الفهرس 
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Abstract
Introduction: Childhood cancers are an increasing problem. Early diagnosis, advances in treatment and prevention of complications improve the prognosis for patients with cancer and increase survival rate. However, chemotherapy causes acute complications as febrile neutropenia with subsequent infections. Febrile Neutropenia (FN) is the commonest emergency in children with malignancy and it is one of the major causes of morbidity and mortality in children with cancer. At the time of blood stream infection in febrile neutropenic patients, lower respiratory tract infections were recorded in (38.7%). Gram-negative pathogens and fungal infections are an important cause of morbidity and mortality Aim of the Work: To determine the common (bacterial and fungal) organisms causing lower respiratory tract infections among cancer children receiving chemotherapy helping in empiric management strategy of such cases till the results of cultures and to identify clinical and microbiological criteria for severe pneumonia with devastating course aiming at early discovery and optimizing its management.Patients and Methods: childhood cancer patients from Pediatric Oncology Unit in Oncology Center Mansoura University (OCMU) <18 years old, were on chemotherapy and had symptoms or signs of pneumonia were subjected to: thorough history, Thorough examination for temperature, cyanosis and grunting, chest examination and any other focus of infection (oral cavity, nose, skin, puncture sites and perianal region). Do CBC, CRP, blood culture, sputum culture for aerobic bacteria, sputum fungal culture, chest X-ray and chest CT.Results: The most common isolated organisms were K.pnumoniae followed by Streptococcus pneumonia. Candida was the most common isolated fungus followed by Aspergillus spp. But high morbidity and mortality reported with Aspergillus spp. Conclusion: severity of pneumonia is associated with usage of intensive chemotherapy, neutropenia (particularly, severe, profound or prolonged), nosocomial pneumonia, pneumonia caused by resistant strains of bacteria (mainly Gram negative bacteria) and fungal pneumonia especially Aspergillus that shows poor prognosis and high mortality.