Danish Medical Bulletin - No. 4. November 2004. Vol. 51 Page 445.

ABSTRACT OF PhD DISSERTATION

Infections in children undergoing treatment for malignant diseases

With special emphasis on viral respiratory diseases

Merete Stubkjær Christensen

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The PhD dissertation was accepted by the Faculty of Health Sciences, University of Aarhus, and defended on October 8, 2004.

Official opponents: Anné Møller-Larsen, Niels Anker Peterslund, and Kjeld Schmiegelow.

Tutors: Henrik Hasle and Lars Peter Nielsen.

Correspondence: Merete Stubkjær Christensen, A-forskning, Skejby Sygehus, 8200 Aarhus N, Denmark.

Dan Med Bull 2004;51:445.

ABSTRACT

The studies for this dissertation were performed in the research section of the paediatric department, Skejby Sygehus. The aim was to clarify the impact of infections on morbidity as well as on mortality in children undergoing treatment for malignant diseases. Three studies were performed:

  1. A retrospective study on treatment-related death acute lymphoblastic leukaemia (ALL).

  2. A 12-month prospective study on infections in children in the department of paediatric oncology, Skejby Sygehus, with special emphasis on the impact of viral respiratory diseases.

  3. A survey on viral load in staff, relatives and non-febrile children at the ward during winter.

1. Treatment-related lethal infections in 1656 Nordic children with non B-cell ALL were studied retrospectively over a ten-year period from 1992 to 2001. Fifty-seven children died of treatment-related causes during induction or in first complete remission, 3%. Approximately 70% of these deaths were due to infections: 50% bacterial, 16% fungal, 8% viral, 5% mixed infections. Microbiological diagnosis was not obtained in 21% of the fatal infections. Four of seven deaths following bone marrow transplantation were caused by infections and viruses were implicated in three of them. An unexpected gender difference was identified. Altogether, 28/33 girls, 85%, died of infections versus only 10/24 boys, 42%, (with the exclusion of bone marrow transplanted children). All early deaths due to aggressive leukaemia occurred in boys.

2. All infections were studied during a 12-month study period at the department of paediatric oncology. Supplementary viral diagnostics by molecular assays were carried out and identified 9% of the 250 registered infections. The documented viral infections caused considerable morbidity and were indistinguishable from blood stream bacterial infections in terms of bed-days, antibiotic treatment, maximal CRP, and postponing of cytotoxic chemotherapy. Seventy-four per cent of the viral infections were diagnosed in neutropenic patients. One of four RSV infections was fatal.

3. Viral load at the ward was surveyed by examination of oral washes from relatives, staff and non-febrile patients at the ward for seven random days in the winter. Furthermore oral washes from individuals with symptoms interpreted to be of viral origin were examined. The occurrence was extremely low and may partly be due to a restricted protective isolation.

In conclusion, infections caused considerable morbidity and mortality. Viral infections were often generalised in these patients and molecular viral diagnostic is recommended.

The studies were supported by the University of Aarhus, and the Danish Childhood Cancer Foundation.
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