Research Projects

Research in Children with Cancer – Dr Gita Naidu

Research in Children with Cancer – Dr Gita Naidu

Dr Gita Naidu

Title of the project:

Infectious Complications in the South African Black Child with Cancer

Highlights of the project:

Studies which have been published to date have enrolled children from the developed world where malnutrition, lack of parental education, poverty, HIV/AIDS and advanced disease with late presentation. The demographic profile  children treated for cancer in the developing world has challenges including malnutrition, diseases associated with lack of sanitation, lack of health facilities, limited immunisation programmes, the burden of tuberculosis and limited parental education.

Infections in children with cancer are influenced by many factors including type and extent of cancer; type of treatment; the premorbid nutritional status which in turn is directly related to the families socioeconomic level; genetic polymorphisms in the immune system; disruptions of the immune system by both cancer and treatment and  the exposure to infectious agents.

Malnutrition as a predisposing factor for infectious complications in children undergoing treatment for cancer has not been previously investigated. Viruses as a cause for febrile neutropaenia has been studied in children undergoing stem cell transplantation but the newer viruses which have only recently identified e.g. Coronavirus, Bocavirus and HMPV have not been studied in children undergoing standard or stem cell treatment.

Scientific report:

The study commenced in April 2009 at the Paediatric Haematology Oncology Unit, Department of Paediatrics, Chris Hani Baragwanath Academic Hospital. 171 patients have been enrolled into the study. Of these approximately 75% have completed treatment. The remaining 25% are still being monitored and investigated for infectious episodes.

The first 100 patients enrolled into the study were screened for tuberculosis. The TB spot test and tuberculin skin test was done. After 100 patients, the TB spot test was stopped. None of the data collected has been analysed. This will be done at the end of the study period.

The immune profile of patients enrolled onto the study i.e. T and B cell function is being investigated at the start and end of treatment.

Presently data is being collected and the results will be statistically analysed.

Non-Scientific Report:

The study faces many challenges, the most difficult being working full time in the busiest children’s oncology unit in the country and attempting a study of this magnitude. I am also enrolled for a PhD at the University of the Witwatersrand. This study is towards the PhD degree and Professor Shabir Madhi is my supervisor. Professor Shane Norris of the Birth to Twenty Unit, University of Witwatersrand is a collaborator on the nutritional study.

Childhood cancer cure rates have improved dramatically  in the last two decades and this is due to the use of intensive curative chemotherapy and radiotherapy protocols and also to the use of intensive surgical procedures. This has resulted in an increased incidence of life-threatening infections as a complication of treatment. Infections in immuno-compromised patients are difficult to diagnose, which results in delays in instituting treatment and may result in death in some patients. Very high-dose broad spectrum antibiotics are used empirically in all individuals with febrile neutropaenia.

The routine markers of infection do not differentiate between inflammation and sepsis caused by bacteria, fungi or viruses. Infections in children with cancer are influenced by many factors including type and extent of cancer; type of treatment; the premorbid nutritional status which in turn is directly related to the families socioeconomic level; genetic polymorphisms in the immune system; disruptions of the immune system by both cancer and treatment and  the exposure to infectious agents.

Malnutrition as a predisposing factor for infectious complications in children undergoing treatment for cancer has not been previously investigated. Viruses as a cause for febrile neutropaenia has been studied in children undergoing stem cell transplantation but the newer viruses which have only recently identified e.g. Coronavirus, Bocavirus and HMPV have not been studied in children undergoing standard or stem cell treatment.

Value of the Project in the Struggle against Cancer

1.  Aim of the study:

The overall aim of the study is to characterize the clinical, demographic and genetic features that predispose African children with cancer to infections. Additionally, we aim to determine the microbiological epidemiology of infections in these children and evaluate the usefulness of indirect markers of suspected bacterial infections in diagnosing bacterial infection.

2.  Objectives of the study:

2.1  Primary Objectives

  • To statistically test a multiple infection risk model pathway incorporating clinical,  demographic and genetic features for African children with cancer
  • To determine the microbiological epidemiology of infections and the associated antibiotic susceptibility patterns.
  • To determine the association between malnutrition and infections in the African     child with cancer.

2.2  Secondary Objectives

  • To  determine the association between clinical features and infection risk for children  with cancer
  • To describe the association of neutropaenia with febrile episodes.
  • To determine the incidence of respiratory viral infections and explore the prevalence of bacterial coinfection using direct and indirect markers of bacterial infection.
  • To evaluate the usefulness of CRP, PCT, IL-6, IL-8 and TNF- α as markers of    bacterial infection in children with cancer.
  • To investigate the role of mannose binding lectin as a predisposing factor for infections in the neutropaenic child with cancer.
  • To compare TST to the quantiferon gamma release assay (Ellispot) for diagnosing TB infection in children treated with chemotherapy.

I hope that this study will help identify children who are at risk for life threatening infectious complications during chemotherapy. It will also be useful if patients could be categorised into high and low risk groups during septic episodes. The low risk group patients could be treated with fewer and less toxic antimicrobials and could perhaps be treated on an outpatient basis. In a resource limited setting as is Chris Hani Baragwanath Academic Hospital, this would reduce the cost of hospitalisation and expensive supportive care.

The diagnosis of tuberculosis in the immune competent child is difficult. Children who are immune compromised, as is the child with cancer, are at risk for contracting active tuberculosis and diagnosis of tuberculosis is more elusive. I hope the newer TB diagnostic test will prove to have value in the diagnosis of TB in the child with cancer. This will ensure early diagnosis, early treatment and better outcome.


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