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Acute respiratory infection and leukemia

Over the past decades, major advances have been made in childhood acute lymphoblastic leukemia (ALL) therapy resulting in 92% 10-year survival rate. However, infectious complications remain a significant cause of morbidity and mortality in children with Leukemia. Of particular importance are respiratory viral infections that are characterized by a wide spectrum of manifestations ranging from mild cold symptoms to progression to lower respiratory tract infection, and increased hospitalization rates. Inaba et al. (2017) As a provider, it will be important to respect the patient’s parent wishes while providing key information about how respiratory viral infections in immunocompromised patients can be detrimental and may even be fatal at time.

The focus on alternative medicine or natural remedies may impact the patient’s life because of her leukemia diagnosis. However, there are many ways a provider can incorporate the family’s beliefs into the treatment of this child. Upper respiratory symptoms are often treated with over the counter drugs, antibiotics, and antiviral medications, such as oseltamivir, zanamivir, or peramivir. Due to concerns about safety and efficacy, there is a demand for an alternative solution. Black elderberry (Sambucus nigra) has been used to treat cold and flu symptoms, but there are no large-scale studies or meta-analyses. This meta-analysis quantifies the effects of elderberry supplementation and evaluates moderators including vaccination status and the underlying pathology. (Hawkins et al., 2019)

Supplementation with elderberry was found to substantially reduce upper respiratory symptoms. The quantitative synthesis of the effects yielded a large mean effect size. These findings present an alternative to antibiotic misuse for upper respiratory symptoms due to viral infections, and a potentially safer alternative to prescription drugs for routine cases of the common cold and influenza.

Nature is still the primary source of healthcare for people in developing countries. According to the WHO, in Africa the ratio of traditional healers to population is 1:500, whereas the ratio of medical doctors to population is 1:40.000, which is related to the lack of availability and accessibility of conventional medicines. Langeder et al. (2020) The most frequently used remedies for the management of upper respiratory infections or acute respiratory infection, especially in children, are natural-based agents (mainly from botanical sources) due to easy access, low cost and lack of specific antiviral drugs. Plants and microorganisms are a rich source of 10 pharmacologically relevant small molecules because they have no immune system and, in consequence, are forced to defend themselves against enemies with potent natural products. Compounds from nature have been used for the treatment of microbial (viral and bacterial) infections throughout history, and it is estimated that two-thirds of all of today’s approved antibacterial drugs are derived from natural products.

Effective prevention and treatment of upper respiratory infections or recurrent respiratory infections remain a high priority worldwide. It is even more important to treat and control the exposure of patients who are immunocompromised such as this patient with leukemia, effectiveness of immunity-targeted approaches, including targeted immunizations and non-specific immunomodulation in the prevention and management of recurrent upper recurrent respiratory infections are essential.

References

Hakim, H., Dallas, R., Zhou, Y., Pei, D., Cheng, C., Flynn, P. M., Pui, C. H., & Jeha, S. (2015). Acute respiratory infections in children and adolescents with acute lymphoblastic leukemia. Cancer, 122(5), 798–805. https://doi.org/10.1002/cncr.29833

Hawkins, J., Baker, C., Cherry, L., & Dunne, E. (2019). Black elderberry (Sambucus nigra) supplementation effectively treats upper respiratory symptoms: A meta-analysis of randomized, controlled clinical trials. Complementary Therapies in Medicine, 42, 361–365. https://doi.org/10.1016/j.ctim.2018.12.004

Inaba, H., Pei, D., Wolf, J., Howard, S., Hayden, R., Go, M., Varechtchouk, O., Hahn, T., Buaboonnam, J., Metzger, M., Rubnitz, J., Ribeiro, R., Sandlund, J., Jeha, S., Cheng, C., Evans, W., Relling, M., & Pui, C. H. (2017). Infection-related complications during treatment for childhood acute lymphoblastic leukemia. Annals of Oncology, 28(2), 386–392. https://doi.org/10.1093/annonc/mdw557

Langeder, J., Grienke, U., Chen, Y., Kirchmair, J., Schmidtke, M., & Rollinger, J. M. (2020). Natural products against acute respiratory infections: Strategies and lessons learned. Journal of Ethnopharmacology, 248, 112298. https://doi.org/10.1016/j.jep.2019.112298