Types of Infections |
Bacterial
Antibiotics can be used in the treatment of bacteria. The challenge here is to properly identify the bacteria, if possible, so the proper antibiotic can be applied. Not all antibiotics work on all bacteria. There are also strains of bacteria that are resistant to antibiotics. Without the help of the body's immune system, these bacterial infections can destroy tissue and organs. Bacterial infections are the leading cause of death in children with cancer.
Viral
Viral infections are very difficult to treat, even in healthy people. Viruses are like little machines that invade cells and make many more of themselves. Because of their simple structure, modern medicine has been unable to find effective cures for these types of infections after they have occurred. Vaccinations are the most common way to prevent viral infections, such as the flu shot. There are a few anti-viral drugs available (such as Tamiflu) that are used with cancer patients if they contract a viral infection.
Fungal
Fungal infections have been rare in humans but have been occurring in greater numbers due to the use of immunosuppressive treatments of cancer and other diseases (i.e. rheumatoid arthritis). Fungi are a very primitive life form that is somewhat plant-like. Spores from fungi are floating all around us. When we inhale the spores, our immune system does a fantastic job of clearing them out of our body. Children with compromised immune systems can miss these spores allowing them to start growing in the body. As the fungus grows, it consumes tissues around it and causes great damage. Fungal infections are very difficult for the body to eradicate as the size of the fungus is gigantic compared to a white blood cell. Compare it to you trying to pull down a tree. Anti-fungal drugs are effective in breaking up the fungus into smaller pieces that then the body's immune system can consume.
Antibiotics can be used in the treatment of bacteria. The challenge here is to properly identify the bacteria, if possible, so the proper antibiotic can be applied. Not all antibiotics work on all bacteria. There are also strains of bacteria that are resistant to antibiotics. Without the help of the body's immune system, these bacterial infections can destroy tissue and organs. Bacterial infections are the leading cause of death in children with cancer.
Viral
Viral infections are very difficult to treat, even in healthy people. Viruses are like little machines that invade cells and make many more of themselves. Because of their simple structure, modern medicine has been unable to find effective cures for these types of infections after they have occurred. Vaccinations are the most common way to prevent viral infections, such as the flu shot. There are a few anti-viral drugs available (such as Tamiflu) that are used with cancer patients if they contract a viral infection.
Fungal
Fungal infections have been rare in humans but have been occurring in greater numbers due to the use of immunosuppressive treatments of cancer and other diseases (i.e. rheumatoid arthritis). Fungi are a very primitive life form that is somewhat plant-like. Spores from fungi are floating all around us. When we inhale the spores, our immune system does a fantastic job of clearing them out of our body. Children with compromised immune systems can miss these spores allowing them to start growing in the body. As the fungus grows, it consumes tissues around it and causes great damage. Fungal infections are very difficult for the body to eradicate as the size of the fungus is gigantic compared to a white blood cell. Compare it to you trying to pull down a tree. Anti-fungal drugs are effective in breaking up the fungus into smaller pieces that then the body's immune system can consume.
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Types of Infections
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Immunosuppressive Agents
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Fungi
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Bacteria
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Viruses
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Patriss Wais Moradi, BS and Thomas J. Walsh, MD, FAAM, FIDSA
Mouth
Mucositis of the Mouth
Also known as mouth soreness and an inflammatory reaction of the soft tissues. It is a common side effect of chemotherapy, radiation therapy, and surgery at the head and neck. The treatments damage the cancer they target, but can also affect delicate cells in the mouth.
Symptoms:
Symtoms can include ulcers and sores on the mouth, gums, and tongue; a burning sensation in the mouth; loss of taste or sensitivity to hot or cold; and dry mouth.
Respiratory Tract
Pneumonia
An infection of the lungs, which can be caused by an invasion bacteria, bacteria-like organisms, viruses, fungi and various parasites into the small air spaces of the lung, called alveoli. It can also develop after another illness. Pneumonia decreases the lungs' ability to receive and distribute oxygen. It is not usually contagious, but the bacterial and viral organisms that cause it can be transmitted through airborne or direct contact.
Symptoms:
Symptoms include fever, cough, chest pain, difficulty breathing, and an increased number of breaths per minute. Mucus production is increased, and therefore children may cough up clumps of mucus, which may be streaked with blood or pus. In extremely severe cases, there may be signs of oxygen deprivation in the lungs, resulting in reduced oxygen levels in the blood, which produce blue color in nail beds or lips.
Types of pneumonia:
Sinusitis
Develops when sinuses (spaces behind the forehead, nasal bones, cheeks and eyes) become infected by bacteria, viruses, or fungi. Healthy sinuses contain relatively few bacteria of fungi and the mucus is able to drain out allowing air to circulate.
Types of sinusitis:
Symptoms:
Symptoms include bad breath or loss of smell; cough; fatigue; fever; headache (pressure-like, pain behind the eyes, gums, or facial tenderness); nasal congestion and darkened discharge; nasal discharge with or without a cough that has been present for more than 10 days and is not improving; sore throat and postnasal drip.
Gastrointestinal Tract
Diarrhea
Loose, watery stool, which is passed three or more times a day.
Types of Diarrhea:
Symptoms:
Symptoms include cramping, abdominal pain, nausea, urgent need to use the bathroom, loss of bowel control. If caused by infection, it can cause fever, chill, or bloody stool.
Dehydration
Diarrhea causes dehydration, which happens due to loss of fluids and electrolytes, and must be treated promptly, so that it does not cause damage.
Symptoms:
Symptoms of dehydration in young children: dry mouth and tongue, no tears when crying, no wet diapers for 3 hours or more, sunken eyes, cheeks, or soft spot in the skull, high fever, listlessness or irritability.
Colitis
Swelling of inflammation of the large intestine. It can be caused by infections, by a virus, parasite, and bacteria causing food poisoning. Lack of blood flow and past radiation to the large bowel can also act as causes for colitis.
Symptoms:
Symptoms include abdominal (stomach) pain and bloating that is constant or comes and goes; blood in stool; chills; constant urge to have a bowel movement, dehydration; diarrhea; fever.
Urinary Tract
Consists of organs, tubes, muscles that work together to make, move, store, and release urine. The kidneys (upper urinary tract) filter wastes and extra fluid from the blood and the ureters, which carry urine from kidneys to the bladder. The bladder (lower urinary tract) is a balloon shaped muscle that stores urine, and the urethra (a tube) carries urine from the bladder to the outside of the body during urination.
Kidney Infection
A type of urinary tract infection that begins in the urethra or bladder and travels up into the kidneys. This can be caused by bacteria entering the urinary tract. Though rare, bacteria from an infection in a different part of the body an also spread to the kidneys.
Symptoms:
Symptoms include fever; back, side, or groin pain; abdominal pain; frequent urination; strong, persistent urge to urinate; burning sensation or pain when urinating; pus or blood in urine; chills and shaking; flushed, warm, reddened skin; nausea; vomiting.
Bladder Infection
Caused by bacteria (which normally live on the skin) enter the bladder. In children, bladder infections can be caused by a problem in the urinary tract (present at birth), which allows urine to flow back up to the ureters (tubes that take urine from each kidney to the bladder) and kidneys; brain or nervous system illness that makes it more difficult to empty the bladder; bubble baths; tight-fitting clothing; not urinating enough during the day; wiping from back to front after going to the bathroom causing the bacteria to enter the tract and travel to the bladder.
Symptoms:
Symptoms include blood in the urine; cloudy urine; foul or strong urine odor; frequent and urgent need to urinate; general ill feeling; pain or burning while urinating; pressure or pain in the lower pelvis or lower back; wetting problems after the child has been toilet trained.
Skin
Ulcer
A sore- an open, painful wound. Most ulcers are caused by a particular bacterial infection in the stomach or upper intestine, certain medication, or smoking.
Rashes
An area of irritated or swollen skin. The skin may appear red and itchy, bumpy, scaly, crusty or blistered. Can be caused by many different medical conditions, diseases, irritating substances, or allergic reactions. Most common cause of rashes is contact dermatitis, which causes redness, itching, burning upon contact.
Brain and Spinal Cord
Meningitis
This bacterial infection of the membranes covering the brain and the spinal cord is usually caused by viral infections as well as chemical irritation, drug allergies, fungi, and tumors. Bacterial meningitis requires immediate treatment and can have detrimental consequences. Meningitis caused by a virus occurs more often and can develop in late summer/early fall. Most infections occur in children under age 5.
Symptoms:
Symptoms include fever (important cause in children and newborns), chills, mental status changes, sensitivity to light, severe headaches, stiff neck, agitation, decreased consciousness, poor feeding or irritability, rapid breathing, unusual posture (head and neck arched backwards).
Encephalitis
This rare condition occurs more often in newborns and decreases with age. It is most often occurs due to a viral infection causing the brain to become irritated and inflamed. This can destroy nerve cells, causing bleeding and later brain damage. It can be transferred through breathing in infected droplets from an infected person, contaminated food or drink, mosquitoes, ticks, other insect bites, skin contact, allergic reaction to vaccinations, autoimmune disease, bacteria (syphilis, tuberculosis), and parasites (roundworms). Viruses, such as the herpes simplex virus are also leading causes of encephalitis. Cancer can also deteriorate the immune system, resulting in such an infection.
Symptoms:
Symptons include fever, mild headache, low energy and poor appetite, clumsiness, confusion, disorientation, drowsiness, irritability, light sensitivity, stiff neck and back, vomiting.
Symptoms in newborns:
Symptoms include body stiffness, irritability and crying more often than usual, poor feeding, soft spot on the top of head may bulge out more, vomiting.
Emergency symptoms:
Symptoms include loss of consciousness, poor responsiveness, stupor, coma, muscle weakness, paralysis, seizures, severe headache, and sudden drastic change in mental functions.
Eyes
Endophthalmitis
This is a condition where an infection due to bacteria, fungi, or viruses inside the lining of the eye causes it to become inflamed.
Symptoms:
Symptoms include decreased vision (may be partial or complete), pain, redness in the white of the eye, swelling of the eyelids, extreme sensitivity to light.
Bacterial of Fungal Keratitis
An infection of the cornea (the clear dome covering the iris and the pupil). This can be due to an infection from a contact lens or an injury to the eye where bacteria can be transferred into the eye.
Symptoms:
Symptoms include pain, reduced vision, light sensitivity and tearing or discharge from the eye.
Other types of Keratitis include:
Also known as Periorbital cellulitis is an infection of the soft tissue around the eye. This can be caused by an infection spreading from the membrane covering the outer part of the eye or from the nose and throat (such as a sinus infection). Pink eye (conjunctivitis) or sinusitis can be the start of a periorbital infection if it results it more redness and swelling around the eye area, including the eyelids
Mouth
Mucositis of the Mouth
Also known as mouth soreness and an inflammatory reaction of the soft tissues. It is a common side effect of chemotherapy, radiation therapy, and surgery at the head and neck. The treatments damage the cancer they target, but can also affect delicate cells in the mouth.
Symptoms:
Symtoms can include ulcers and sores on the mouth, gums, and tongue; a burning sensation in the mouth; loss of taste or sensitivity to hot or cold; and dry mouth.
Respiratory Tract
Pneumonia
An infection of the lungs, which can be caused by an invasion bacteria, bacteria-like organisms, viruses, fungi and various parasites into the small air spaces of the lung, called alveoli. It can also develop after another illness. Pneumonia decreases the lungs' ability to receive and distribute oxygen. It is not usually contagious, but the bacterial and viral organisms that cause it can be transmitted through airborne or direct contact.
Symptoms:
Symptoms include fever, cough, chest pain, difficulty breathing, and an increased number of breaths per minute. Mucus production is increased, and therefore children may cough up clumps of mucus, which may be streaked with blood or pus. In extremely severe cases, there may be signs of oxygen deprivation in the lungs, resulting in reduced oxygen levels in the blood, which produce blue color in nail beds or lips.
Types of pneumonia:
- Aspiration pneumonia - something, such as food or other particles, breathed into the lungs from the upper airway.
- Bacterial pneumonia - develops after a child inhales bacteria or other harmful pathogens into the lungs.
- Viral pneumonia - develops from inhaling infected droplets into the lungs from the upper airway.
- Fungal pneumonia - develops after inhalation of "spores" of fungi into the lungs
Sinusitis
Develops when sinuses (spaces behind the forehead, nasal bones, cheeks and eyes) become infected by bacteria, viruses, or fungi. Healthy sinuses contain relatively few bacteria of fungi and the mucus is able to drain out allowing air to circulate.
Types of sinusitis:
- Acute - caused by a bacterial infection and can last up to 4 weeks.
- Sub-acute - lasts 4-12 weeks
- Chronic - caused by bacteria or fungus and is a long-term swelling or inflammation of the sinuses lasting up to 3 months or longer.
Symptoms:
Symptoms include bad breath or loss of smell; cough; fatigue; fever; headache (pressure-like, pain behind the eyes, gums, or facial tenderness); nasal congestion and darkened discharge; nasal discharge with or without a cough that has been present for more than 10 days and is not improving; sore throat and postnasal drip.
Gastrointestinal Tract
Diarrhea
Loose, watery stool, which is passed three or more times a day.
Types of Diarrhea:
- Acute - caused by bacterial, viral, parasitic infections lasting 1-2 days.
- Chronic - can be related to a functional disorder such as irritable bowel syndrome or a chronic disease. It lasts at least 4 weeks. Symptoms may continue or come and go.
Symptoms:
Symptoms include cramping, abdominal pain, nausea, urgent need to use the bathroom, loss of bowel control. If caused by infection, it can cause fever, chill, or bloody stool.
Dehydration
Diarrhea causes dehydration, which happens due to loss of fluids and electrolytes, and must be treated promptly, so that it does not cause damage.
Symptoms:
Symptoms of dehydration in young children: dry mouth and tongue, no tears when crying, no wet diapers for 3 hours or more, sunken eyes, cheeks, or soft spot in the skull, high fever, listlessness or irritability.
Colitis
Swelling of inflammation of the large intestine. It can be caused by infections, by a virus, parasite, and bacteria causing food poisoning. Lack of blood flow and past radiation to the large bowel can also act as causes for colitis.
Symptoms:
Symptoms include abdominal (stomach) pain and bloating that is constant or comes and goes; blood in stool; chills; constant urge to have a bowel movement, dehydration; diarrhea; fever.
Urinary Tract
Consists of organs, tubes, muscles that work together to make, move, store, and release urine. The kidneys (upper urinary tract) filter wastes and extra fluid from the blood and the ureters, which carry urine from kidneys to the bladder. The bladder (lower urinary tract) is a balloon shaped muscle that stores urine, and the urethra (a tube) carries urine from the bladder to the outside of the body during urination.
Kidney Infection
A type of urinary tract infection that begins in the urethra or bladder and travels up into the kidneys. This can be caused by bacteria entering the urinary tract. Though rare, bacteria from an infection in a different part of the body an also spread to the kidneys.
Symptoms:
Symptoms include fever; back, side, or groin pain; abdominal pain; frequent urination; strong, persistent urge to urinate; burning sensation or pain when urinating; pus or blood in urine; chills and shaking; flushed, warm, reddened skin; nausea; vomiting.
Bladder Infection
Caused by bacteria (which normally live on the skin) enter the bladder. In children, bladder infections can be caused by a problem in the urinary tract (present at birth), which allows urine to flow back up to the ureters (tubes that take urine from each kidney to the bladder) and kidneys; brain or nervous system illness that makes it more difficult to empty the bladder; bubble baths; tight-fitting clothing; not urinating enough during the day; wiping from back to front after going to the bathroom causing the bacteria to enter the tract and travel to the bladder.
Symptoms:
Symptoms include blood in the urine; cloudy urine; foul or strong urine odor; frequent and urgent need to urinate; general ill feeling; pain or burning while urinating; pressure or pain in the lower pelvis or lower back; wetting problems after the child has been toilet trained.
Skin
Ulcer
A sore- an open, painful wound. Most ulcers are caused by a particular bacterial infection in the stomach or upper intestine, certain medication, or smoking.
Rashes
An area of irritated or swollen skin. The skin may appear red and itchy, bumpy, scaly, crusty or blistered. Can be caused by many different medical conditions, diseases, irritating substances, or allergic reactions. Most common cause of rashes is contact dermatitis, which causes redness, itching, burning upon contact.
Brain and Spinal Cord
Meningitis
This bacterial infection of the membranes covering the brain and the spinal cord is usually caused by viral infections as well as chemical irritation, drug allergies, fungi, and tumors. Bacterial meningitis requires immediate treatment and can have detrimental consequences. Meningitis caused by a virus occurs more often and can develop in late summer/early fall. Most infections occur in children under age 5.
Symptoms:
Symptoms include fever (important cause in children and newborns), chills, mental status changes, sensitivity to light, severe headaches, stiff neck, agitation, decreased consciousness, poor feeding or irritability, rapid breathing, unusual posture (head and neck arched backwards).
Encephalitis
This rare condition occurs more often in newborns and decreases with age. It is most often occurs due to a viral infection causing the brain to become irritated and inflamed. This can destroy nerve cells, causing bleeding and later brain damage. It can be transferred through breathing in infected droplets from an infected person, contaminated food or drink, mosquitoes, ticks, other insect bites, skin contact, allergic reaction to vaccinations, autoimmune disease, bacteria (syphilis, tuberculosis), and parasites (roundworms). Viruses, such as the herpes simplex virus are also leading causes of encephalitis. Cancer can also deteriorate the immune system, resulting in such an infection.
Symptoms:
Symptons include fever, mild headache, low energy and poor appetite, clumsiness, confusion, disorientation, drowsiness, irritability, light sensitivity, stiff neck and back, vomiting.
Symptoms in newborns:
Symptoms include body stiffness, irritability and crying more often than usual, poor feeding, soft spot on the top of head may bulge out more, vomiting.
Emergency symptoms:
Symptoms include loss of consciousness, poor responsiveness, stupor, coma, muscle weakness, paralysis, seizures, severe headache, and sudden drastic change in mental functions.
Eyes
Endophthalmitis
This is a condition where an infection due to bacteria, fungi, or viruses inside the lining of the eye causes it to become inflamed.
Symptoms:
Symptoms include decreased vision (may be partial or complete), pain, redness in the white of the eye, swelling of the eyelids, extreme sensitivity to light.
Bacterial of Fungal Keratitis
An infection of the cornea (the clear dome covering the iris and the pupil). This can be due to an infection from a contact lens or an injury to the eye where bacteria can be transferred into the eye.
Symptoms:
Symptoms include pain, reduced vision, light sensitivity and tearing or discharge from the eye.
Other types of Keratitis include:
- Amoebic Keratitis - which can be caused by parasites entering the eye by way of contact lenses.
- Fungal Keratitis - results due to an infection with fungi.
- Viral Keratitis - is caused by a viral infection such as herpes simplex and herpes zoster.
- Photokeratitis - results from an intense ultraviolet radiation exposure (an example is snow blindness).
Also known as Periorbital cellulitis is an infection of the soft tissue around the eye. This can be caused by an infection spreading from the membrane covering the outer part of the eye or from the nose and throat (such as a sinus infection). Pink eye (conjunctivitis) or sinusitis can be the start of a periorbital infection if it results it more redness and swelling around the eye area, including the eyelids
Immunosuppressive Drugs and Effects Used in Pediatric Patients
Patriss Wais Moradi, BS and Thomas J. Walsh, MD, FAAM, FIDSA
Effects of Hematological malignancies and chemotherapy
Anemia
Describes the disorder in which patients have less than normal levels of oxygen circulating in their blood stream. Common symptoms of anemia are weakness, headaches, and shortness of breath.
Neutropenia
Describes the condition in which patients have a markedly decreased number of immune cells called neutrophils. These immune cells are the body's soldiers and work to prevent and eliminate infectious organisms, such as bacteria and fungi, from invading the body. An increased risk of infection is characteristic of neutropenia.
Thrombocytopenia
This is a disorder in which there is a low amount of platelets in the blood. Platelets are sticky particles in the blood that prevent the body form bleeding. Patients with thrombocytopenia are easily bruised, and can have spontaneous nose bleeds.
Like all drugs, chemotherapeutic agents come with side effects. Some of the side effects of chemotherapy are Anemia, Neutropenia, and Thrombocytopenia. These side effects can also arise from blood cancers.
Basic Description of the Hematological malignancies
Leukemia
Leukemia is a type of cancer that takes place in the bone marrow. The bone marrow is responsible for regenerating and replenishing old blood, and immune cells. Leukemia is the state in which new blood or immune cells formed are defective in their function, and are not eliminated from the body. These defective blood cells multiply in vast numbers and cause damage to the body and the bone marrow.
There are two major forms of the leukemia (blood cancers) in children, and each form describes the characteristic family of blood cells it effects, and the 'rate' at which the cancer progresses. These are the Acute leukemias: Acute Myeloid Leukemia, and Acute lymphoblastic leukemia. The word acute describes the blood cancer as rapidly occurring over a short time. The Chronic Leukemias (Chronic lymphocytic leukemia, and Chronic myeloid leukemia) usually do not occur in children. The word Chronic describes the blood cancer as occurring over a long period of time.
Symptoms:
Symptoms of leukemia are fever or chills, frequent infections, small red spots in your skin (called petechiae), and bone pain or tenderness.
Hodgkin's and non-Hodgkin's Lymphomas
Hodgkin's and non-Hodgkin's lymphomas are a type of blood cancers that occurs when the bone marrow accidentally produces defective immune cells. Immune cells are important in helping people fight off infection. These particular immune cells are called B-cells and T-cells. B-cells exist to neutralize infectious pathogens, and T-cells serve to protect the body by destroying pathogens. Usually these defective cells are destroyed and eliminated, but in Hodgkin's and non-Hodgkin's lymphomas the defective cells escape the elimination process and duplicate uncontrollably, creating copies of themselves that serve no better purpose than to hurt the patient. Patients have a markedly increase in the number of infections because these cells are defective and thus cannot serve their purpose to defend the body from pathogens.
The main difference between Hodgkin's and non-Hodgkin's lymphoma is the specific immune cell each involves. Hodgkin's lymphoma is characterized by the presence of Reed-Sternberg cells, abnormal B-cells involved in neutralizing pathogens. If these reed-Sternberg cells are not present the lymphoma is usually characterized as non-Hodgkin's lymphoma. The difference is important because each has their own course of drug treatment.
There are chemotherapeutic agents, radiation therapy and stem cell transplant procedures that help patients overcome Hodgkin's and non-Hodgkin's lymphomas.
Symptoms:
Symptoms of Hodgkin's and non-Hodgkin's lymphomas are persistent fatigue, fever and chills, loss of appetite, and itching.
The Immune system
The immune system exists to protect us from the vast number of pathogens that try to take advantage of our body. The system contains a number of subsets and cells, which direct their actions to various parts of the infection fighting process. Some of the immune cells, B-cells and Plasma cells, recognize and tag pathogenic organisms to be eliminated and destroyed from the body. In contrast, T-cells directly kill pathogens by recognizing them as foreign invaders. There are other immune cells, Macrophages, neutrophils, and dendritic cells that respond first to an encounter of a pathogen. These immune cells, Macrophages, neutrophils, and dendritic cells, engulf or eat the pathogen they encounter.
As you can see the immune system serves as an army with separate divisions to aid an individual stay healthy. Therefore, these immune cells are readily created in the bone marrow. The bone marrow serves to create new immune cells to replenish those lost. Sometimes, the newly created immune cells attain mutations in their DNA, causing them to become cancerous, and multiply uncontrollably leading to various cancers, such as leukemia, lymphoma, etc.
These cancers arise due to defective states, i.e. mutations, in the immune cell's DNA. Therefore, pharmaceutical companies created various classes of chemotherapeutic agents to stop the replication of a cancer cell's DNA, leading to remission of the cancer.
Mechanism of Drug Action (Chemotherapeutic agents)
L-asparaginase (ELSPAR)
This is a drug that degrades a compound called asparagine. Asparagine is very important for proteins to function. Normal cells can make their own asparagine, but cancer cells in ALL (Acute Lymphoblastic Leukemia) rely on asparagine in the body to replicate and cause harm.
Alkylating agents
These are the class of chemotherapeutic agents that exert their action by inhibition of DNA replication, promoting cell death, and damaging the cancer cell's DNA structure. Note that DNA replication is pivotal for a cancer cell to proliferate and cause harm. Thus, any change or damage made to a cancer cell's DNA that hinders DNA replication cause that cancer cell to die off.
The following are different Drugs that are alkylating agents:
These are a class of chemotherapeutic agents that provide an impasse for cancer cells to multiply.
The following are different agents that are antimetabolites:
Cytarabine or Cytosine Arabinoside (AraC) - This agent exerts its effect by acting as a false components of DNA and thus halting a cancer cell from multiplying.
These are a class of therapeutic agent directed to stop the immune system from attacking the body. The body uses a natural steroid called cortisol, to regulate the extent of an immune response. Synthetic and natural agents that imitate the action of cortisol are called glucocorticosteroids or corticosteroids.
It is important to note that glucocorticosteroid therapy does not remedy the underlying disease but only decreases the inflammation as a result of the disorder.
Corticosteroids are used widely to regulate and decrease the extent of an autoimmune disorder. Autoimmune disorders are those in which the body's own immune system attacks itself, e.g. asthma or arthritis. These drugs are used to reduce the extent of nausea and vomiting caused by chemotherapeutic agents; corticosteroids are also utilized to control the pain and swelling that originates from cancer. Corticosteroid therapy is also used to prevent a recipient from rejecting his/her transplanted organ.
The following are different glucocorticosteroids in use:
This is the condition in which the Graft's, donor's bone marrow, immune cells attacks the recipient's body. This occurs because the transplant is allogeneic; the bone marrow donated is not an exact match with the recipient. There are therapeutic agents that are used to suppress the immune response of the graft donated to the recipient.
The following are agents are used to control GVHD:
Effects of Hematological malignancies and chemotherapy
Anemia
Describes the disorder in which patients have less than normal levels of oxygen circulating in their blood stream. Common symptoms of anemia are weakness, headaches, and shortness of breath.
Neutropenia
Describes the condition in which patients have a markedly decreased number of immune cells called neutrophils. These immune cells are the body's soldiers and work to prevent and eliminate infectious organisms, such as bacteria and fungi, from invading the body. An increased risk of infection is characteristic of neutropenia.
Thrombocytopenia
This is a disorder in which there is a low amount of platelets in the blood. Platelets are sticky particles in the blood that prevent the body form bleeding. Patients with thrombocytopenia are easily bruised, and can have spontaneous nose bleeds.
Like all drugs, chemotherapeutic agents come with side effects. Some of the side effects of chemotherapy are Anemia, Neutropenia, and Thrombocytopenia. These side effects can also arise from blood cancers.
Basic Description of the Hematological malignancies
Leukemia
Leukemia is a type of cancer that takes place in the bone marrow. The bone marrow is responsible for regenerating and replenishing old blood, and immune cells. Leukemia is the state in which new blood or immune cells formed are defective in their function, and are not eliminated from the body. These defective blood cells multiply in vast numbers and cause damage to the body and the bone marrow.
There are two major forms of the leukemia (blood cancers) in children, and each form describes the characteristic family of blood cells it effects, and the 'rate' at which the cancer progresses. These are the Acute leukemias: Acute Myeloid Leukemia, and Acute lymphoblastic leukemia. The word acute describes the blood cancer as rapidly occurring over a short time. The Chronic Leukemias (Chronic lymphocytic leukemia, and Chronic myeloid leukemia) usually do not occur in children. The word Chronic describes the blood cancer as occurring over a long period of time.
Symptoms:
Symptoms of leukemia are fever or chills, frequent infections, small red spots in your skin (called petechiae), and bone pain or tenderness.
Hodgkin's and non-Hodgkin's Lymphomas
Hodgkin's and non-Hodgkin's lymphomas are a type of blood cancers that occurs when the bone marrow accidentally produces defective immune cells. Immune cells are important in helping people fight off infection. These particular immune cells are called B-cells and T-cells. B-cells exist to neutralize infectious pathogens, and T-cells serve to protect the body by destroying pathogens. Usually these defective cells are destroyed and eliminated, but in Hodgkin's and non-Hodgkin's lymphomas the defective cells escape the elimination process and duplicate uncontrollably, creating copies of themselves that serve no better purpose than to hurt the patient. Patients have a markedly increase in the number of infections because these cells are defective and thus cannot serve their purpose to defend the body from pathogens.
The main difference between Hodgkin's and non-Hodgkin's lymphoma is the specific immune cell each involves. Hodgkin's lymphoma is characterized by the presence of Reed-Sternberg cells, abnormal B-cells involved in neutralizing pathogens. If these reed-Sternberg cells are not present the lymphoma is usually characterized as non-Hodgkin's lymphoma. The difference is important because each has their own course of drug treatment.
There are chemotherapeutic agents, radiation therapy and stem cell transplant procedures that help patients overcome Hodgkin's and non-Hodgkin's lymphomas.
Symptoms:
Symptoms of Hodgkin's and non-Hodgkin's lymphomas are persistent fatigue, fever and chills, loss of appetite, and itching.
The Immune system
The immune system exists to protect us from the vast number of pathogens that try to take advantage of our body. The system contains a number of subsets and cells, which direct their actions to various parts of the infection fighting process. Some of the immune cells, B-cells and Plasma cells, recognize and tag pathogenic organisms to be eliminated and destroyed from the body. In contrast, T-cells directly kill pathogens by recognizing them as foreign invaders. There are other immune cells, Macrophages, neutrophils, and dendritic cells that respond first to an encounter of a pathogen. These immune cells, Macrophages, neutrophils, and dendritic cells, engulf or eat the pathogen they encounter.
As you can see the immune system serves as an army with separate divisions to aid an individual stay healthy. Therefore, these immune cells are readily created in the bone marrow. The bone marrow serves to create new immune cells to replenish those lost. Sometimes, the newly created immune cells attain mutations in their DNA, causing them to become cancerous, and multiply uncontrollably leading to various cancers, such as leukemia, lymphoma, etc.
These cancers arise due to defective states, i.e. mutations, in the immune cell's DNA. Therefore, pharmaceutical companies created various classes of chemotherapeutic agents to stop the replication of a cancer cell's DNA, leading to remission of the cancer.
Mechanism of Drug Action (Chemotherapeutic agents)
L-asparaginase (ELSPAR)
This is a drug that degrades a compound called asparagine. Asparagine is very important for proteins to function. Normal cells can make their own asparagine, but cancer cells in ALL (Acute Lymphoblastic Leukemia) rely on asparagine in the body to replicate and cause harm.
Alkylating agents
These are the class of chemotherapeutic agents that exert their action by inhibition of DNA replication, promoting cell death, and damaging the cancer cell's DNA structure. Note that DNA replication is pivotal for a cancer cell to proliferate and cause harm. Thus, any change or damage made to a cancer cell's DNA that hinders DNA replication cause that cancer cell to die off.
The following are different Drugs that are alkylating agents:
- Busulfan
- Cyclophosphamide
- Anthracycline agents
- Adriamycin
These are a class of chemotherapeutic agents that provide an impasse for cancer cells to multiply.
The following are different agents that are antimetabolites:
Cytarabine or Cytosine Arabinoside (AraC) - This agent exerts its effect by acting as a false components of DNA and thus halting a cancer cell from multiplying.
- Fludarabine - This agent stops a cancer cell's DNA from replicating correctly thus promoting the cancer cell to kill it self. This agent is widely used to treat Chronic Lymphocytic Leukemia
- Methotrexate - This therapeutic agent prevents the regeneration of important components for DNA replication. This agent is used to treat Acute Lymphocytic Leukemia.
- Etoposide - This agent is used to cause damage to a cancer cell's DNA forcing the cancer cell to kill itself since it cannot multiply anymore.
These are a class of therapeutic agent directed to stop the immune system from attacking the body. The body uses a natural steroid called cortisol, to regulate the extent of an immune response. Synthetic and natural agents that imitate the action of cortisol are called glucocorticosteroids or corticosteroids.
It is important to note that glucocorticosteroid therapy does not remedy the underlying disease but only decreases the inflammation as a result of the disorder.
Corticosteroids are used widely to regulate and decrease the extent of an autoimmune disorder. Autoimmune disorders are those in which the body's own immune system attacks itself, e.g. asthma or arthritis. These drugs are used to reduce the extent of nausea and vomiting caused by chemotherapeutic agents; corticosteroids are also utilized to control the pain and swelling that originates from cancer. Corticosteroid therapy is also used to prevent a recipient from rejecting his/her transplanted organ.
The following are different glucocorticosteroids in use:
- Prednisolone - This drug is administered orally and is given to transplant patients to control organ rejection. Prednisolone is also in use to control the extent of pain caused by cancer.
- Methylprednisolone - This drug has a similar action as Prednisolone, but carries a 5-6 times the potency of Prednisolone.
- Dexamethasone - This agent works just like Prednisolone and Methylprednisolone, but carries potency as high as 18 times that of the aforementioned agents.
This is the condition in which the Graft's, donor's bone marrow, immune cells attacks the recipient's body. This occurs because the transplant is allogeneic; the bone marrow donated is not an exact match with the recipient. There are therapeutic agents that are used to suppress the immune response of the graft donated to the recipient.
The following are agents are used to control GVHD:
- Cyclosporine (CsA) - This agent paralyzes the graft's immune cells, thereby preventing an attack against the recipient.
- Tacrolimus - This agent works similarly like cyclosporine, but is 50-100 times more potent.
- Sirolimus - This drug prevents the graft's immune cells from growing rapidly, thus decreasing the extent of an immune response.
Candida Infections in Immunocompromised ChildrenCandida Infections in Immunocompromised Children
Gittel Sussman BS and Thomas J. Walsh, MD, FAAM, FIDSA
The human body has many harmless microorganisms living inside it, specifically in the gastrointestinal tract, otherwise known as the gut. One such microorganism is Candida, a yeast from the fungus kingdom. Candida can also be found under the nails or on the skin of the human body. There are numerous strains of Candida and each behaves differently like different members of the same family. Candida albicans is the species most likely to cause infection. Other common Candida pathogens are Candida tropicalis, Candida glabrata, Candida parapsilosis, and Candida krusei.
In a healthy body, helpful bacteria in the gastrointestinal tract as well as cells from the body's immune system prevent Candida from overgrowing. When a person takes antibiotics, steroids or chemotherapy drugs, these protective systems become suppressed allowing Candida to overgrow. Once Candida is overgrown, it is able to enter the blood stream in two ways.
From the blood stream, Candida is able to travel to many organs, such as the brain, heart, lungs, kidneys, liver, spleen, and eyes and infect them. This is known as invasive candidiasis.
Candida causes life-threatening infection in the form of blood stream infection, but when it's caught early, it is treatable. However, Candida is difficult to diagnose because it has the same symptoms as bacteremia, the presence of bacteria in the blood. Additionally, organs could be infected while blood tests are negative for Candida, which could cause a delay in diagnosis.
Because it is important to treat early, patients with a high risk for Candida who are displaying the symptoms for Candida are sometimes treated before absolute confirmation of the disease. There are also situations when a patient is treated for Candida even without displaying any symptoms. This usually happens in patients where there is a high risk of Candida infection.
Candida can be treated with many different medicines. These medicines fall into three categories.
Polyenes:
Frequently Asked Questions
What are the symptoms of Candida?
Usually when a person gets an infection, cells from the immune system rush to that area and cause inflammation which is heat, redness, and swelling. When a person has a suppressed immune system, they have fewer of those types of cells making it harder to detect an infection. Additionally, most fungal infections have similar symptoms making it difficult to distinguish between different types of infection. These symptoms include fever, pain, and swelling.
How can another infection be prevented?
Keeping the environment clean is an important method of preventing infection. Because Candida is sometimes located on the hands and under the nails, hands should be kept clean and washed well. It is also important to keep medical equipment clean and sterile.
How long will my child need treatment?
Treatment for candidiasis usually lasts 2 weeks. However, some patients need a much longer course of treatment.
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Aspergillosis Infections in Immunocompromised ChildrenEgle Petraityte BA and Thomas J. Walsh MD, FAAM, FIDSA
Aspergillus is commonly found growing on dead leaves, stored grain, compost piles, or in decaying vegetation as well as in marijuana leaves. It spreads via microscopically small spores that are extremely light and float easily in the air. Normally when these spores are inhaled by people, their immune systems recognize them as foreign and they are destroyed. However, the spores can grow to hyphae (long microscopic tubes) that can invade the airways and air sacs of the lungs in patients that are immunocompromised (have weakened immune systems).
The term "aspergillosis" describes a large number of diseases involving both infection and growth of this fungus inside the body.
Although there are many different type of aspergillosis, we will focus on the type called Invasive Aspergillosis:
Invasive pulmonary aspergillosis
This is a serious infection with pneumonia that can spread to other parts of the body. This infection is a life-threatening complication in immunocompromised children. It occurs in people with a weakened immune system due to cancer, leukemia, an organ transplant, chemotherapy, or other conditions or medications that lower the number of normal white blood cells or weaken the immune system. This disease is commonly seen in the lungs, but can also spread to other tissues including central nervous system, sinuses, bone, hear, kidney, eye, blood and skin.
Symptoms:
Symptoms of invasive pulmonary aspergillosis depend on the type of infection.
Other symptoms:
Other symptoms depend on the part of the body affected, and may include:
Tests to diagnose Aspergillus infection include:
Initial Therapy:
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Cryptococcus Infections in Immunocompromised ChildrenGittel Sussman BS and Thomas J. Walsh, MD, FAAM, FIDSA
Cryptococcus is a type of yeast that is part of the fungus kingdom. Although there are many species of Cryptococcus, only two are relevant to patients who are already sick. These species are called Cryptococcus neoformans and Cryptococcus gattii. C. neoformans is found in pigeon excretions, soil, and tree hollows.
When Cryptococcus is in an environment that is not conducive to growth, it releases spores, which are separate reproductive structures. Spores either stay where they are and wait for better conditions so they can reproduce, or they find a better environment to live in.
Because Cryptococcus is commonly found in the environment, people inhale the spores all the time. For a healthy person, this usually isn't a problem because the immune system can kill the fungus. However, Cryptococcus takes advantage of people with weakened immune systems and causes infection. Cryptococcus is most common in patients with AIDS, but it can also be dangerous to patients who have recently had an organ transplant or taken chemotherapy drugs.
Because spores are inhaled, their first target is the lung where they often cause infection. From the lung, Cryptococcus is able to travel via the bloodstream to other parts of the body. This happens because cells from the immune system ingest Cryptococcus but are unable to kill it. Instead, Cryptococcus thrives inside the cells as the cells give it a free ride to other parts of the body.
The Central Nervous System, including the brain, is most commonly infected after the lungs. This can cause either meningitis or meningoencephalitis. Meningitis is an infection of the meninges, membranes that cover the brain and spinal cord. Meningoencephalitis is an infection of the meninges and the brain.
It is often difficult to diagnose Cryptococcus early because the lung can be infected without showing any signs or symptoms. When there are symptoms, they can include fever, coughing, shortness of breath, chest pain, and weight loss. Once Cryptococcus has caused meningitis or meningoencephalitis, the symptoms can include headache, fever, visual disturbances, abnormal mental state, seizures, personality change, lethargy, memory loss, and coma.
There are several medicines used to treat Cryptococcus. They include amphotericin B, other formulations of amphotericin B, flucytosine, and fluconazole. Treatment for Cryptococcus is lengthy, often taking several months or longer to complete.
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Mucormycosis Infections in Immunocompromised ChildrenEgle Patraityte BA and Thomas J. Walsh MD, FAAM, FIDSA
Mucormycosis (also know as zygomycosis) is a fungal infection of the sinuses, brain, or lungs that occurs mostly in people with weakened immune systems.
It is caused by common fungi frequently found in the soil and in decaying vegetation. Most individuals are exposed to these fungi on a daily basis, but people with weakened immune systems are more susceptible to infection. Neutropenic patients have an increased risk of developing mucormycosis. It is less common than other fungal infections. Mucormycosis is more known to occur in patients with diabetes (usually poorly controlled diabetes), chronic steroid use, metabolic acidosis, organ transplantation, leukemia, lymphoma, treatment with deferoxamine, and AIDS.
Types of Mucormycosis:
Rhinocerebral infection
is most common (infection of sinuses and brain)
pneumonia that gets worse quickly and may spread to the chest cavity, heart, and brain. Most commonly this occurs in leukemic patients who are receiving chemotherapy or in patients undergoing hematopoietic stem cell transplants.
Mucormycosis of the gastrointestinal tract, skin, and kidneys
This type is rare and occurs mostly in patients who are malnourished and is thought to arise from ingestion of fungi. The stomach, colon, and ileum are the most commonly involves sites.
Symptoms of rhinocerebral mucormycosis include:
The human body has many harmless microorganisms living inside it, specifically in the gastrointestinal tract, otherwise known as the gut. One such microorganism is Candida, a yeast from the fungus kingdom. Candida can also be found under the nails or on the skin of the human body. There are numerous strains of Candida and each behaves differently like different members of the same family. Candida albicans is the species most likely to cause infection. Other common Candida pathogens are Candida tropicalis, Candida glabrata, Candida parapsilosis, and Candida krusei.
In a healthy body, helpful bacteria in the gastrointestinal tract as well as cells from the body's immune system prevent Candida from overgrowing. When a person takes antibiotics, steroids or chemotherapy drugs, these protective systems become suppressed allowing Candida to overgrow. Once Candida is overgrown, it is able to enter the blood stream in two ways.
- Through the gut wall if it has lost its integrity.
- Through a vascular catheter that is connected to the blood stream.
From the blood stream, Candida is able to travel to many organs, such as the brain, heart, lungs, kidneys, liver, spleen, and eyes and infect them. This is known as invasive candidiasis.
Candida causes life-threatening infection in the form of blood stream infection, but when it's caught early, it is treatable. However, Candida is difficult to diagnose because it has the same symptoms as bacteremia, the presence of bacteria in the blood. Additionally, organs could be infected while blood tests are negative for Candida, which could cause a delay in diagnosis.
Because it is important to treat early, patients with a high risk for Candida who are displaying the symptoms for Candida are sometimes treated before absolute confirmation of the disease. There are also situations when a patient is treated for Candida even without displaying any symptoms. This usually happens in patients where there is a high risk of Candida infection.
Candida can be treated with many different medicines. These medicines fall into three categories.
Polyenes:
- Amphotericin B
- Amphotericin B deoxycholate
- liposomal Amphotericin B
- Fluconazole
- Voriconazole
- Caspofungin
- Micafungin
- Anidulafungin
Frequently Asked Questions
What are the symptoms of Candida?
Usually when a person gets an infection, cells from the immune system rush to that area and cause inflammation which is heat, redness, and swelling. When a person has a suppressed immune system, they have fewer of those types of cells making it harder to detect an infection. Additionally, most fungal infections have similar symptoms making it difficult to distinguish between different types of infection. These symptoms include fever, pain, and swelling.
How can another infection be prevented?
Keeping the environment clean is an important method of preventing infection. Because Candida is sometimes located on the hands and under the nails, hands should be kept clean and washed well. It is also important to keep medical equipment clean and sterile.
How long will my child need treatment?
Treatment for candidiasis usually lasts 2 weeks. However, some patients need a much longer course of treatment.
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Aspergillosis Infections in Immunocompromised ChildrenEgle Petraityte BA and Thomas J. Walsh MD, FAAM, FIDSA
Aspergillus is commonly found growing on dead leaves, stored grain, compost piles, or in decaying vegetation as well as in marijuana leaves. It spreads via microscopically small spores that are extremely light and float easily in the air. Normally when these spores are inhaled by people, their immune systems recognize them as foreign and they are destroyed. However, the spores can grow to hyphae (long microscopic tubes) that can invade the airways and air sacs of the lungs in patients that are immunocompromised (have weakened immune systems).
The term "aspergillosis" describes a large number of diseases involving both infection and growth of this fungus inside the body.
Although there are many different type of aspergillosis, we will focus on the type called Invasive Aspergillosis:
Invasive pulmonary aspergillosis
This is a serious infection with pneumonia that can spread to other parts of the body. This infection is a life-threatening complication in immunocompromised children. It occurs in people with a weakened immune system due to cancer, leukemia, an organ transplant, chemotherapy, or other conditions or medications that lower the number of normal white blood cells or weaken the immune system. This disease is commonly seen in the lungs, but can also spread to other tissues including central nervous system, sinuses, bone, hear, kidney, eye, blood and skin.
Symptoms:
Symptoms of invasive pulmonary aspergillosis depend on the type of infection.
- Fever
- Chills
- Cough
- Coughing up blood
- Coughing up phlegm
- Chest pain
- Shortness of breath
Other symptoms:
Other symptoms depend on the part of the body affected, and may include:
- Blood in the urine
- Bone pain
- Headaches
- Skin sores (lesions)
- Vision problems
- Weakness of an arm or a leg
Tests to diagnose Aspergillus infection include:
- Chest x-ray
- CT scan - chest
- Galactomannan (a molecule from the fungus that is sometimes found in the blood)
- Glucan (a molecule from the fungus that is sometimes found in the blood)
- Stain and culture for Aspergillus in bronchoalveolar lavage (BAL) fluid
- Tissue biopsy
Initial Therapy:
- Voriconazole
- Liposomal amphotericin B
- Amphotericin B
- Amphotericin B lipid complex
- Posaconazole
- Itraconazole
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Cryptococcus Infections in Immunocompromised ChildrenGittel Sussman BS and Thomas J. Walsh, MD, FAAM, FIDSA
Cryptococcus is a type of yeast that is part of the fungus kingdom. Although there are many species of Cryptococcus, only two are relevant to patients who are already sick. These species are called Cryptococcus neoformans and Cryptococcus gattii. C. neoformans is found in pigeon excretions, soil, and tree hollows.
When Cryptococcus is in an environment that is not conducive to growth, it releases spores, which are separate reproductive structures. Spores either stay where they are and wait for better conditions so they can reproduce, or they find a better environment to live in.
Because Cryptococcus is commonly found in the environment, people inhale the spores all the time. For a healthy person, this usually isn't a problem because the immune system can kill the fungus. However, Cryptococcus takes advantage of people with weakened immune systems and causes infection. Cryptococcus is most common in patients with AIDS, but it can also be dangerous to patients who have recently had an organ transplant or taken chemotherapy drugs.
Because spores are inhaled, their first target is the lung where they often cause infection. From the lung, Cryptococcus is able to travel via the bloodstream to other parts of the body. This happens because cells from the immune system ingest Cryptococcus but are unable to kill it. Instead, Cryptococcus thrives inside the cells as the cells give it a free ride to other parts of the body.
The Central Nervous System, including the brain, is most commonly infected after the lungs. This can cause either meningitis or meningoencephalitis. Meningitis is an infection of the meninges, membranes that cover the brain and spinal cord. Meningoencephalitis is an infection of the meninges and the brain.
It is often difficult to diagnose Cryptococcus early because the lung can be infected without showing any signs or symptoms. When there are symptoms, they can include fever, coughing, shortness of breath, chest pain, and weight loss. Once Cryptococcus has caused meningitis or meningoencephalitis, the symptoms can include headache, fever, visual disturbances, abnormal mental state, seizures, personality change, lethargy, memory loss, and coma.
There are several medicines used to treat Cryptococcus. They include amphotericin B, other formulations of amphotericin B, flucytosine, and fluconazole. Treatment for Cryptococcus is lengthy, often taking several months or longer to complete.
Back To Top
Mucormycosis Infections in Immunocompromised ChildrenEgle Patraityte BA and Thomas J. Walsh MD, FAAM, FIDSA
Mucormycosis (also know as zygomycosis) is a fungal infection of the sinuses, brain, or lungs that occurs mostly in people with weakened immune systems.
It is caused by common fungi frequently found in the soil and in decaying vegetation. Most individuals are exposed to these fungi on a daily basis, but people with weakened immune systems are more susceptible to infection. Neutropenic patients have an increased risk of developing mucormycosis. It is less common than other fungal infections. Mucormycosis is more known to occur in patients with diabetes (usually poorly controlled diabetes), chronic steroid use, metabolic acidosis, organ transplantation, leukemia, lymphoma, treatment with deferoxamine, and AIDS.
Types of Mucormycosis:
Rhinocerebral infection
is most common (infection of sinuses and brain)
- May start as a sinus infection
- Blurry vision
- Soft tissue swelling
- White blood cell counts are typically elevated, as long as the patients has a functioning bone marrow
- May progress to involve inflammation of cranial nerves
- May cause blood clots that block vessels to the brain (thrombosis)
pneumonia that gets worse quickly and may spread to the chest cavity, heart, and brain. Most commonly this occurs in leukemic patients who are receiving chemotherapy or in patients undergoing hematopoietic stem cell transplants.
Mucormycosis of the gastrointestinal tract, skin, and kidneys
This type is rare and occurs mostly in patients who are malnourished and is thought to arise from ingestion of fungi. The stomach, colon, and ileum are the most commonly involves sites.
Symptoms of rhinocerebral mucormycosis include:
- Eye swelling and protrusion (proptosis)
- Dark nasal eschar (scabbing)
- Fever
- Headache
- Redness of skin overlying sinuses
- Sinus pain or congestion
- Cough
- Coughing blood (occasionally)
- Fever
- Shortness of breath
- Abdominal pain
- Vomiting blood
- Fever may occur
- Fever
- Flank (side) pain
- A single, painful, hardened area of skin that may have a blackened center.
Gram-Negative Bacteria That Commonly Cause Infection in Immunocompromised Children
Gittel Sussman BS and Thomas J. Walsh, MD, FAAM, FIDSA
Escherichia coli, commonly known as E. coli, is a group of bacteria normally found in human feces. E. coli can cause urinary tract infection when feces accidentally enter the urethra (the tube through which urine flows). Urinary tract infection can be treated with antibiotics and usually causes no lasting effects. However, children who have urinary tract infections before the age of one are likely to become infected again later in life. When food or water that is contaminated with human or animal feces is swallowed, it can also cause diarrhea. The diarrhea usually goes away on its own after several days and without medication. It is important though to keep the body hydrated because it will likely loose a lot of water due to vomiting and loose stool. Occasionally, there are complications such as bloody diarrhea and kidney failure. E. coli is different from many other bacteria in that it is able to affect healthy, non-hospitalized people. However, it can also cause other types of infection, such as wound infection and meningitis, in hospitalized patients. When E. coli causes blood stream infection in immunocompromised children, it must be treated with antibiotics as soon as possible.
Klebsiella pneumoniae is a bacterium that exists naturally in the environment. It causes several types of infections including those of the urinary tract infection, lung, and blood stream. Some strains of Klebsiella pneumoniae may be difficult to treat because they are resistant to many of the medicines commonly used to treat bacterial infections. Additionally, over time, certain strains of Klebsiella stop responding even to the medicines that had previously worked against them.
Enterobacter is a type of bacteria that is commonly found throughout nature. It is also found in the gastrointestinal tract of the human body. Usually, it does not cause any harm, but it can cause disease in immunocompromised patients. The usually harmless Enterobacter of the gastrointestinal tract may spread into the blood stream and other sites of the body where it can cause harm. Enterobacter may become resistant to antibiotics that are commonly used in immunocompromised children. Enterobacter can cause many different types of infections including meningitis, respiratory tract infection, wound infection, urinary tract infection, and bone and joint disease.
Pseudomonas aeruginosais a bacterium that is found widely in the environment, particularly in moist areas. It can grow in many areas because it does not need much nutrition to survive. For this reason, it can also adapt to many different ecological areas. Pseudomonas is an opportunistic pathogen, which means that it doesn’t usually cause disease in healthy people. Immunocompromised children who are receiving chemotherapy, bone marrow transplantation or those with open wounds and catheters or those on a ventilator may become infected with Pseudomonas aeruginosa. In patients who have compromised immune systems, Pseudomonas aeruginosa also can spread throughout the entire body via the blood stream, causing a systemic infection. Infections caused by Pseudomonas are difficult to treat due to its ability to adapt to its surroundings and become resistant to antibiotics.
Stenotrophomonas maltophilia is a bacterium that is readily found in nature. It has a specific affinity for water, and can be found in and around water sources such as sinks and faucets. From there it can be spread by hand to other areas, especially moist surfaces. Healthy people are not usually affected by Stenotrophomonas maltophilia, but immunocompromised and hospitalized patients may be infected by it. Stenotrophomonas maltophilia can cause many different types of infections including bloodstream infection, pneumonia, urinary tract infection, and skin and soft tissue infections. Stenotrophomonas maltophilia is also difficult to treat because it is naturally resistant to many medicines and may become resistant to more medicines over time. There is one medicine (trimethoprim-sulfamethoxazole, cotrimoxazole or “Bactrim”) that is most reliably used to treat Stenotrophomonas maltophilia; however, there are some strains that are resistant to this medicine as well.
Acinetobacter is a type of bacteria that survives by getting nutrition from decaying organic matter. It is found in moist areas such as soil and water. It has the ability to survive for long periods of time in hospital environments. In hospitals, Acinetobacter also can live in moist places on a patient’s body, such as open wounds or around catheters. Acinetobacter can spread to other patients usually by the hands of hospital staff. Acinetobacter baumannii is a particularly dangerous species that is often resistant to many antibiotics. Acinetobacter baumannii may cause many problems such as pneumonia, urinary tract infection, and bloodstream infections. Acinetobacter baumannii is difficult to treat because it can be resistant to most of the available medicines.
Escherichia coli, commonly known as E. coli, is a group of bacteria normally found in human feces. E. coli can cause urinary tract infection when feces accidentally enter the urethra (the tube through which urine flows). Urinary tract infection can be treated with antibiotics and usually causes no lasting effects. However, children who have urinary tract infections before the age of one are likely to become infected again later in life. When food or water that is contaminated with human or animal feces is swallowed, it can also cause diarrhea. The diarrhea usually goes away on its own after several days and without medication. It is important though to keep the body hydrated because it will likely loose a lot of water due to vomiting and loose stool. Occasionally, there are complications such as bloody diarrhea and kidney failure. E. coli is different from many other bacteria in that it is able to affect healthy, non-hospitalized people. However, it can also cause other types of infection, such as wound infection and meningitis, in hospitalized patients. When E. coli causes blood stream infection in immunocompromised children, it must be treated with antibiotics as soon as possible.
Klebsiella pneumoniae is a bacterium that exists naturally in the environment. It causes several types of infections including those of the urinary tract infection, lung, and blood stream. Some strains of Klebsiella pneumoniae may be difficult to treat because they are resistant to many of the medicines commonly used to treat bacterial infections. Additionally, over time, certain strains of Klebsiella stop responding even to the medicines that had previously worked against them.
Enterobacter is a type of bacteria that is commonly found throughout nature. It is also found in the gastrointestinal tract of the human body. Usually, it does not cause any harm, but it can cause disease in immunocompromised patients. The usually harmless Enterobacter of the gastrointestinal tract may spread into the blood stream and other sites of the body where it can cause harm. Enterobacter may become resistant to antibiotics that are commonly used in immunocompromised children. Enterobacter can cause many different types of infections including meningitis, respiratory tract infection, wound infection, urinary tract infection, and bone and joint disease.
Pseudomonas aeruginosais a bacterium that is found widely in the environment, particularly in moist areas. It can grow in many areas because it does not need much nutrition to survive. For this reason, it can also adapt to many different ecological areas. Pseudomonas is an opportunistic pathogen, which means that it doesn’t usually cause disease in healthy people. Immunocompromised children who are receiving chemotherapy, bone marrow transplantation or those with open wounds and catheters or those on a ventilator may become infected with Pseudomonas aeruginosa. In patients who have compromised immune systems, Pseudomonas aeruginosa also can spread throughout the entire body via the blood stream, causing a systemic infection. Infections caused by Pseudomonas are difficult to treat due to its ability to adapt to its surroundings and become resistant to antibiotics.
Stenotrophomonas maltophilia is a bacterium that is readily found in nature. It has a specific affinity for water, and can be found in and around water sources such as sinks and faucets. From there it can be spread by hand to other areas, especially moist surfaces. Healthy people are not usually affected by Stenotrophomonas maltophilia, but immunocompromised and hospitalized patients may be infected by it. Stenotrophomonas maltophilia can cause many different types of infections including bloodstream infection, pneumonia, urinary tract infection, and skin and soft tissue infections. Stenotrophomonas maltophilia is also difficult to treat because it is naturally resistant to many medicines and may become resistant to more medicines over time. There is one medicine (trimethoprim-sulfamethoxazole, cotrimoxazole or “Bactrim”) that is most reliably used to treat Stenotrophomonas maltophilia; however, there are some strains that are resistant to this medicine as well.
Acinetobacter is a type of bacteria that survives by getting nutrition from decaying organic matter. It is found in moist areas such as soil and water. It has the ability to survive for long periods of time in hospital environments. In hospitals, Acinetobacter also can live in moist places on a patient’s body, such as open wounds or around catheters. Acinetobacter can spread to other patients usually by the hands of hospital staff. Acinetobacter baumannii is a particularly dangerous species that is often resistant to many antibiotics. Acinetobacter baumannii may cause many problems such as pneumonia, urinary tract infection, and bloodstream infections. Acinetobacter baumannii is difficult to treat because it can be resistant to most of the available medicines.
DNA Viruses in Pediatric Patients: A Guide for Families with Immunocompromised Children
Rosa M. Hirsch1,2 and Thomas J. Walsh2
1University of Manchester School of Medicine, Manchester, UK
2Tranasplantation-Oncology-Infectious Diseases Program, Departments of Medicine, Pediatrics, and Microbiology & Immunology, Weill Cornell Medical Center, New York, NY
DNA VIRUSES
Cytomegalovirus (CMV)
CMV infection is a common viral infection.
Cytomegalo means larges cell, as the appearance of the infected cell under the microscope is large and swollen.
Many people first become infected with CMV as a child. Once infected with CMV, the virus stays in your body for the rest of your life. It cans sometimes recur which can be a problem when the immune system is weakened.
CMV may cause a sore throat and a fever but will usually not cause symptoms in a healthy individual. It can cause severe illness in children who are immunocompromised due to their cancer treatment.
In these patients CMV can cause complications such as pneumonia (chest infection) and hepatitis (inflammation of the liver).
Children undergoing organ transplants are a particular risk of CMV infection. Before the organ transplant the recipient and the donor will be checked for CMV infection. In some cases children may be put on a prophylactic treatment to prevent them getting the infection.
During bone marrow/ stem cell transplantation, your doctors may monitor the blood stream for CMV virus. If the virus is found, they may initiate treatment with ganciclovir. This is usually given intravenously if the infection is severe. Foscarnet is another medication that is used for treatment of CMV infection.
Varicella zoster virus (VZV)
VZV is the same virus that causes chickenpox. In an immunocompromised patient VZV can cause complications such as pneumonia and a painful condition called shingles. Most patients who develop get shingles have had chickenpox in the past. That is because VZV lies dormant and can become active again when the immune system is weak.
Varicella is the primary infection that causes chicken pox and zoster is the secondary infection that causes shingles.
Children with cancer who have leukemia, lymphoma, or bone marrow transplantation are at particular risk of developing zoster. Symptoms include fever and a painful rash. Complications can include pneumonia, meningoencephalitis (infection of the brain and the surrounding membranes) and iritis (inflammation of the iris in the eye).
Certain measures are undertaken to prevent children at high risk from developing zoster. A vaccination program has been introduced in the USA so that all children are immunized against VZV. Immunization is thought to decrease the incidence of zoster.
Antiviral medication is used for treatment of VZV. The most common medicine for treatment of VZV is acyclovir. Acyclovir works by inhibiting the virus from replicating. There are other antiviral medicines available if acyclovir is ineffective in treating the infection.
Epstein Barr Virus (EBV)
EBV is a type of herpes virus. 90% of adults have been infected. In some people it can cause infectious mononucleosis. This causes sore throat, muscle aches and fatigue.
In immunocompromised children EBV can cause serious complications.
EBV infects B and T cells. These are cells that are part of the immune system and in a healthy person they help fight infection. EBV infection can lead to lymphoproliferative disorder (EBV-LPD). This is a condition where the B and T cells replicate uncontrollably. This can make the patient very unwell and needs to be treated quickly.
There are no medicines currently available to treat EBV. However, early use of rituximab (a medicine that attacks the infected B) in imunocompromised patients with high levels of EBV in the blood stream may reduce the risk of development of EBV-LPD. Management of EBV infection also may include giving the patient an infusion of healthy T cells to help fight the infection. They may need to stop any medications that cause immunosuppression. If EBV-LPD is confined to one area, this area of affected cells can be surgically removed.
Herpes Simplex Virus (HSV)
HSV has two strains type one and type two. Type one (HSV-1) is spread by saliva and type two (HSV-2) is spread by genital secretions. Most children will be infected with HSV-1 by the time they are two years old. In some this can cause cold sores.
In cancer patients, HSV virus can be reactivated and cause a range of symptoms. As well as cold sores, HSV may cause esophagitis (inflammation of the tube carrying food from the mouth to stomach), which can make swallowing painful. In severe cases, it can cause encephalitis (inflammation of the brain) and disseminated disease. In disseminated disease the virus spreads to many organs including the liver, kidneys and lungs. As this can be very serious, different strategies have been developed to prevent cancer patients from developing HSV disseminated disease. These include prophylactic antiviral medications to be given before starting chemotherapy.
Treatment for severe HSV infection is with antiviral medication. Acyclovir is usually the first treatment. However in some cases the virus can become resistant to acyclovir and thus another drug, foscarnet, will be used. Foscarnet has a different mechanism in killing the virus so is more likely to be effective in acyclovir resistant HSV.
Respiratory Viruses in Pediatric Patients: A Guide for Families with Immunocompromised Children
Rosa M. Hirsch1,2 and Thomas J. Walsh2
1University of Manchester School of Medicine, Manchester, UK
2Tranasplantation-Oncology-Infectious Diseases Program, Departments of Medicine, Pediatrics, and Microbiology & Immunology, Weill Cornell Medical Center, New York, NY
Respiratory viruses
This group of viruses targets the respiratory tract. The respiratory tract can be divided in to the upper respiratory tract, including the nose, sinuses and throat, and the lower respiratory tract, including the airways and the lungs. Respiratory viruses share some characteristics such as short incubation periods (the time between exposure to the virus and symptoms developing) and person-to-person spread.
Adenovirus
Adenovirus is a respiratory virus common in children. Adenovirus is not only a respiratory virus but can also infect the gut leading to diarrhea and vomiting.
Respiratory disease caused by adenovirus is common in the winter months when outbreaks occur.
In the immunocompromised patient, symptoms can range from a runny nose to a severe pneumonia.
Adenovirus is usually self-limiting in healthy individuals. However, in imunocompromised patients, it may cause severe pneumonia, gastroenteritis (infection of the GI tract), hepatitis, hemorrhagic cystitis (infection and bleeding of the urinary bladder).
Prevention in cancer patients in important and this can be achieved with good infectious control practices such as isolating patients with the virus and good hand hygiene. There is no standard medicine for treatment of adenovirus infection; however, a medicine known as cidofovir may be effective in some patients.
Influenza
Influenza is a virus that causes flu. It is very infectious. You mainly catch it from cough and sneezes from infected individuals. It can cause fever, muscle aches, headache, and cough. In immunocompromised patients it can cause a severe infection of the lungs. Therefore we try to protect cancer patients from getting flu. This may include immunization. However in immunocompromised patients this is not always effective. We also immunize health care professionals to prevent them from passing on the virus to those at risk.
If the influenza virus is detected, your doctor may initiate an antiviral medicine known as oseltamivir, which may help reduce the complications of the flu.
Parainfluenza viruses (PIVs)
PIVs are a group of similar viruses that cause parainfluenza. They cause infected cells to stick together and inflammation that can make breathing difficult.
PIVs can affect the upper respiratory tract, causing croup - an inflammation of the larynx (voice box) and the lower respiratory tract causing pneumonia and bronchiolitis (am infection of the lungs small breathing tubes).
In immunocompromised children they are more at risk of severe disease therefore it is important to prevent them from developing any breathing difficulties.
Respiratory Syncytial Virus (RSV)
RSV is a very common respiratory virus in children. It usually causes mild cold like symptoms. RSV can spread from the upper airway down to the lungs. RSV can cause blockage of the small airways (bronchiolitis) and infection of the lungs (pneumonia). In children who develop these complications aerosolized ribavirin may beneficial. Prevention is very important through isolation and other measures. Research is currently ongoing in developing an effective vaccine.
A medicine known as ribavirin may be effective in treatment of the early phase of lung infection. This medicine is usually administered as an aerosol for treatment of RSV infection of the lungs.
Rosa M. Hirsch1,2 and Thomas J. Walsh2
1University of Manchester School of Medicine, Manchester, UK
2Tranasplantation-Oncology-Infectious Diseases Program, Departments of Medicine, Pediatrics, and Microbiology & Immunology, Weill Cornell Medical Center, New York, NY
DNA VIRUSES
Cytomegalovirus (CMV)
CMV infection is a common viral infection.
Cytomegalo means larges cell, as the appearance of the infected cell under the microscope is large and swollen.
Many people first become infected with CMV as a child. Once infected with CMV, the virus stays in your body for the rest of your life. It cans sometimes recur which can be a problem when the immune system is weakened.
CMV may cause a sore throat and a fever but will usually not cause symptoms in a healthy individual. It can cause severe illness in children who are immunocompromised due to their cancer treatment.
In these patients CMV can cause complications such as pneumonia (chest infection) and hepatitis (inflammation of the liver).
Children undergoing organ transplants are a particular risk of CMV infection. Before the organ transplant the recipient and the donor will be checked for CMV infection. In some cases children may be put on a prophylactic treatment to prevent them getting the infection.
During bone marrow/ stem cell transplantation, your doctors may monitor the blood stream for CMV virus. If the virus is found, they may initiate treatment with ganciclovir. This is usually given intravenously if the infection is severe. Foscarnet is another medication that is used for treatment of CMV infection.
Varicella zoster virus (VZV)
VZV is the same virus that causes chickenpox. In an immunocompromised patient VZV can cause complications such as pneumonia and a painful condition called shingles. Most patients who develop get shingles have had chickenpox in the past. That is because VZV lies dormant and can become active again when the immune system is weak.
Varicella is the primary infection that causes chicken pox and zoster is the secondary infection that causes shingles.
Children with cancer who have leukemia, lymphoma, or bone marrow transplantation are at particular risk of developing zoster. Symptoms include fever and a painful rash. Complications can include pneumonia, meningoencephalitis (infection of the brain and the surrounding membranes) and iritis (inflammation of the iris in the eye).
Certain measures are undertaken to prevent children at high risk from developing zoster. A vaccination program has been introduced in the USA so that all children are immunized against VZV. Immunization is thought to decrease the incidence of zoster.
Antiviral medication is used for treatment of VZV. The most common medicine for treatment of VZV is acyclovir. Acyclovir works by inhibiting the virus from replicating. There are other antiviral medicines available if acyclovir is ineffective in treating the infection.
Epstein Barr Virus (EBV)
EBV is a type of herpes virus. 90% of adults have been infected. In some people it can cause infectious mononucleosis. This causes sore throat, muscle aches and fatigue.
In immunocompromised children EBV can cause serious complications.
EBV infects B and T cells. These are cells that are part of the immune system and in a healthy person they help fight infection. EBV infection can lead to lymphoproliferative disorder (EBV-LPD). This is a condition where the B and T cells replicate uncontrollably. This can make the patient very unwell and needs to be treated quickly.
There are no medicines currently available to treat EBV. However, early use of rituximab (a medicine that attacks the infected B) in imunocompromised patients with high levels of EBV in the blood stream may reduce the risk of development of EBV-LPD. Management of EBV infection also may include giving the patient an infusion of healthy T cells to help fight the infection. They may need to stop any medications that cause immunosuppression. If EBV-LPD is confined to one area, this area of affected cells can be surgically removed.
Herpes Simplex Virus (HSV)
HSV has two strains type one and type two. Type one (HSV-1) is spread by saliva and type two (HSV-2) is spread by genital secretions. Most children will be infected with HSV-1 by the time they are two years old. In some this can cause cold sores.
In cancer patients, HSV virus can be reactivated and cause a range of symptoms. As well as cold sores, HSV may cause esophagitis (inflammation of the tube carrying food from the mouth to stomach), which can make swallowing painful. In severe cases, it can cause encephalitis (inflammation of the brain) and disseminated disease. In disseminated disease the virus spreads to many organs including the liver, kidneys and lungs. As this can be very serious, different strategies have been developed to prevent cancer patients from developing HSV disseminated disease. These include prophylactic antiviral medications to be given before starting chemotherapy.
Treatment for severe HSV infection is with antiviral medication. Acyclovir is usually the first treatment. However in some cases the virus can become resistant to acyclovir and thus another drug, foscarnet, will be used. Foscarnet has a different mechanism in killing the virus so is more likely to be effective in acyclovir resistant HSV.
Respiratory Viruses in Pediatric Patients: A Guide for Families with Immunocompromised Children
Rosa M. Hirsch1,2 and Thomas J. Walsh2
1University of Manchester School of Medicine, Manchester, UK
2Tranasplantation-Oncology-Infectious Diseases Program, Departments of Medicine, Pediatrics, and Microbiology & Immunology, Weill Cornell Medical Center, New York, NY
Respiratory viruses
This group of viruses targets the respiratory tract. The respiratory tract can be divided in to the upper respiratory tract, including the nose, sinuses and throat, and the lower respiratory tract, including the airways and the lungs. Respiratory viruses share some characteristics such as short incubation periods (the time between exposure to the virus and symptoms developing) and person-to-person spread.
Adenovirus
Adenovirus is a respiratory virus common in children. Adenovirus is not only a respiratory virus but can also infect the gut leading to diarrhea and vomiting.
Respiratory disease caused by adenovirus is common in the winter months when outbreaks occur.
In the immunocompromised patient, symptoms can range from a runny nose to a severe pneumonia.
Adenovirus is usually self-limiting in healthy individuals. However, in imunocompromised patients, it may cause severe pneumonia, gastroenteritis (infection of the GI tract), hepatitis, hemorrhagic cystitis (infection and bleeding of the urinary bladder).
Prevention in cancer patients in important and this can be achieved with good infectious control practices such as isolating patients with the virus and good hand hygiene. There is no standard medicine for treatment of adenovirus infection; however, a medicine known as cidofovir may be effective in some patients.
Influenza
Influenza is a virus that causes flu. It is very infectious. You mainly catch it from cough and sneezes from infected individuals. It can cause fever, muscle aches, headache, and cough. In immunocompromised patients it can cause a severe infection of the lungs. Therefore we try to protect cancer patients from getting flu. This may include immunization. However in immunocompromised patients this is not always effective. We also immunize health care professionals to prevent them from passing on the virus to those at risk.
If the influenza virus is detected, your doctor may initiate an antiviral medicine known as oseltamivir, which may help reduce the complications of the flu.
Parainfluenza viruses (PIVs)
PIVs are a group of similar viruses that cause parainfluenza. They cause infected cells to stick together and inflammation that can make breathing difficult.
PIVs can affect the upper respiratory tract, causing croup - an inflammation of the larynx (voice box) and the lower respiratory tract causing pneumonia and bronchiolitis (am infection of the lungs small breathing tubes).
In immunocompromised children they are more at risk of severe disease therefore it is important to prevent them from developing any breathing difficulties.
Respiratory Syncytial Virus (RSV)
RSV is a very common respiratory virus in children. It usually causes mild cold like symptoms. RSV can spread from the upper airway down to the lungs. RSV can cause blockage of the small airways (bronchiolitis) and infection of the lungs (pneumonia). In children who develop these complications aerosolized ribavirin may beneficial. Prevention is very important through isolation and other measures. Research is currently ongoing in developing an effective vaccine.
A medicine known as ribavirin may be effective in treatment of the early phase of lung infection. This medicine is usually administered as an aerosol for treatment of RSV infection of the lungs.
