Treatment strategy for mycobacterial infections in pediatric hematology and oncology

Abstract

Cytopenic children during or after cancer chemotherapy or hematopoietic cell transplantation (HCT) are at a high risk of infections. Mycobacterial infections are quite rare compared with bacterial, viral or fungal infections in pediatric patients on cancer chemotherapy or HCT. However, their early diagnosis and appropriate management are required because of their severity and mortality. More than 30 species of nontuberculous mycobacteria have been reported in Japan, including slowly growing mycobacteria (SGM) and rapidly growing mycobacteria (RGM). SGM such as Mycobacterium avium, Mycobacterium kansasii, and Mycobacterium marinum often cause disseminated infection. RGM including Mycobacterium chelonae, Mycobacterium abscessus, and Mycobacterium fortuitum cause catheter-related infection. The number of pediatric patients infected with Mycobacterium tuberculosis is decreasing yearly to less than 100 of the annual incidences of newly diagnosed pediatric cases in Japan. Because of the low morbidity but high mortality of mycobacterial infections in immunocompromised children, accurate diagnosis and treatment are indispensable for their management in pediatric hematology and oncology.