الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Prolonged neutropenia is a major risk factor for invasive fungal infection among pediatric oncology patients. Invasive fungal infections remain a major cause of morbidity and mortality, particularly in immunocompromised patients. The majority of fungal infections are caused by Aspergillus specieses. This work was done to determine the role of innate immunity (Mannose-binding lectin) and cytokines (Interleukin 8) in identifying children with cancer for developing more frequent or more severe episodes of fever and severe chemotherapy induced neutropenia. This study was carried out on 53 children (33 cancer patients, 15 cases were studied at diagnosis with cancer,18 cases were studied when they developed febrile neutropenia(48 febrile neutropenic episodes) and 20 healthy children were taken as controls. They were 10 males and 9 females. Cancer patients were admitted to the Hematology-Oncology unit; Pediatric hospital, Menoufiya University during the period from January 2010, until June 2011. Studied populations were divided to 2 groups: *Patients: Group 1: Consists of 15 cases at the diagnosis with malignancy(with no febrile neutropenia. They were 9 males and 6 females. Their diagnosis was 12 cases ALL, 2 cases neuroblastoma and 1 case histocytosis. Their median age was 5 years. Group 2: Consists of 18 cases with 48 febrile neutropenic episodes. 43 episodes in patients with acute lymphoblastic leukemia, 2 episodes in patients with neuroblastoma and 3 episodes in patients with histocytosis. They were 29 males and 19 females. Their median age was 5.5 years. *Controls: Consists of 20 clinically healthy control children recruited from the out-patients clinics of pediatric department, Menoufiya University. They presented with minor acute illness. They were 12 males and 8 females. Their age ranged from 3-14 years with median age of 6 years. **Inclusion criteria: 1-patients presenting with febrile neutropenia (either with a single oral or equivalent temperature of greater than 38.3ºC or two consecutive temperatures greater than 38.0 ºC in a 12-hour period lasting at least 1 hour, and absolute neutrophil count less than 500/mm3). 2-Patients presenting with cancer at diagnosis with no febrile neutropenia. 3-They had no personal or family history suggestive of leukemia. **Exclusion criteria: 1-Patients with fever only (fever with normal count). 2- Patients with afebrile neutropenia. ***Clinical data of patients: -Risk stratification of febrile neutropenic patients, they are high risk as most of them are hematological malignancy and needed admistion to hospital with severe neutropenia. -Two patients had porta catheters and we did culture from them. Patients were subjected to the following investigations: I-Diagnosis and classification of cancer was established by; a)-History and physical examination. b) -Laboratory investigations including:- - 130 - Summary i. Complete blood picture including hemoglobin, total leukocytic count with absolute neutrophil count and platelets count. ii.Bone marrow aspiration. iii.Immunophenotyping (Elson et al., 1995). iv.Biopsy in cases of solid tumours. II-Once fever was reported with neutropenia according to previously mentioned criteria, the child was subjected to: 1-Complete history taking with special consideration of the age, sex, the type of underlying malignancy and mode of presentation. 2-Careful physical examination with particular attention to common sites of infection e.g. respiratory tract, perianal, perioral regions, gastrointestinal tract, genitourinary tract and systemic infections. 3-For every patient, the following laboratory investigations were done. They include: a)-Complete blood picture with differential count. All febrile neutropenic episodes, ANC<500/mm3 (severe neutropenia). b)-Urea, creatinine, electrolytes, liver function tests and urine analysis. c)-Blood culture for both bacteria and fungi and catheter culture if found. d)- Chest x-ray and CT chest if chest signs were found. e)-Semi-quantitative serelogic estimation of C-reactive protein. f)-Serum mannose –binding lectin by ELISA. g)-Serum IL-8 by ELISA. It was found that: The prevalence of fungal infections was 47.9% and bacterial infections 45.9% among febrile neutropenic oncology patients. The prevalence of bacterial infections were 45.9%, in the following sequence:- gram-positive bacteremia (staph. Aureus 16.7%) and gram-negative bacteremia 29.2% in the form of Klebsiella 10.4% and E.coli 18.8%. There was statistical significant (P<0.05) difference between duration of neutropenia and occurrence of bacterial infection. There was statistical significant (P<0.05) difference between duration of neutropenia and occurrence of fungal infection. There was statistical significant (P<0.05) difference between stage of treatment of cancer and occurrence of fungal infection, in which fungal infections were increased in the induction, consolidation (HDMTX) and maintenece stages. The present study shows negative correlation between duration of neutropenia and serum MBL level in febrile neutropenic episodes (P-value<0.001). The present study shows that MBL deficiency has no benefit at all in diagnosis of fungal infection, the area under the ROC curve is 0.01 (95% confidence interval, 0-1, P value <0.001). The present study shows that interleukin-8 and CRP have moderate accuracy in diagnosis of bacteremia and high accuracy in diagnosis of gram negative bacteremia. In the present study there was significant association between interleukin 8 and bacteremia (p value<0.001) and significant association between CRP and bacteremia (p value=0.002).