Arning M, Gehrt A, Aul C, Runde V, Hadding U, Schneider W
Department of Internal Medicine, Heinrich-Heine-University, Düsseldorf, Federal Republic of Germany.
Blut. 1990 Dec;61(6):364-8. doi: 10.1007/BF01738551.
Eight neutropenic patients with acute lymphocytic or nonlymphocytic leukemia had septicemia due to different strains of Streptococcus mitis (St. mitis), a microorganism not commonly recognized as a special pathogen in leukemic patients. Four of the patients had been treated with high-dose cytosine arabinoside as part of the cytostatic regimen, six had a central venous line and four patients had oral lesions prior to the infection. Selective gut decontamination consisted of co-trimoxazole/colistin in five patients and quinolones in three patients. The first three patients died, either due to interstitial pneumonia with the adult respiratory distress syndrome (ARDS), or due to infection-triggered disseminated intravascular coagulation despite prompt empiric antibiotic therapy including vancomycin. The other patients improved after empiric supplementation of penicillin G (30 Mega/day) to the antibiotic regimen. Beginning ARDS in two of these patients dramatically responded to high-dose steroids. We conclude that St. mitis is a major pathogen in neutropenic leukemic patients. Infection appears to occur independently of acute leukemic cell type, regimen of selective gut decontamination, venous access, visible oral lesions or treatment with high-dose cytosine arabinoside. The clinical course of our patients raises questions about the value of commonly recommended empiric antibiotic regimens, which were clearly ineffective to control infections with St. mitis in this patient group. Our data indicate that immediate antibiotic therapy with penicillin G is indicated and may be life-saving for suspected St. mitis infections in neutropenic leukemic patients.
八名急性淋巴细胞白血病或非淋巴细胞白血病的中性粒细胞减少患者发生了由不同株缓症链球菌（St. mitis）引起的败血症，缓症链球菌是一种在白血病患者中通常不被视为特殊病原体的微生物。其中四名患者在细胞毒性治疗方案中接受了大剂量阿糖胞苷治疗，六名患者有中心静脉导管，四名患者在感染前有口腔病变。五名患者采用复方新诺明/黏菌素进行选择性肠道去污，三名患者采用喹诺酮类药物。前三例患者死亡，要么死于伴有成人呼吸窘迫综合征（ARDS）的间质性肺炎，要么死于感染引发的弥散性血管内凝血，尽管及时进行了包括万古霉素在内的经验性抗生素治疗。其他患者在抗生素治疗方案中经验性补充青霉素G（3000万单位/天）后病情好转。其中两名患者开始出现的ARDS对大剂量类固醇有显著反应。我们得出结论，缓症链球菌是中性粒细胞减少白血病患者的主要病原体。感染似乎与急性白血病细胞类型、选择性肠道去污方案、静脉通路、可见口腔病变或大剂量阿糖胞苷治疗无关。我们患者的临床病程对常用的经验性抗生素治疗方案的价值提出了疑问，这些方案在该患者组中显然无法有效控制缓症链球菌感染。我们的数据表明，对于中性粒细胞减少白血病患者疑似缓症链球菌感染，应立即使用青霉素G进行抗生素治疗，这可能挽救生命。
