Diagnosis and Management of Infectious Disease Problems in the Child with Malignant Disease

Abstract

Among the first questions to be raised in considering the infectious complications that occur in the child with cancer is whether they are different from those found in adults. Are the predominant pathogens, susceptible hosts, patterns of presentation, and response to therapy sufficiently different in children such that age-specific management guidelines are necessary? Does the antigenic naiveté and susceptibility of healthy children to “common” ubiquitous pathogens (e.g., respiratory viruses, herpes viruses, encapsulated bacteria) influence the pattern of infections that occur when a malignancy intercepts the normal process of growth and development? Clearly, infection is a common event during normal childhood, the “average” child experiencing 6–10 febrile illnesses per year. Against this backdrop, an understanding of the types of malignancies that occur during childhood, the modalities used to treat them and their impact on host defenses permits additional insights into the types of infections that might be anticipated. In generating an approach to management, the facts that children may require modifications of the diagnostic techniques used in adults and that therapy must be individualized to the growing child’s body weight or surface area are important additional considerations. That the child and adolescent may cooperate with the diagnostic plan or treatment differently from the adult and, importantly, that they may tolerate greater pathogenic burdens as well as therapeutic assaults should also be considered. In this chapter, an attempt is made to highlight some of the features unique to childhood cancers and that may be important to the successful management of the infectious complications associated with them.