Two illnesses that are especially dangerous for children during treatment are pneumonia and chicken pox.

Pneumonia

Pneumonia is inflammation of the lungs caused primarily by bacteria, viruses, or other organisms. The symptoms of pneumonia are rapid breathing, chills, fever, chest pain, cough, and bloody sputum. Children with low WBC counts can rapidly develop a fatal infection and must be treated quickly and aggressively. Most cancer centers recommend an annual influenza (flu) shot to help prevent pneumonia.

My son received his high-dose methotrexate and vincristine injection just days before he was scheduled to go to cancer camp. His ANC was 1,200 and he looked so sick, but he begged to go and I let him. It was early in his treatment, and I didn’t realize the pattern of his blood counts. They called me from camp on Friday to say he had a temperature of 103° and needed to go to the hospital. He was very weak and feverish; his WBC was 140, and his ANC was 0. Both lungs were full of pneumonia. I was furious at the doctor for giving him permission to go to camp and at myself for not paying closer attention to how quickly his counts dropped. I’m sure he had the pneumonia before he even went to camp. They started him on five different antibiotics, and his fever went up to 106° that night. We didn’t know if he would live or die. He started to improve the next morning and was completely recovered in a week.

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Erica complained that her back hurt for two days. Then she woke up in the night crying, and she couldn’t move because it hurt her too badly. She was blazing with fever, and screamed if I touched her. Her x-ray showed that her left lung was half full of fluid. They put her on antibiotics, and within 24 hours she was on the mend.

Children taking steroids (e.g., prednisone, dexamethasone) are at increased risk for contracting serious and potentially life-threatening lung infections. See section called “Prophylactic antibiotics” in Chapter 13, Chemotherapy and Other Medications.

Chicken pox

Chicken pox is a common childhood disease (although less so than it used to be because of the vaccine) caused by a virus called varicella zoster. The symptoms are headaches, fever, and tiredness, followed by eruptions of pimple-like red bumps that typically start on the stomach, chest, or back. The bumps rapidly develop into blister-like sores that break open, then scab over in three to five days. Any contact with the sores can spread the disease. Children are contagious up to 48 hours before breaking out.

Chicken pox can be a fatal disease for children with low ANCs, so extreme care must be taken to prevent exposure. You will need to educate all teachers and friends so they will vigilantly report any outbreaks. Your child should not go to school or preschool until the outbreak is over.

Chicken pox can be transmitted through the air or by touch. Exposure is considered to have occurred if a child is in direct contact or in a room for as little as 10 minutes with an infected person. If an immunosuppressed child is exposed to chicken pox, call the doctor immediately. If the doctor gives a shot called VZIG (varicella zoster immune globulin) within 72 hours of exposure, it may prevent the disease from occurring or lessen its effects.

We knew when Jeremy was exposed, so he was able to get VZIG. He did get chicken pox, but only developed a few spots. He didn’t get sick; he got bored. He spent two weeks in the hospital in isolation. We asked for a pass, and we were able to go outside for some fresh air between doses of acyclovir.

If a child develops chicken pox while on chemotherapy, the current treatment is hospitalization or, if possible, home therapy for IV administration of acyclovir, a potent antiviral medication that has dramatically lowered the complication rate of chicken pox.

Kristin broke out with chicken pox on the Fourth of July weekend. Our hospital room was the best seat in the house for watching the city fireworks. She did get covered with pox, though, from the soles of her feet to the very top of her scalp. We’d just give her gauze pads soaked in calamine lotion and let her hermetically seal herself. They kept her in the hospital for six days of IV acyclovir; then she was at home on the pump (a small computerized machine that will administer the drug in small amounts for several hours) for four more days of acyclovir. She had no complications.

A child who has already had chicken pox may develop herpes zoster (shingles). If your child develops crusty bumps similar to chicken pox that are in lines (along nerves), call the doctor. The treatment for shingles is the same as that for chicken pox.

Kristin also got a herpes zoster infection, this time on Thanksgiving. It looked like a mild case of chicken pox, limited to her upper right arm, her upper right chest, and her right leg. They kept her overnight on IV acyclovir and then let her go home for nine more days on the pump.

Untreated chicken pox or shingles can result in life-threatening complications, including pneumonia, hepatitis, and encephalitis. Parents must make every effort to prevent exposure and watch for signs of these diseases while their child is on treatment.