Alpha–streptococcal septicemia in leukemic children treated with continuous or large dosage intermittent cytosine arabinoside

Sara V. Sotiropoulos, Mary Anne Jackson, Gerald M. Woods, Ralph A. Hicks, John Cullen, Arnold I. Freeman

Research output: Contribution to journalArticle

47 Scopus citations


During a 2-year period after the introduction of an intensive chemotherapeutic protocol, alpha-hemolytic streptococci accounted for 75% of all episodes of sepsis among children with acute nonlymphocytic leukemia at our institution. Only one case had occurred in the previous 8 years. Fourteen of 15 episodes of streptococcal sepsis occurred after therapy with either continuous or large dosage intermittent cytosine arabinoside. Eleven episodes occurred at two specific treatment points. Septic episodes were complicated by shock (2 of 15), encephalopathy (2 of 15), pneumonia (3 of 15) and death (1 of 15). Oral mucosal lesions may provide a portal of entry for alpha-hemolytic streptococci. These data suggest that children receiving continuous or large dosage intermittent cytosine arabinoside for treatment of acute nonlymphocytic leukemia may be at increased risk for alpha-he- molytic streptococcal sepsis. Empiric antimicrobial therapy in these children when febrile and neutropenic should include antibiotics effective against alpha-hemolytic streptococci.

Original languageEnglish (US)
Pages (from-to)755-758
Number of pages4
JournalPediatric Infectious Disease Journal
Issue number11
StatePublished - Nov 1989



  • Acute non-lymphocytic leukemia
  • Alpha-hemolytic streptococci
  • Cytosine arabinoside

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)
  • Infectious Diseases

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