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CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2012; 33(02): 95-101
DOI: 10.4103/0971-5851.99742
ORIGINAL ARTICLE

Diarrhea in neutropenic children with cancer: An Egyptian center experience, with emphasis on neutropenic enterocolitis

Laila M Sherief
Department of Pediatrics, Pediatric Hematology and Oncology Units, Faculty of Medicine, Zagazig University, Egypt
,
Mohamed R Beshir
Department of Pediatrics, Pediatric Hematology and Oncology Units, Faculty of Medicine, Zagazig University, Egypt
,
Naglaa Mohamed Kamal
Pediatric Hepatology Unit, Faculty of Medicine, Cairo University, Egypt
,
Maha K Gohar
Department of Medical Microbiology and Immunology, Zagazig University, Egypt
,
Ghada K Gohar
Department of Radiodiagnosis, Zagazig University, Egypt
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Abstract

Background: Diarrhea is a frequent complication in children with cancer who received intensive chemotheraputic regimens. It may be caused by several factors, neutropenic enterocolitis (NE) being the most serious. Aim: To study diarrhea in neutropenic cancer patients in the pediatric age group, with its underlying etiologies and risk factors, especially the bacterial causes, with special concern on NE. Materials and Methods: This study was carried out at the Pediatric Hematology and Oncology Units, Zagazig University Hospitals, Egypt, from January 2009 to September 2010. All children with malignant diseases who are ≤12 years of age were included. Patients who were neutropenic (<500/ mm 3 ) on admission or who became neutropenic during their stay in the hospital were monitored regularly (daily) for diarrhea. Neutropenic cancer patients with diarrhea were grouped into two groups: Group 1, with NE, and group 2, with neutropenic diarrhea rather than NE. On the first day of diarrhea, patients were subjected to complete blood count, blood cultures, stool microscopy and culture. Abdominal ultrasonography was carried out within 3 days of diarrhea. Results: A total of 200 children ≤12 years old, suffering from different malignancies, with a total of 180 neutropenic episodes were followed. Diarrhea was observed in 100 episodes (55.5%). NE constituted 16% of these diarrheal episodes. All patients with NE had significantly more severe neutropenia, and this was of longer duration than the other group. All patients with NE were febrile, with 100% positive blood culture. Stool analysis diagnosed giardiasis in 4.8% of the non-NE patients and in none of the NE patients, while stool culture was positive in 75% of the NE patients compared with 40.5% of the other group. Conclusions: Diarrhea is a common complication in neutropenic cancer children. Gram negative bacteria and Candida are the most incriminated pathogens. Duration and severity of neutropenia carry a great risk for the development of NE.

Keywords

Cancer - children - diarrhea - neutropenia - neutropenic enterocolitis


Publication History

Article published online:
13 April 2022

© 2012. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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