Infectious disease complications in children with cancer
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Keywords

Paediatric oncology
Childhood cancer
Risk factors
Infectious complications

How to Cite

Infectious disease complications in children with cancer. (2026). Undergraduate Research in Health Journal, 4(1), e3853. https://doi.org/10.1796/

Abstract

Infectious complications in childhood cancer contribute to increased morbidity and mortality. Factors predisposing to infection include malignancy- related immune dysregulation, cytotoxic chemotherapy-induced myelosuppression, high-dose corticosteroid use, the presence of indwelling venous catheters, malnutrition, frequent and prolonged hospital stays, and coexisting HIV infection. In the southern African context, infectious complications are associated with worse clinical outcomes than in higher-income countries. More region-specific research is needed to improve patient management and increase survival rates.

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References

1. National Cancer Registry. Cancer in South Africa 2019 Full Report. Johannesburg: National Institute for Communicable Diseases. https://www.nicd.ac.za/wp-content/uploads/2021/12/NCR_Path_2019_Full_ Report_8dec2021.pdf (accessed 7 May 2025).

2. National Cancer Registry. Cancer in South Africa 2020 Full Report. Johannesburg: National Institute for Communicable Diseases. https://www.nicd.ac.za/wp-content/uploads/2023/04/The-National-Pathology- Cancer-Incidence-Report-2020.pdf (accessed 7 May 2025).

3. National Cancer Registry. Cancer in South Africa 2021 Full Report. Johannesburg: National Institute for Communicable Diseases. https://www.nicd.ac.za/wp-content/uploads/2024/04/NCR_ASR_tables_2021_ final.pdf (accessed 7 May 2025).

4. National Cancer Registry. Cancer in South Africa 2022 Full Report. Johannesburg: National Institute for Communicable Diseases. https://www.nicd.ac.za/wp-content/uploads/2024/04/NCR_ASR_tables_2022_ final.pdf (accessed 7 May 2025).

5. National Cancer Registry. Cancer in South Africa 2023 Full Report. Johannesburg: National Institute for Communicable Diseases. https://www.nicd.ac.za/wp-content/uploads/2025/04/NCR_ASR_tables_2023. pdf (accessed 7 May 2025).

6. Adekunle MO, Davidson A, Hendricks M. Risk factors and predictors of adverse outcomes in paediatric febrile neutropenia. SA J Oncol 2023;7:232. https://doi.org/10.4102/sajo.v7i0.232

7. Davis K, Wilson S. Febrile neutropenia in paediatric oncology. Paediatr Child Health 2020;30(3):93-97.

https://doi.org/10.1016/j.paed.2019.12.002

8. Israels T, Afungchwi GM, Klootwijk L, et al. Fever and neutropenia outcomes and areas for intervention: A report from SUCCOUR‐Supportive Care for Children with Cancer in Africa. Pediatr Blood Cancer 2021;68(9):e29224. https://doi.org/10.1002/pbc.29224

9. Basu SK, Fernandez ID, Fisher SG, Asselin BL, Lyman GH. Length of stay and mortality associated with febrile neutropenia among children with cancer. J Clin Oncol 2005;23(31):7958-7966. https://doi. org/10.1200/jco.2005.01.6378

10. Erbaş İC, Güzin AÇ, Alataş ŞÖ, et al. Etiology and factors affecting severe complications and mortality of febrile neutropenia in children with acute leukemia. Turk J Hematol 2023;40(3):143-153. https://doi. org/10.4274/tjh.galenos.2023.2023.0185

11. Mvalo T, Eley B, Bamford C, et al. Bloodstream infections in oncology patients at Red Cross War Memorial Children’s Hospital, Cape Town, from 2012 to 2014. Int J Infect Dis 2018;77:40-47. https://doi. org/10.1016/j.ijid.2018.09.012

12. Van de Wetering MD, Poole J, Friedland I, Caron HN. Bacteraemia in a paediatric oncology unit in South Africa. Med Pediatr Oncol 2001;37(6):525-531. https://doi.org/10.1002/mpo.1246

13. Naidu G, Izu A, Poyiadjis S, MacKinnon D, Rowe B, Madhi SA. High burden of serious bacterial infections in African children treated for cancer. Pediatr Infect Dis J 2020;39(10):943-948. https://doi.org/10.1097/ inf.0000000000002758

14. Joosse IR, van den Ham HA, Mantel-Teeuwisse AK, Perumal-Pillay VA, Suleman F. Access to childhood cancer medicines in South Africa: A health systems analysis of barriers and enablers. J Pharm Policy Pract 2024;17(1):2372033. https://doi.org/10.1080/20523211.2024.2372033

15. EdwardsLB,GreeffLE.ExploringgrassrootsfeedbackaboutcancerchallengesinSouthAfrica:Adiscussion of themes derived from content thematic analysis of 316 photo-narratives. Pan Afr Med J 2017;28(1):173. https://doi.org/10.11604/pamj.2017.28.173.11894

16. Hendricks M, Cois A, Geel J, et al. Socioeconomic status significantly impacts childhood cancer survival in South Africa. Pediatr Blood Cancer 2023;70(12):e30669. https://doi.org/10.1002/pbc.30669

17. Chitha W, Swartbooi B, Jafta Z, et al. Model of delivery of cancer care in South Africa’s Eastern Cape and Mpumalanga provinces: A situational analysis protocol. BMJ Open 2022;12(2):e058377. https://doi. org/10.1136/bmjopen-2021-058377

18. 1Pondy A, Taguebue J, Ngome R, Obama J, Chelo D, Obama BM. Distribution of bacterial and fungal etiologies of bloodstream infections in children treated for cancer in Cameroon. Health Res Afr 2024;2(10):44-50.

19. Bouw MC, Hesseling PB, Nel E, Wessels G, Janse van Rensburg E. Viral infections in children receiving anticancer chemotherapy. S Afr J Child Health 2007;1(4):151-155. https://journals.co.za/doi/ epdf/10.10520/EJC64682

20. Zawitkowska J, Drabko K, Czyżewski K, et al. Viral infection profile in children treated for acute lymphoblastic leukemia – results of nationwide study. Pathogens 2022;11(10):1091. https://doi.org/10.3390/ pathogens11101091

21. Barrientos ACM, Nobrega de Almeida Junior J, Litvinov N, et al. Breakthrough candidemia in pediatric patients with cancer from a Brazilian center. Pediatr Infect Dis J 2021;40(3):251-254. https://doi. org/10.1097/inf.0000000000003027

22. Kazakou N, Vyzantiadis TA, Gambeta A, et al. Invasive fungal infections in a pediatric hematology-oncology department: A 16-year retrospective study. Curr Med Mycol 2020;6(2):37-42. https://doi.org/10.18502/ cmm.6.2.2840

23. Pollock RE, Roth JA. Cancer-induced immunosuppression: Implications for therapy? Semin Surg Oncol 1989;5(6):414-419. https://doi.org/10.1002/ssu.2980050607

24. Gholipour E, Kahroba H, Soltani N, et al. Paediatric pre-B acute lymphoblastic leukaemia-derived exosomes regulate immune function in human T cells. J Cell Mol Med 2022;26(16):4566-4576. https://doi. org/10.1111/jcmm.17482

25. Hillinger SM, Herzig GP. Impaired cell-mediated immunity in Hodgkin’s disease mediated by suppressor lymphocytes and monocytes. J Clin Invest 1978;61(6):1620-1627. https://doi.org/10.1172/jci109082

26. Corrie PG. Cytotoxic chemotherapy: Clinical aspects. Medicine 2008;36(1):24-28. https://doi. org/10.1016/j.mpmed.2007.10.012

27. Cheng KKF, Lee V, Li CH, et al. Incidence and risk factors of oral mucositis in paediatric and adolescent patients undergoing chemotherapy. Oral Oncol 2011;47(3):153-162. https://doi.org/10.1016/j. oraloncology.2010.11.019

28. Madu AJ, Ocheni S, Ibegbulam OG, Aguwa EN, Madu KA. Pattern of CD4 T-lymphocyte values in cancer patients on cytotoxic therapy. Ann Med Health Sci Res 2013;3(4):498-503.

29. Liberman AC, Budziñski ML, Sokn C, Gobbini RP, Steininger A, Arzt E. Regulatory and mechanistic actions of glucocorticoids on T and inflammatory cells. Front Endocrinol (Lausanne) 2018;9:235. https:// doi.org/10.3389/fendo.2018.00235

30. Naidu G, Izu A, Madimabe MR, et al. Burden of tuberculosis in South African children during treatment for underlying malignancies: A single-center experience in Johannesburg. Pediatr Infect Dis J 2020;39(12):1111- 1115. https://doi.org/10.1097/INF.0000000000002873

31. Möricke A, Zimmermann M, Valsecchi MG, et al. Dexamethasone vs prednisone in induction treatment of pediatric ALL: Results of the randomized trial AIEOP-BFM ALL 2000. Blood 2016;127(17):2101-2112. https://doi.org/10.1182/blood-2015-09-670729

32. Christison-Lagay ER, Brown EG, Bruny J, et al. Central venous catheter consideration in pediatric oncology: A systematic review and meta-analysis from the American Pediatric Surgical Association Cancer Committee. J Pediatr Surg 2024;59(8):1427-1443. https://doi.org/10.1016/j.jpedsurg.2024.03.047

33. Elias PM. The skin barrier as an innate immune element. Semin Immunopathol 2007;29(1):3-14. https:// doi.org/10.1007/s00281-007-0060-9

34. Mokone L, Ndove P, Magooa K, et al. Complications associated with central venous lines for paediatric oncology patients at Universitas Academic Hospital, Bloemfontein, from 1992 to 2018. S Afr J Child Health 2021;15(4):189-192.

35. Park M, Seo Y, Shin YJ, Han JW, Cho E, Jang H. Factors affecting the timing of a central line associated bloodstream infection onset in children with cancer. J Pediatr Hematol Oncol Nurs 2021;38(1):26-35. https:// doi.org/10.1177/1043454220966831

36. Lochs H, Allison SP, Meier R, et al. Introductory to the ESPEN guidelines on enteral nutrition: Terminology, definitions and general topics. Clin Nutr 2006;25(2):180-186. https://doi.org/10.1016/j.clnu.2006.02.007

37. Sala A, Pencharz P, Barr RD. Children, cancer, and nutrition – a dynamic triangle in review. Cancer 2004;100(4):677-687. https://doi.org/10.1002/cncr.11833

38. Pribnow AK, Ortiz R, Báez LF, Mendieta L, Luna‐Fineman S. Effects of malnutrition on treatment‐related morbidity and survival of children with cancer in Nicaragua. Pediatr Blood Cancer 2017;64(11). https:// doi.org/10.1002/pbc.26590

39. Israëls T, van de Wetering MD, Hesseling P, van Geloven N, Caron HN, Molyneux EM. Malnutrition and neutropenia in children treated for Burkitt lymphoma in Malawi. Pediatr Blood Cancer 2009;53(1):47-52. https://doi.org/10.1002/pbc.22032

40. Geddara N, Mubaiwa L, Thejpal R, Hendricks C. Prevalence of malnutrition and its impact on outcomes in children with cancer in a South African setting. S Afr J Child Health 2023;17(4):187-191. https://doi. org/10.7196/sajch.2023.v17i4.1986

41. Joint United Nations Programme on HIV/AIDS (UNAIDS). UNAIDS data 2024. Geneva: UNAIDS, 2024. https://www.unaids.org/sites/default/files/media_asset/data-book-2024_en.pdf (accessed May 2025).

42. Levy JA. HIV pathogenesis: 25 years of progress and persistent challenges. AIDS 2009;23(2):147-160.

https://doi.org/10.1097/qad.0b013e3283217f9f

43. Davidson A, Wainwright RD, Stones DK, et al. Malignancies in South African children with HIV. J Pediatr Hematol Oncol 2014;36(2):111-117. https://doi.org/10.1097/mph.0b013e31829cdd49

44. BohliusJ,MaxwellN,SpoerriA,etal.IncidenceofAIDS-definingandothercancersinHIV-positivechildren in South Africa: Record linkage study. Pediatr Infect Dis J 2016;35(6):e164-e170. https://doi.org/10.1097/ inf.0000000000001117

45. Achieng C, Bunani N, Kagaayi J, Nuwaha F. Adherence to antiretroviral and cancer chemotherapy, and associated factors among patients with HIV-cancer co-morbidity at the Uganda Cancer Institute: A cross sectional study. BMC Public Health 2023;23(1):1451. https://doi.org/10.1186/s12889-023-16387-z

46. Strope JD, Lochrin SE, Sissung TM, et al. Drug-drug interactions in patients with HIV and cancer in Sub- Saharan Africa. AIDS Rev 2021;23(1):13-27. https://doi.org/10.24875/aidsrev.20000005

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Copyright (c) 2026 F Vosloo, C Downing , T Goddard , K Govender , N Kabamba , O Payne , T Toweel-Moore, I Wait , J Wylie, G Naidu