癌症中性粒细胞减少儿童的腹泻：一家埃及中心的经验，重点关注中性粒细胞减少性小肠结肠炎。

Diarrhea in neutropenic children with cancer: An Egyptian center experience, with emphasis on neutropenic enterocolitis.

作者信息

Sherief Laila M, Beshir Mohamed R, Kamal Naglaa Mohamed, Gohar Maha K, Gohar Ghada K

机构信息

Department of Pediatrics, Pediatric Hematology and Oncology Units, Faculty of Medicine, Zagazig University, Egypt.

出版信息

Indian J Med Paediatr Oncol. 2012 Apr;33(2):95-101. doi: 10.4103/0971-5851.99742.

DOI:10.4103/0971-5851.99742

PMID:22988351

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3439797/

Abstract

BACKGROUND

Diarrhea is a frequent complication in children with cancer who received intensive chemotheraputic regimens. It may be caused by several factors, neutropenic enterocolitis (NE) being the most serious.

AIM

To study diarrhea in neutropenic cancer patients in the pediatric age group, with its underlying etiologies and risk factors, especially the bacterial causes, with special concern on NE.

MATERIALS AND METHODS

This study was carried out at the Pediatric Hematology and Oncology Units, Zagazig University Hospitals, Egypt, from January 2009 to September 2010. All children with malignant diseases who are ≤12 years of age were included. Patients who were neutropenic (<500/ mm(3)) on admission or who became neutropenic during their stay in the hospital were monitored regularly (daily) for diarrhea. Neutropenic cancer patients with diarrhea were grouped into two groups: Group 1, with NE, and group 2, with neutropenic diarrhea rather than NE. On the first day of diarrhea, patients were subjected to complete blood count, blood cultures, stool microscopy and culture. Abdominal ultrasonography was carried out within 3 days of diarrhea.

RESULTS

A total of 200 children ≤12 years old, suffering from different malignancies, with a total of 180 neutropenic episodes were followed. Diarrhea was observed in 100 episodes (55.5%). NE constituted 16% of these diarrheal episodes. All patients with NE had significantly more severe neutropenia, and this was of longer duration than the other group. All patients with NE were febrile, with 100% positive blood culture. Stool analysis diagnosed giardiasis in 4.8% of the non-NE patients and in none of the NE patients, while stool culture was positive in 75% of the NE patients compared with 40.5% of the other group.

CONCLUSIONS

Diarrhea is a common complication in neutropenic cancer children. Gram negative bacteria and Candida are the most incriminated pathogens. Duration and severity of neutropenia carry a great risk for the development of NE.

摘要

背景

腹泻是接受强化化疗方案的癌症患儿常见的并发症。它可能由多种因素引起，其中中性粒细胞减少性小肠结肠炎（NE）最为严重。

目的

研究儿科年龄组中性粒细胞减少的癌症患者的腹泻情况，包括其潜在病因和危险因素，特别是细菌病因，尤其关注NE。

材料与方法

本研究于2009年1月至2010年9月在埃及扎加齐格大学医院的儿科血液学和肿瘤学科室进行。纳入所有年龄≤12岁的恶性疾病患儿。对入院时中性粒细胞减少（<500/mm³）或住院期间出现中性粒细胞减少的患者进行腹泻的定期（每日）监测。腹泻的中性粒细胞减少癌症患者分为两组：第1组为NE患者，第2组为非NE的中性粒细胞减少性腹泻患者。腹泻首日，对患者进行全血细胞计数、血培养、粪便显微镜检查和培养。腹泻3天内进行腹部超声检查。

结果

共随访了200例年龄≤12岁、患有不同恶性肿瘤且共有180次中性粒细胞减少发作的患儿。观察到100次腹泻发作（55.5%）。NE占这些腹泻发作的16%。所有NE患者的中性粒细胞减少明显更严重，且持续时间比另一组更长。所有NE患者均发热，血培养100%阳性。粪便分析在4.8%的非NE患者中诊断出贾第虫病，而NE患者中无一例诊断出，同时NE患者粪便培养阳性率为75%，另一组为40.5%。