Infectious complications in the South African Black child with cancer
| dc.contributor.author | Naidu, Gita | |
| dc.date.accessioned | 2017-05-11T07:47:49Z | |
| dc.date.available | 2017-05-11T07:47:49Z | |
| dc.date.issued | 2016 | |
| dc.description | A thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Doctorate of Philosophy in the branch of Medicine. Johannesburg 2016 | en_ZA |
| dc.description.abstract | Introduction: The cure rates for children with cancer have improved with the use of high-intensity chemotherapy, aggressive surgical techniques, radiotherapy, and bone marrow transplantation. These treatment modalities render them more susceptible to immunosuppression and increase their susceptibility to infectious complications, which is a leading cause of death in this group of patients. Children diagnosed with cancer additionally are immunocompromised due to underlying malnutrition, HIV-infection, and Mycobacterium tuberculosis infection, which could further compound the increased susceptibility to infectious complications. Objectives: The aim of this research program was to investigate the infectious related morbidity and mortality in predominantly black-African children treated for cancer at one of the largest hospitals in the Southern Hemisphere (Johannesburg, South Africa) and in a setting with a high prevalence of HIV-infection and tuberculosis. Methods: The events studied were all febrile episodes in children who received cancer treatment. The standard care for these patients included a detailed history and physical examination, blood investigations (full blood count with a differential and a blood culture for suspected sepsis). In addition, patients enrolled into the study had anthropometric measures undertaken on admission, a tuberculin skin test by the Mantoux method and blood was drawn to undertake the T.-SPOT.TB test. For each septic episode, a detailed history and physical examination was performed, blood was obtained for culture, full blood count and differential, CRP and PCT, a nasopharyngeal aspirate was performed for the identification of respiratory viruses, and empiric antibiotic treatment was initiated. Results: We documented a high incidence (per 100 child years) of suspected septic episodes (102.9), microbiologically confirmed sepsis (69.4), respiratory virus associated (61), and 27.4% of all microbiologically confirmed septic episodes had respiratory viral and bacterial/fungal co-infections. In addition, a high proportion of septic episodes were polymicrobial in aetiology (40.6%). We also documented an incidence of 4.7 per 100 child years of tuberculosis in our study cohort. All of these were higher in the cohort with haematological malignancies than in those with solid tumours. Indwelling catheters, high-dose corticosteroids, high-risk haematological malignancies, metastatic solid tumours, high-intensity treatment, the presence of pneumonia, and tuberculosis increased the risk of sepsis and death in our patients. In HIV-infected patients with Non-Hodgkin’s lymphoma, advanced disease, and severe immunosuppression due to the HIV-infection and chemotherapy, increased the risk of sepsis in this group of patients. The incidence risk ratio for pneumonia was 6.5, for tuberculosis 10.8, for invasive fungal infections 4.1, and for Herpes stomatitis 3.1 compared with the HIV-uninfected cohort. Conclusion: Infectious complications following treatment in the Black South African child with cancer is a major burden, which contributes significantly to morbidity and mortality in this group of children. We need to pay greater attention to nutritional therapy (as the majority of patients were malnourished), aseptic techniques, monitoring of patients who are at risk for sepsis, and the judicious use of antibiotic therapy, paying heed to the principals of anti-microbial stewardship. Additionally there needs to be an increased vigilance for tuberculosis and pneumonia in children treated for cancer. Patients with haematological malignancies and HIV-infected children should be treated with Isoniazid prophylaxis for the course of the cancer therapy. Isolation facilities would help control the spread of infections in the unit. Increasing the awareness of childhood cancer will result in children being diagnosed with less advanced and aggressive cancer, which will ultimately decrease the infectious complications associated with intensive chemotherapy advanced surgery and extended-field radiotherapy for advanced disease. Early identification of HIV-infection, antiretroviral therapy and screening for malignant diseases in HIV-infected children may allow for earlier identification of AIDS-related malignancies. | en_ZA |
| dc.description.librarian | MT2017 | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/10539/22523 | |
| dc.language.iso | en | en_ZA |
| dc.title | Infectious complications in the South African Black child with cancer | en_ZA |
| dc.type | Thesis | en_ZA |
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