Background Little data are available on bacterial contamination (BC) of platelet units or acute transfusion reactions to platelet transfusions (PT) in sub-Saharan Africa (SSA). Methods This prospective observational study evaluated the rate of BC of whole blood derived platelet units (WB-PU), the utility of performing Gram stains (GS) to prevent septic reactions, characteristics of patients receiving PT and the rate of acute reactions associated with PT at the Uganda Cancer Institute in Kampala, Uganda. An aliquot of each WB-PU studied was taken to perform GS and culture using the Bactec™ 9120 instrument. Study participants were monitored for reactions. Results 337 WB-PU were evaluated for BC, of which 323 units were transfused in 151 transfusion episodes to 50 patients. The frequency of BC ranged from 0.3%–2.1% (according to criteria used to define BC). The GS had high specificity (99.1%), but low sensitivity to detect units with BC. The median platelet count prior to PT was 10,900 (IQR 6,000–18,900) cells/μL. 78% of PT were given to patients with no bleeding. Acute reactions occurred in 11 transfusion episodes, involving 13 WB-PU, for a rate of 7.3% (95%CI=3.7–12.7%) per transfusion episode. All recipients of units with positive bacterial cultures were receiving antibiotics at the time of transfusion; none experienced a reaction. Conclusions The rate of BC observed in this study is lower than previously reported in SSA, but still remains a safety issue. As GS appears to be an ineffective screening tool, alternate methods should be explored to prevent transfusing bacterially-contaminated platelets in SSA.

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Background There have hardly been any reported cases of children presenting with Kaposi sarcoma as a second malignancy following treatment for acute lymphoblastic leukemia outside a transplant setting. Case presentation We report a case of a 5-year-old boy of Bantu origin, which, to our knowledge, could be only the second reported case of oral–visceral Kaposi sarcoma after acute lymphoblastic leukemia treatment. The patient presented with a 1-month history of progressive, non-painful, soft tissue oral mass, 1 month after completing treatment for high-risk acute lymphoblastic leukemia. He was successfully treated for Kaposi sarcoma on a two-drug regimen (bleomycin and vincristine) with good clinical response. Conclusion Visceral Kaposi sarcoma as a second malignancy may occur after pediatric acute lymphoblastic leukemia treatment, but its rarity makes it unlikely to raise suspicion among clinicians, thus precluding early diagnosis and treatment. We recommend routine evaluation for Kaposi sarcoma lesions in children undergoing long-term surveillance following treatment for childhood acute leukemia.

BackgroundOur paediatric oncology unit serves a population of over 37 million. Reducing mortality secondary to neutropaenic sepsis is a central focus of quality-improvement efforts. Lack of routine microbiology investigations represents a major obstacle to rational choice of empiric therapy for febrile neutropaenia (FN) and appropriate individualised management when first line treatment fails.AimsTo investigate causes of blood-stream infections and local antibiotic sensitivity patterns in paediatric oncology patients treated for FN.MethodsWe piloted routine use of blood cultures in children treated for FN over a 1-month period in May 2015. Peripheral blood cultures were taken from all potentially neutropaenic patients with fever ≥38°C prior to antibiotic treatment per local FN protocol. Sensitivity testing was performed manually and using BD Phoenix™ Automated Microbiology System.ResultsThere were 26 febrile episodes affecting 21 patients. Of 23 cultures performed, 5 (22%) demonstrated growth, all within 48 h. Three patients grew Staphylococcus areus; two grew Gram-negative organisms with sensitivity patterns consistent with extended-spectrum beta-lactamase (ESBL) expression. All three patients with S. aureus bacteraemia had clinically diagnosed soft tissue infection at a peripheral venous cannula site. All S. aureus isolates were methicillin-sensitive, but showed beta-lactamase activity and macrolide resistance. Both Gram-negative infections occurred in newly diagnosed leukaemia patients, one of whom was cultured immediately after transfer from another hospital. Both Gram-negative infections resulted in late septic deaths despite initial treatment with piperacillin-tazobactam/gentamicin followed by carbapenem/amikacin based on 48hr sensitivity results. Carbapenamase testing was unavailable.ConclusionsThis audit demonstrated a high yield of virulent pathogens associated with an unacceptable level of infection-related morbidity and mortality. None of the organisms cultured were sensitive to antibiotics mentioned in the SIOP PODC FN guideline. There is a clear need to review cannula care practices. Emergence and uncontrolled spread of resistant organisms poses a serious threat to our ongoing ability to deliver curative chemotherapy. There is an urgent need to address infection control on a local and healthcare system level, and to acknowledge that microbiology services are an essential component of any viable oncology service and must be prioritised in resource-limited settings.

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