Objective: Infections are among the most important causes of mortality and morbidity in immunocompromised children. Although, the microbiological agents are usually opportunistic infections, sometimes rare infectious agents can also cause severe clinical conditions. Here, we present eight different microbial agents that can rarely cause infections in children with febrile neutropenia.
Case report: Case 1 is a 5-year-old girl with acute lymphoblastic leukemia (ALL) had a bloodstream infection during the reinduction therapy. Candida pelliculosa was detected in the blood culture taken from the port catheter. The catheter was removed and the patient was successfully treated with caspofungin. Case 2 is a 1-year-old girl with acute myeloblastic leukemia had a bloodstream infection during the first induction therapy. Cronobacter sakazakii was detected in peripheral blood culture. The patient was treated with cefepime and amikacin without port removal. Case 3 is a 5 month old girl with hemophagocytic lymphohistiocytosis had a pneumonia during the HLH 2004 protocol. Nocardia asteroides was detected in the bronchoalveolar lavage fluid. The patient was treated with trimethoprim-sulfamethoxazole and meropenem, however, she died of sepsis and multiple organ failure. Case 4 is a 2-year-old girl with ALL had a sepsis during the consolidation therapy. Candida tropicalis was detected in the port catheter and peripheral blood culture and renal abscess had developed. The patient was treated with broad spectrum antibiotics however she died sepsis and multiple organ failure. Case 5 is a 9-year-old male with ALL had a bloodstream and port catheter infection after the first induction therapy. Herbaspirillum huttiense was detected in the blood culture taken from the port catheter. The patient was successfully treated with meropenem without port removal. Case 6 is a 10-year-old girl with ALL had a bloodstream and port catheter infection during the second induction therapy. Ralstonia pickettii was detected in the blood culture taken from the port catheter. The catheter was removed and the patient was successfully treated with piperacillin-tazobactam. Case 7 is a 7 month old male with Juvenile myelomonocytic leukemia had a bloodstream and port catheter infection in the neutropenic period. The patient was constantly inserting the port catheter into her mouth. Staphylococcus salivarius was detected in the blood culture taken from the port catheter. Then, 5 day after, Rothia mucilaginosa was detected in the peripheral blood culture. The patient was successfully treated with meropenem without port removal. Case 8 is a 9-year-old girl with ALL had a infective endocarditis and sepsis during the induction therapy. Magnusiomyces capitatus was detected in the peripheral blood culture. The patient was treated with fluconazole and amphotericin-B, but she died of multi-organ failure.
Conclusion: Many different microorganisms can cause infections in immune-compromised children as a result of primary disease or chemotherapy. Though empiric antibiotic therapy should be initiated early, the treatment should be revised according to the antibiogram and catheter should be removed as needed.
