El-Mahallawy Hadir A, El-Din Nelly H Aly, Salah Fatma, El-Arousy Maha, El-Naga Sherif Abou
Clinical Pathology, National Cancer Institute, Cairo University, Egypt.
Pediatr Blood Cancer. 2004 Apr;42(4):338-42. doi: 10.1002/pbc.10394.
Patients with cancer who receive intensive chemotherapeutic regimens are subject to profound immunosuppression and are susceptible to an extended array of pathogens.
The infectious causes of symptomatic gastroenteritis as evidenced by diarrhea +/- fever, vomiting, and abdominal colic in children following chemotherapy were prospectively monitored at National Cancer Institute, Cairo University.
A total of 104 diarrhea episodes were recorded in our institution during a 10-month period, of which an infectious cause was detected in 74 (71.1%). Bacterial and fungal pathogens were isolated in culture from 41 (39.4%) and 24 (23.1%), respectively, while Clostridia difficile (C. difficile) and Cryptosporidium parvum (C. parvum) were detected in 15 (14.4%) and 10 (9.6%) of 104 diarrhea episodes following chemotherapy, respectively. Mixed infections were found in 24 of the patients; whereas, no cause was demonstrable in 30. Hospital acquired and mixed infections were the worst as regards morbidity (P = 0.004 and 0.02) and mortality (P = 0.007 and <0.001) of the infectious episode regardless the cause, respectively. On multivariate analysis, C. difficile was associated with the highest mortality rate (OR = 0.04, 95% CI = 0.01-0.19), followed by fungal pathogens (OR = 0.20, 95% CI = 0.05-0.74) and bacterial infections (OR = 0.20, 95% CI = 0.05-0.79).
Infectious gastroenteritis is an important cause of morbidity and mortality in hospitalized pediatric cancer patients receiving intensified protocols of chemotherapy.
接受强化化疗方案的癌症患者会受到严重的免疫抑制，易感染多种病原体。
在开罗大学国家癌症研究所对化疗后出现腹泻±发热、呕吐和腹部绞痛症状的儿童症状性肠胃炎的感染原因进行前瞻性监测。
在我们机构的十个月期间共记录了104次腹泻发作，其中74次（71.1%）检测到感染原因。分别从41次（39.4%）和24次（23.1%）的培养物中分离出细菌和真菌病原体，而在104次化疗后腹泻发作中，分别有15次（14.4%）和10次（9.6%）检测到艰难梭菌和微小隐孢子虫。24名患者中发现混合感染；而30次未发现病因。无论病因如何，医院获得性感染和混合感染在感染发作后的发病率（P = 0.004和0.02）和死亡率（P = 0.007和<0.001）方面是最严重的。多因素分析显示，艰难梭菌的死亡率最高（OR = 0.04，95%CI = 0.01 - 0.19），其次是真菌病原体（OR = 0.20，95%CI = 0.05 - 0.74）和细菌感染（OR = 0.20，95%CI = 0.05 - 0.79）。
感染性肠胃炎是接受强化化疗方案的住院儿科癌症患者发病和死亡的重要原因。
