Clinical Pediatric Emergency Medicine
Volume 6, Issue 3 , Pages 173-183 , September 2005

Emergency Department Management of the Immunosuppressed Host

  • Leah Tzimenatos, MD

      Affiliations

    • Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
    • Corresponding Author InformationReprint requests and correspondence: Leah Tzimenatos, MD, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2008, Cincinnati, OH 45229-3039.
  • ,
  • Gary L. Geis, MD

      Affiliations

    • Clinical Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH

References 

  1. Bodey G, Buckley M, Sathe Y, et al. Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Ann Intern Med. 1966;64:328–340
  2. Mullen CA, Petropoulos D, Roberts WM, et al. Outpatient treatment of fever and neutropenia for low risk pediatric cancer patients. Cancer. 1999;86:126–134
  3. Hughes WT, Armstrong D, Bodey GP, et al. 1997 guidelines for the use of antimicrobial agents in neutropenic patients with unexplained fever. Clin Infect Dis. 1997;25:551–573
  4. Freifeld A, Pizzo P. Use of fluoroquinolones for empirical management of febrile neutropenia in pediatric cancer patients. Pediatr Infect Dis J. 1997;16:140–146
  5. Klaasen RJ, Goodman R, Pham B, et al. “Low-risk” prediction rule for pediatric oncology patients presenting with fever and neutropenia. J Clin Oncol. 2000;18:1012–1019
  6. Lehrnbecher T, Venzon D, de Haas M, et al. Assessment of measuring circulating levels of interleukin-6, interleukin-8, C-reactive protein, soluble Fc-gamma receptor type III, and mannose-binding protein in febrile children with cancer and neutropenia. Clin Infect Dis. 1999;29:414–419
  7. Roguin A, Kasis I, Ben-Arush MW, et al. Fever and neutropenia in children with malignant disease. Pediatr Hematol Oncol. 1996;13:503–510
  8. Lucas KG, Brown AE, Armstrong D, et al. The identification of febrile, neutropenic children with neoplastic disease at low risk for bacteremia and complications of sepsis. Cancer. 1996;77:791–798
  9. Ammann RA, Hirt A, Luthy AR, et al. Identification of children presenting with fever in chemotherapy-induced neutropenia at low risk for severe bacterial infection. Med Pediatr Oncol. 2003;41:436–443
  10. Oude Nijuis CS, Vellenga E, Daenen SM, et al. Lipopolysaccharide-binding protein: a possible diagnostic marker for gram-negative bacteremia in neutropenic cancer patients. Intensive Care Med. 2003;29:2157–2161
  11. Petrilli AS, Cypriano M, Dantas LS, et al. Evaluation of ticarcillin/clavulanic acid versus ceftriaxone plus amikacin for fever and neutropenia in pediatric patients with leukemia and lymphoma. Br J Infect Dis. 2003;7:111–120
  12. Mullen CA. Ciprofloxacin in treatment of fever and neutropenia in pediatric cancer patients. Pediatr Infect Dis J. 2003;22:1138–1142
  13. Paley C. Supportive care and management of oncologic emergencies. In:  Lanzkowsky P editors. Manual of pediatric hematology and oncology. 3rd ed.. San Diego (Calif): Academic Press; 2000;p. 678–679
  14. Adamkiewicz TV, Lorenzana A, Doyle J, et al. Peripheral vs. central blood cultures in patients admitted to a pediatric oncology ward. Pediatr Infect Dis J. 1999;18:556–558
  15. Renoult E, Buteau C, Turgeon N, et al. Is routine chest radiography necessary for the initial evaluation of fever in neutropenic children with cancer?. Pediatr Blood Cancer. 2004;43:224–228
  16. Korones DN, Hussong MR, Gullace MA. Routine chest radiography of children with cancer hospitalized for fever and neutropenia: is it really necessary?. Cancer. 1997;80:1160–1164
  17. Pizzo PA. Management of fevers in patients with cancer and treatment-induced neutropenias. N Engl J Med. 1993;328:1323–1332
  18. Gamis AS, Howells WB, DeSwarte-Wallace J, et al. Alpha hemolytic streptococcal infections during intensive treatment for acute myeloid leukemia: a report from the Children's Cancer Group Study CCG-2891. J Clin Oncol. 2000;18:1845–1855
  19. Bruckner LB, Korones DN, Karnauchow T, et al. High incidence of penicillin resistance among α-hemolytic streptococci isolated from the blood of children with cancer. J Pediatr. 2002;140:20–26
  20. Kebudi R, Gorgun O, Ayan I, et al. Randomized comparison of cefepime versus ceftazidime monotherapy for fever and neutropenia in children with solid tumors. Med Pediatr Oncol. 2001;36:434–441
  21. Mustafa MM, Carlson L, Tkaczewski , et al. Comparative study of cefepime versus ceftazidime in the empiric treatment of pediatric cancer patients with fever and neutropenia. Pediatr Infect Dis J. 2001;20:362–369
  22. Kutluk T, Kurne O, Akyuz C, et al. Cefepime vs. meropenem as empirical therapy for neutropenic fever in children with lymphoma and solid tumors. Pediatr Blood Cancer. 2004;42:284–286
  23. Holdsworth MT, Hanrahan J, Albanese B, et al. Outpatient management of febrile neutropenia in children with cancer. Pediatr Drugs. 2003;5:443–455
  24. Aksoylar S, Cetingul N, Kantar M, et al. Meropenem plus amikacin versus piperacillin-tazobactam plus netilmicin as empiric therapy for high-risk febrile neutropenia in children. Pediatr Hematol Oncol. 2004;21:115–123
  25. Paul M, Benuri-Silbiger I, Soares-Weiser K, et al. Beta lactam monotherapy versus beta lactam-aminoglycoside combination therapy for sepsis in immunocompetent patients: systematic review and meta-analysis of randomized trials. BMJ. 2004;328:668
  26. Santolaya ME, Alvarez AM, Becker A, et al. Prospective, multicenter evaluation of risk factors associated with invasive bacterial infection in children with cancer, neutropenia, and fever. J Clin Oncol. 2001;19:3415–3421
  27. Alexander SW, Wade KC, Hibberd PL, et al. Evaluation of risk prediction criteria for episodes of febrile neutropenia in children with cancer. J Pediatr Hematol Oncol. 2002;24:38–42
  28. Baorto EP, Aquino VM, Mullen CA, et al. Clinical parameters associated with low bacteremia risk in 1100 pediatric oncology patients with fever and neutropenia. Cancer. 2001;92:909–913
  29. Ammann RA, Hirt A, Luthy AR, et al. Predicting bacteremia in children with fever and chemotherapy-induced neutropenia. Pediatr Infect Dis J. 2004;23:61–67
  30. Rackoff WR, Gonin R, Robinson C, et al. Predicting risk of bacteremia in children with fever and neutropenia. J Clin Oncol. 1996;14:919–924
  31. West DC, Marcin JP, Mawis R, et al. Children with cancer, fever, and treatment-induced neutropenia: risk factors associated with illness requiring the administration of critical care therapies. Pediatr Emerg Care. 2004;20:79–84
  32. Soker M, Coplan L, Ece A, et al. Serum levels of IL-1 beta, sIL-2R, IL-6, IL-8, and TNF-alpha in febrile children with cancer and neutropenia. Med Oncol. 2001;18:51–57
  33. Shemesh E, Yaniv I, Drucker M, et al. Home intravenous antibiotic treatment for febrile episodes in immune-compromised pediatric patients. Med Pediatr Oncol. 1998;30:95–100
  34. Petrilli AS, Dantas LS, Campos MC, et al. Oral ciprofloxacin vs. intravenous ceftriaxone administered in an outpatient setting for fever and neutropenia in low-risk pediatric oncology patients: randomized prospective trial. Med Pediatr Oncol. 2000;34:87–91
  35. Salzer W, Steinberg SM, Liewehr DJ, et al. Evaluation and treatment of fever in the non-neutropenic child with cancer. J Pediatr Hematol Oncol. 2003;25:606–612
  36. Lujan-Zilbermann J, Patrick CC. Opportunistic infections in hematopoietic stem cell transplantation. In:  Feigin RD,  Cherry JD,  Demmler GJ, et al. editor. 5th ed.. Textbook of pediatric infectious diseases. vol. 1:Philadelphia (Pa): Saunders; 2004;p. 982–991
  37. Collin BA, Leather HL, Wingard JL, et al. Evolution, incidence and susceptibility of bacterial bloodstream isolates from 519 bone marrow transplant patients. Clin Infect Dis. 2001;33:947–953
  38. Hovi L, Saarinen-Pihkala UM, Vettenranta K, et al. Invasive fungal infections in pediatric bone marrow transplant recipients: single center experience of 10 years. Bone Marrow Transplant. 2000;9:999–1004
  39. Maltezou HC, Kafetzis DA, Abisaid D, et al. Viral infections in children undergoing hematopoietic stem cell transplant. Pediatr Infect Dis J. 2000;19:307–312
  40. Lujan-Zilbermann J, Benaim E, Tong X, et al. Respiratory virus infections in pediatric hematopoietic stem cell transplantation. Clin Infect Dis. 2001;33:962–968
  41. Han CS, Miller W, Haake R, et al. Varicella zoster infection after bone marrow transplantation: incidence, risk factors and complications. Bone Marrow Transplant. 1994;13:277–283
  42. Grose CF. Varicella-zoster virus infections. In:  McMillan JA,  DeAngelis CD,  Feigin RD, et al. editor. Oski's pediatrics. 3rd ed.. Philadelphia (Pa): Lippincott Williams and Wilkins; 1999;p. 1127–1130
  43. Gershon A. Varicella-zoster virus. In:  Feigin RD,  Cherry JD,  Demmler GJ, et al. editor. 5th ed.. Textbook of pediatric infectious diseases. vol. 1:Philadelphia (Pa): Saunders; 2004;p. 962–971
  44. American Academy of Pediatrics. Varicella-zoster infections. In:  Pickerling LK editors. Red book: 2003 report of the committee on infectious diseases. 26th ed.. Elk Grove Village (Ill): American Academy of Pediatrics; 2003;p. 672–686
  45. Kawasaki H, Takayama J, Ohira M. Herpes zoster infection after bone marrow transplantation in children. J Pediatr. 1996;128:353–356
  46. Leung TF, Chik KW, Li CK, et al. Incidence, risk factors and outcome of varicella-zoster virus infection in children after haematopoietic stem cell transplant. Bone Marrow Transplant. 2000;25:167–172
  47. Wacker P, Hartmann O, Benhamou E, et al. Varicella-zoster virus infections after autologous bone marrow transplantation in children. Bone Marrow Transplant. 1989;4:191–194
  48. Coffin SE, Hodinka RL. Utility of direct immunofluorescence and virus culture for detection of varicella-zoster virus in skin lesions. J Clin Microbiol. 1995;33:2792–2795
  49. Shepp DH, Dandliker PS, Meyers JD. Treatment of varicella-zoster infection in severely immunocompromised patients. N Engl J Med. 1986;314:208–212
  50. Feldman S, Lott L. Varicella in children with cancer: impact of antiviral therapy and prophylaxis. Pediatrics. 1987;80:465–472
  51. Prober CG, Kirk LE, Keeney RE. Acyclovir therapy of chickenpox in immunosuppressed children—a collaborative study. J Pediatr. 1982;101:622–625
  52. Nyerges G, Meszner Z, Gyarmati E, et al. Acyclovir prevents dissemination of varicella in immunocompromised children. J Infect Dis. 1988;157:309–313
  53. Kanda Y, Mineishi S, Saito T, et al. Long-term low-dose acyclovir against varicella-zoster virus reactivation after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant. 2001;28:689–692
  54. Sempere A, Sanz GF, Senent L, et al. Long-term acyclovir prophylaxis for prevention of varicella zoster virus infection after autologous blood stem cell transplantation in patients with acute leukemia. Bone Marrow Transplant. 1992;10:495–498
  55. Reusser P, Cordonnier C, Einsele H, et al. European survey of herpesvirus resistance to antiviral drugs in bone marrow transplant recipients. Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation (EBMT). Bone Marrow Transplant. 1996;17:813–817
  56. American Academy of Pediatrics. Immunization in special clinical circumstances. In:  Pickerling LK editors. Red book: 2003 report of the committee on infectious diseases. 26th ed.. Elk Grove Village (Ill): American Academy of Pediatrics; 2003;p. 76–77
  57. Sauerbrei A, Praeger J, Hengst U, et al. Varicella vaccination in children after bone marrow transplantation. Bone Marrow Transplant. 1997;20:381–383
  58. Constantopoulos A, Najjar VA, Wish JB, et al. Defective phagocytosis due to tuftsin deficiency in splenectomized patients. Am J Dis Child. 1973;125:663–665
  59. Claret I, Morales L, Montaner A. Immunological studies in the postsplenectomy syndrome. J Pediatr Surg. 1975;10:59–64
  60. King HB, Schumaker HB. Splenic studies. I. Susceptibility to infection after splenectomy performed in infancy. Ann Surg. 1952;136:239–242
  61. Green JB, Shackford SR, Sise MJ, et al. Postsplenectomy sepsis in pediatric patients following splenectomy for trauma: a proposal for a multi-institutional study. J Pediatr Surg. 1986;21:1084–1086
  62. Karp MP, Guralnick-Scheff S, Schiffman G, et al. Immune consequences of nonoperative treatment of splenic trauma in the rat model. J Pediatr Surg. 1989;24:112–117
  63. Camel JE, Kim KS, Tchejeyan GH, et al. Efficacy of passive immunotherapy in experimental postsplenectomy sepsis due to Haemophilus influenzae type B. J Pediatr Surg. 1993;28:1441–1445
  64. Lane PA. The spleen in children. Curr Opin Pediatr. 1995;7:36–41
  65. Diamond LK. Splenectomy in childhood and the hazard of overwhelming infection. Pediatrics. 1969;43:886–889
  66. Hays DM, Ternberg JL, Chen TT, et al. Complications related to 234 staging laparotomies performed in the Intergroup Hodgkin's Disease in Childhood Study. Surgery. 1984;96:471–478
  67. Overturf GD. Indications for the immunological evaluation of patients with meningitis. Clin Infect Dis. 2003;36:189–194
  68. Singer DB. Postsplenectomy sepsis. Perspect Pediatr Pathol. 1973;1:285–311
  69. Sumaraju V, Smith LG, Smith SM. Infectious complications in asplenic hosts. Infect Dis Clin North Am. 2001;15:1–10
  70. Loggie BW, Hinchey EJ. Does splenectomy predispose to meningococcal sepsis? An experimental study and clinical review. J Pediatr Surg. 1986;21:326–330
  71. Katcher AL. Familial asplenia, other malformations, and sudden death. Pediatrics. 1980;65:633–635
  72. Chilcote RR, Baehner RL, Hammond GD. Septicemia and meningitis in children splenectomized for Hodgkin's disease. N Engl J Med. 1976;295:798–800
  73. Chaikof EL, McCabe CJ. Fatal overwhelming postsplenectomy infection. Am J Surg. 1985;149:534–538
  74. Erlakis AJ, Filler RM. Splenectomy in childhood: a review of 1413 cases. J Pediatr Surg. 1972;7:382–388
  75. Krivit W. Overwhelming post-splenectomy infection. Am J Hematol. 1977;2:193–201
  76. Horan M, Colebatch JH. Relation between splenectomy and subsequent infection: a clinical study. Am J Dis Child. 1962;37:398–414
  77. Jugenburg M, Haddock G, Freedman MH. The morbidity and mortality of pediatric splenectomy: does prophylaxis make a difference?. J Pediatr Surg. 1999;34:1064–1067
  78. Waldman JD, Rosenthal A, Smith AL, et al. Sepsis and congenital asplenia. J Pediatr. 1977;90:555
  79. Standage BA, Goss JC. Outcome and sepsis after splenectomy in adults. Am J Surg. 1982;143:545–548
  80. Lanzkowsky P, Shende A, Karayalcin G, et al. Staging laparotomy and splenectomy: treatment and complications of Hodgkin's disease in children. Am J Hematol. 1976;1:393–394
  81. Hays DM, Ternberg JL, Chen TT, et al. Postsplenectomy sepsis and other complications following staging laparotomy for Hodgkin's disease in childhood. J Pediatr Surg. 1986;21:628–632

PII: S1522-8401(05)00078-9

doi: 10.1016/j.cpem.2005.05.004

Clinical Pediatric Emergency Medicine
Volume 6, Issue 3 , Pages 173-183 , September 2005