Supplementary Material for: The Nutritional Management of Typhlitis in a Limited-Resource Setting: A Case Series with Recommendations for Implementation

Introduction: Typhlitis is a life-threatening complication of chemotherapy. The recommended nutritional management of typhlitis involves bowel rest and initiating parenteral nutrition. However, in limited resource settings, parenteral nutrition is not readily available, leaving patients who develop typhlitis without nutrition for prolonged periods. Strategies for the nutritional management of typhlitis in settings without access to advanced nutritional therapies are urgently needed. Case Presentations: Three patients with acute leukemia presented to Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa, Ethiopia for treatment, where parenteral nutrition is unavailable. All three patients presented with acute malnutrition at diagnosis and developed typhlitis during chemotherapy. In each case, oral feeding was reintroduced prior to complete resolution of typhlitis, guided by improved bowel thickness, recovery from neutropenia, and resolution of gastrointestinal symptoms. Conclusion: Gradual reintroduction of oral feeding based on clinical indicators was successfully implemented across this case series, minimizing prolonged periods without oral intake and preventing further decline in nutritional status in the absence of parenteral nutrition. Drawing from this experience and the existing literature, we propose an algorithm to guide nutritional management during typhlitis in similar clinical contexts.