Sotiropoulos S V, Jackson M A, Woods G M, Hicks R A, Cullen J, Freeman A I
Section of Infectious Diseases, University of Missouri-Kansas City School of Medicine.
Pediatr Infect Dis J. 1989 Nov;8(11):755-8. doi: 10.1097/00006454-198911000-00005.
During a 2-year period after the introduction of an intensive chemotherapeutic protocol, alpha-hemolytic streptococci accounted for 75% of all episodes of sepsis among children with acute nonlymphocytic leukemia at our institution. Only one case had occurred in the previous 8 years. Fourteen of 15 episodes of streptococcal sepsis occurred after therapy with either continuous or large dosage intermittent cytosine arabinoside. Eleven episodes occurred at two specific treatment points. Septic episodes were complicated by shock (2 of 15), encephalopathy (2 of 15), pneumonia (3 of 15) and death (1 of 15). Oral mucosal lesions may provide a portal of entry for alpha-hemolytic streptococci. These data suggest that children receiving continuous or large dosage intermittent cytosine arabinoside for treatment of acute nonlymphocytic leukemia may be at increased risk for alpha-hemolytic streptococcal sepsis. Empiric antimicrobial therapy in these children when febrile and neutropenic should include antibiotics effective against alpha-hemolytic streptococci.
在采用强化化疗方案后的两年期间，在我们机构中，α-溶血性链球菌在急性非淋巴细胞白血病患儿的所有败血症发作中占75%。在过去8年中仅发生过1例。15例链球菌败血症发作中有14例发生在连续或大剂量间歇使用阿糖胞苷治疗后。11例发作发生在两个特定治疗点。败血症发作并发休克（15例中的2例）、脑病（15例中的2例）、肺炎（15例中的3例）和死亡（15例中的1例）。口腔黏膜病变可能为α-溶血性链球菌提供了一个入口。这些数据表明，接受连续或大剂量间歇阿糖胞苷治疗急性非淋巴细胞白血病的儿童可能发生α-溶血性链球菌败血症的风险增加。这些发热且中性粒细胞减少的儿童的经验性抗菌治疗应包括对α-溶血性链球菌有效的抗生素。
