Systematic Reviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 7, 2016; 22(25): 5853-5866
Published online Jul 7, 2016. doi: 10.3748/wjg.v22.i25.5853
Gastrointestinal and liver infections in children undergoing antineoplastic chemotherapy in the years 2000
Elio Castagnola, Eliana Ruberto, Alfredo Guarino
Elio Castagnola, Infectious Diseases Unit, Istituto Giannina Gaslini, 16147 Genoa, Italy
Eliana Ruberto, Alfredo Guarino, Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, 80131 Naples, Italy
Author contributions: All authors contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and approval of the final version.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Elio Castagnola, MD, PhD, Infectious Diseases Unit, Istituto Giannina Gaslini, Largo G. Gaslini 5, 16147 Genoa, Italy.
Telephone: +39-10-56362428 Fax: +39-10-384323
Received: March 24, 2016
Peer-review started: March 25, 2016
First decision: May 12, 2016
Revised: May 27, 2016
Accepted: June 15, 2016
Article in press: June 15, 2016
Published online: July 7, 2016

AIM: To review gastrointestinal and liver infections in children undergoing antineoplastic chemotherapy. To look at gut microflora features in oncology children.

METHODS: We selected studies published after year 2000, excluding trials on transplanted pediatric patients. We searched English language publications in MEDLINE using the keywords: “gastrointestinal infection AND antineoplastic chemotherapy AND children”, “gastrointestinal infection AND oncology AND children”, “liver infection AND antineoplastic chemotherapy AND children”, “liver abscess AND chemotherapy AND child”, “neutropenic enterocolitis AND chemotherapy AND children”, “thyphlitis AND chemotherapy AND children”, “infectious diarrhea AND children AND oncology”, “abdominal pain AND infection AND children AND oncology”, “perianal sepsis AND children AND oncology”, “colonic pseudo-obstruction AND oncology AND child AND chemotherapy”, “microflora AND children AND malignancy”, “microbiota AND children AND malignancy”, “fungal flora AND children AND malignancy”. We also analysed evidence from several articles and book references.

RESULTS: Gastrointestinal and liver infections represent a major cause of morbidity and mortality in children undergoing antineoplastic chemotherapy. Antineoplastic drugs cause immunosuppression in addition to direct toxicity, predisposing to infections, although the specific risk is variable according to disease and host features. Common pathogens potentially induce severe diseases whereas opportunistic microorganisms may attack vulnerable hosts. Clinical manifestations can be subtle and not specific. In addition, several conditions are rare and diagnostic process and treatments are not standardized. Diagnosis may be challenging, however early diagnosis is needed for quick and appropriate interventions. Interestingly, the source of infection in those children can be exogenous or endogenous. Indeed, mucosal damage may allow the penetrance of endogenous microbes towards the bowel wall and their translocation into the bloodstream. However, only limited knowledge of intestinal dysbiosis in oncology children is available.

CONCLUSION: The diagnostic work-up requires a multimodal approach and should be implemented (also by further studies on new biomarkers) for a prompt and individualized therapy.

Keywords: Gastrointestinal tract, Liver, Microflora, Infection, Oncology, Chemotherapy, Children

Core tip: The presence of an infectious complication should be always suspected in children with cancer who experience abdominal symptoms. Gastrointestinal and liver infections may be severe complications of chemotherapy that require early diagnosis and appropriate treatment. In these patients there are no absolute predictive markers of gastrointestinal infections, with the possible exception of viral hepatitis. Therefore diagnosis requires a comprehensive approach based on medical history, clinical examination, microbiological tests, imaging and sometimes also invasive procedures.