Objectives Fever is a known complication in pediatric cancer patients when on chemotherapy for which prompt initiation of empiric antibiotics is the single most important life-saving intervention. Nearly two-thirds of all children are treated without identifying the source of fever. Molecular diagnostics can improve management of febrile episodes and reduce unnecessary antibiotic use. The purpose of our study was to evaluate the pathogenic etiology of febrile episodes and analyze their clinical characteristics.

Materials and Methods We conducted a prospective observational study at our tertiary care institution from January 2019 to March 2020, to identify the etiology of febrile episodes with or without neutropenia in pediatric cancer patients and to study their clinical outcomes.

Results Forty febrile episodes were observed among 27 patients over a period of 15 months. The mean age group was 5 years. In 28 febrile episodes without a focus (70%), a respiratory organism (virus, bacteria, or coinfection) was detected. Rhinovirus was the most common single respiratory isolate (47.36%), followed by Streptococcus pneumoniae (21.05%) and six episodes had multiple viral isolates (21.42%). There was no prolonged hospitalization, need for intensive care unit or oxygen requirement, or mortality. The most common antibiotic used in empiric management was piperacillin–tazobactam. Aminoglycosides were added when there was a clinical suspicion of resistant organism.

Conclusion Around 70% of febrile episodes without a focus or documented infection in cancer children had a respiratory pathogen identified in nasopharyngeal swab. Molecular diagnostics greatly enhances diagnostic sensitivity and thereby individualizes the management of febrile illness in these children.

Loganathan A, Bharadwaj R, Srinivasan A, Scott JX. Cytogenetics and molecular genetics in pediatric acute lymphoblastic leukemia (ALL) and its correlation with induction outcomes. South Asian J Cancer. 2022;11(4):353–360. Published 2022 Aug 22. doi:10.1055/s-0042-1754337.

A.S. was responsible for the conception and design of the study, as well as for revising the manuscript critically for important intellectual content and approving the final version for publication. M.S.R. handled the acquisition of data, conducted the analysis and interpretation of that data, drafted the manuscript, and approved the version to be published. S.C. contributed to the analysis and interpretation of data, revised the manuscript critically for important intellectual content, and approved the final version for publication. Lastly, S.B. was involved in the conception and design of the study, revised the manuscript critically for important intellectual content, and approved the manuscript for publication.

This study was cleared by the Institutional Ethics Committee (IEC) for its scientific content and ethics (IEC-23/MAY2018-IRB min dt 30.05.2018; IRB EC Re-Registration No. ECR/676/Inst/TN/2014/RR-17).

Study was funded by The CHILDS Trust Medical Research Foundation.

Received: 19 March 2024

Accepted: 21 September 2024

Article published online:
29 October 2024

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