Tuberculosis in Pediatric Cancer Patients during Chemotherapy

Lim, Jung Hwa; Lee, Ye Jhin; Choi, Eun Jin; Lee, Kun Soo

Abstract

PURPOSE: Tuberculosis may cause a serious complication in children with cancer who are receiving the chemotherapy. But its diagnosis is not easy if we do not suspect the disease in patients with uncontrolled persistent fever. We studied retrospectively the importances of prevention and early diagnosis of tuberculosis in cancer patients. METHPDS: Twelve patients were diagnosed as having tuberculosis during cancer chemotherapy in Kyungpook National University Hospital from May, 1981 to May, 1998. We reviewed their clinical features, diagnostic methods, treatment and prevention. RESULTS: The median age of the patients was 14 (2~18) years. The underlying diseases were seven acute lymphoblastic leukemia (ALL), two acute undifferentiated leukemia (AUL), one acute nonlymphoblastic leukemia (ANLL), one mixed-lineage leukemia, and one Burkitt's lymphoma. The disease categories of tuberculosis were seven pulmonary tuberculosis, two tuberculous pleurisy, one miliary tuberculosis, one bone and endotracheal tuberculosis and one tuberculous meningitis. The family history of tuberculosis is positive in one case. The clues of the suspicion of tuberculosis infections were 9 cases of persistent fever despite broad spectrum of antibiotics and/or antifungal agent therapy, 2 chronic cough and 1 chest pain. We could diagnose four by AFB culture, three cases by AFB smear, two by polymerase chain reaction (PCR), one by pleural biopsy, one by transbronchial lung biopsy and one by chest X-ray and CSF study. We treated pulmonary tuberculosis and tuberculous pleurisy by triple therapy (isoniazid, rifampin, pyrazinamide) and miliary, bone, endotracheal tuberculosis and tuberculous meningitis by quadriple therapy (isoniazid, rifampin, pyrazinamide, streptomycin or kanamycin). The mean duration of defervescence after treatment was 15.4 days. One died of fulminant hepatitis probably by hepatitis B after completion of cancer chemotherapy, one died of adult respiratory distress syndrome, two died of DIC, three died of relapse of underlying disease, but no one died of tuberculosis infection itself.
CONCLUSION
The early diagnosis of tuberculosis is an important factor for decreasing the mortality rates of cancer patients, so we should have a suspicion of this disease in patients with persistent fever in spite of appropriate antibiotic and antifungal agents. Isoniazid prophylaxis may be needed in childhood cancer patients with chemotherapy in Korea.