HIGH-DOSE CYTOSINE-ARABINOSIDE AND VIRIDANS STREPTOCOCCUS-SEPSIS IN CHILDREN WITH LEUKEMIA

We report three cases of fulminant sepsis due to viridans streptococci in leukemic children treated with high-dose cytosine arabinoside (Ara -C). The major predisposing factors to this occurrence are the presenc e of oropharngeal mucositis, which is the entry of streptococci into t he bloodstream, and the use of antibiotic prophylactic regimens agains t gram-negative bacteria. In order to avoid fatal events during virida ns streptococci sepsis, specific measures such as penicillin prophylax is or early antibiotic treatment are needed. We suggest that the promp t empiric use of a glycopeptide antibiotic in addition to the conventi onal association of a beta-lactam plus an aminoglycoside may significa ntly decrease the mortality rate due to fulminant streptococci sepsis while the patient is severely neutropenic. In this regard, our current policy considers the addition of an anti-gram-positive antibiotic to the first-choice fever treatment in neutropenic patients who have rece ived high-dose Ara-C.