulmonary leukemia (3), and lymphoma (1). The largest proportion of specific diagnoses came from lavage (14/50) and the smallest from brushings (1/40). Biopsies were also useful for selected patients. The low overall yield for bronchoscopy was probably due to the routine use of empiric broad-spectrum antibiotics and antifungal therapy, as well as trimethoprim-sulfamethoxazole prophylaxis for Pneumocystis carinii pneumonitis. Subsequent specific diagnoses were obtained by other procedures (open biopsy, needle aspiration, or autopsy) for 10 patients with negative bronchoscopy results and 3 patients with diagnostic bronchoscopies. These additional diagnoses included 7 infections (Pneumocystis carinii (1), Candida tropicalis (1), cytomegalovirus (1), and Aspergillus (4), and 6 other diagnoses with nonspecific histologic findings. A positive bronchoscopy result may be useful, but negative bronchoscopy findings do not justify delaying other diagnostic procedures or discontinuing antibiotic and antifungal therapy in children with cancer and pulmonary infiltrates.
Asunto(s)
Broncoscopía , Enfermedades Pulmonares/diagnóstico , Neoplasias/complicaciones , Adolescente , Adulto , Anfotericina B/uso terapéutico , Antibacterianos/uso terapéutico , Biopsia , Niño , Preescolar , Humanos , Enfermedades Pulmonares/etiología , Neumonía por Pneumocystis/diagnóstico , Irrigación TerapéuticaRESUMEN
The efficacy of orally administered sucralfate suspension in preventing and treating chemotherapy-induced mucositis was evaluated in a double-blind trial. Forty-eight children and adolescents with newly diagnosed acute nonlymphocytic leukemia were randomized to receive suspensions of either sucralfate or placebo orally every 6 hours during the first 10 weeks of intensive remission-induction chemotherapy. Patients given sucralfate suspension were less likely than subjects receiving placebo to acquire colonization with potentially pathogenic microorganisms: 14 (58%) of 24 versus 22 (92%) of 24, respectively (p = 0.008). However, no effect on preexisting colonization was noted. Subjective reporting of discomfort, objective scoring of the severity of mucositis, and the maximal percent of body weight lost during therapy were similar; 58% of patients receiving sucralfate reported no oral pain compared with 25% receiving placebo (p = 0.06). Ten episodes of gastrointestinal bleeding, 25 documented infections, and 886 days with fever were also equally distributed between sucralfate and placebo groups. We conclude that sucralfate suspension is of limited, if any efficacy, in the prevention and treatment of chemotherapy-induced mucositis. Sucralfate administration can, however, reduce acquisition of alimentary colonization with potential pathogens, perhaps by interfering with adherence to mucosal membranes.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Mucosa Bucal/patología , Estomatitis/prevención & control , Sucralfato/uso terapéutico , Administración Oral , Adolescente , Niño , Ensayos Clínicos como Asunto , Método Doble Ciego , Femenino , Hemorragia Gastrointestinal/prevención & control , Humanos , Leucemia Mieloide Aguda/tratamiento farmacológico , Masculino , Distribución Aleatoria , Estomatitis/inducido químicamente , Sucralfato/administración & dosificación , Sucralfato/efectos adversosRESUMEN
Four children developed mycotic cervical lymphadenitis while receiving cytotoxic chemotherapy for acute leukemia. Neutropenia, oral mucositis, and broad-spectrum antibiotic administration preceded the appearance of lymphadenitis in each case. Enlarged tender cervical lymph nodes of mycotic origin were not clinically distinguishable from lymphadenitis of bacterial or viral origin. Although cervical lymphadenitis was the initial clinical manifestation of deep fungal infection, computerized tomography of the chest and abdomen subsequently demonstrated asymptomatic pulmonic, splenic, or hepatic lesions characteristic of fungal abscesses in all four children. These findings demonstrate the importance of microbiologic identification of the etiologic agents of cervical lymphadenitis following mucositis and neutropenia in children with leukemia.