Patients with Leukemia or Cancer

Central venous catheter (CVC)-associated and soft tissue NTM infections have been reported in association with leukemias, lymphomas and solid tumors (Reilly and McGowan, 2004; Levendoglu-Tugal et al., 1998). Among hematopoietic stem cell transplant recipients, adult series suggest that the incidence of NTM infection is 50-600 times greater than in the general population (Doucette and Fishman, 2004). Usually these infections are due to rapid growing NTM but M. avium intracellular has also been reported (Reilly and McGowan, 2004; Levendoglu-Tugal et al., 1998). Occasionally NTM in blood cultures may be mistaken for Corynebac-terium or Nocardia species which leads to a delay in appropriate management or the initiation of inappropriate therapy (Levendoglu-Tugal et al., 1998). Affected patients are not necessarily neutropenic but are frequently lymphopenic (total lymphocyte count <1000/mm3) and may also have lung involvement. Some children have been effectively treated with CVC removal alone. However, standard treatment includes line removal, treatment with at least 2 anti-mycobacterial drugs for 2-12 weeks for localized disease and 6 months or longer for widespread disease (Reilly and McGowan, 2004; Levendoglu-Tugal et al., 1998). The intensity of immunosuppressive therapy may need to be modified and for tunnel or exit site infections, surgical excision of surrounding tissues may also be necessary (Burns et al., 1997). NTM infection should be considered in all persistently febrile children with cancer or leukemia, particularly those who don't respond to conventional antibiotics or antifungals. Individuals with lymphopenia and profound immunocompromise are at high risk. Although conventional blood cultures will detect rapidly growing NTM, they are unlikely to detect M. avium intracellulare or other slow-growing mycobac-teria. Specific blood cultures are required for this purpose (Reilly and McGowan, 2004; Levendoglu-Tugal et al., 1998).

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