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J Pediatr Infect Dis 2023; 18(06): 331-340
DOI: 10.1055/s-0043-1775839
Original Article

A Retrospective Study of the Association between Respiratory Tract Viral PCR Panel Results and Clinical Outcomes in Children with Cancer and Febrile Neutropenia and Review of the Literature

Özlem Terzi 
1   Department of Pediatric Hematology and Oncology, Basaksehir Cam and Sakura Training and Research Hospital Istanbul, University of Health Science, İstanbul, Türkiye
,
Nuran Karabulut 
2   Department of Medical Virology, Basaksehir Cam and Sakura Training and Research Hospital Istanbul, University of Health Science, İstanbul, Türkiye
,
Ezgi Paslı Uysalol 
1   Department of Pediatric Hematology and Oncology, Basaksehir Cam and Sakura Training and Research Hospital Istanbul, University of Health Science, İstanbul, Türkiye
,
Ayşe Gonca Kaçar 
1   Department of Pediatric Hematology and Oncology, Basaksehir Cam and Sakura Training and Research Hospital Istanbul, University of Health Science, İstanbul, Türkiye
,
Hüseyin Avni Solgun 
1   Department of Pediatric Hematology and Oncology, Basaksehir Cam and Sakura Training and Research Hospital Istanbul, University of Health Science, İstanbul, Türkiye
,
Saide Ertürk 
1   Department of Pediatric Hematology and Oncology, Basaksehir Cam and Sakura Training and Research Hospital Istanbul, University of Health Science, İstanbul, Türkiye
,
Halil İbrahim Şimşek
3   Department of Child Health and Diseases, Basaksehir Cam and Sakura Training and Research Hospital Istanbul, University of Health Science, İstanbul, Türkiye
,
Cengiz Bayram 
1   Department of Pediatric Hematology and Oncology, Basaksehir Cam and Sakura Training and Research Hospital Istanbul, University of Health Science, İstanbul, Türkiye
,
Ali Ayçiçek 
1   Department of Pediatric Hematology and Oncology, Basaksehir Cam and Sakura Training and Research Hospital Istanbul, University of Health Science, İstanbul, Türkiye
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Abstract

Objective The role of respiratory viral pathogens (RVPs) in children with cancer having febrile neutropenic (FEN) episodes has not been well studied. The objectives of this study were to investigate the prevalence and clinical outcomes of RVP in this group.

Methods Pediatric patients with cancer and an episode of FEN, presenting between March 2021 and March 2022 were included. All data were retrospectively retrieved from patient files. A throat swab sample was obtained for the detection of 17 RVPs and evaluated by a polymerase chain reaction (PCR) method.

Results A total of 110 (male n = 76; 69.1%) patients with a mean ± standard deviation age of 6.68 ± 4.92 years were included. Reproduction in PCR was seen in 76 (69.1%) children. Rhinovirus (31.6%) and respiratory syncytial virus (15.8%) were the most frequently detected viruses. Mixed respiratory viruses (coinfections of ≥2 viruses) were only seen in 13%. The median (range) duration of hospitalization was 11 (2–143) days, and 8.2% of the children were admitted to the pediatric intensive care unit (PICU). The median (range) length of stay (LOS) in the PICU was 8 (1–100) days. Overall mortality rate was 3.6%. There was no significant difference in LOS in the hospital, rate of admission to PICU, LOS in the PICU, and the mortality rate between children with and without growth in PCR (p > 0.05).

Conclusion There was high prevalence of RVP in children with cancer and FEN. However, given that having a positive RVP does not affect LOS in the hospital/PICU or disease severity, in this population, there was no association between positive PCR findings and clinical features investigated or outcome.

Keywords

febrile neutropenia - oncology - respiratory viral infection - children


Publication History

Received: 23 July 2023

Accepted: 11 September 2023

Article published online:
16 October 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Basu SK, Fernandez ID, Fisher SG, Asselin BL, Lyman GH. Length of stay and mortality associated with febrile neutropenia among children with cancer. J Clin Oncol 2005; 23 (31) 7958-7966
    CrossrefPubMedGoogle Scholar
  • 2 Maxwell RR, Egan-Sherry D, Gill JB, Roth ME. Management of chemotherapy-induced febrile neutropenia in pediatric oncology patients: a North American survey of pediatric hematology/oncology and pediatric infectious disease physicians. Pediatr Blood Cancer 2017;64(12).
    PubMedGoogle Scholar
  • 3 Freifeld AG, Bow EJ, Sepkowitz KA. et al; Infectious Diseases Society of America. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis 2011; 52 (04) e56-e93
    CrossrefPubMedGoogle Scholar
  • 4 Licciardello M, Pegoraro A, Cesaro S. Prophylaxis and therapy of viral infections in pediatric patients treated for malignancy. Pediatr Rep 2011; 3 (01) e5
    CrossrefPubMedGoogle Scholar
  • 5 Hakim H, Flynn PM, Knapp KM, Srivastava DK, Gaur AH. Etiology and clinical course of febrile neutropenia in children with cancer. J Pediatr Hematol Oncol 2009; 31 (09) 623-629
    CrossrefPubMedGoogle Scholar
  • 6 Lindblom A, Bhadri V, Söderhäll S. et al. Respiratory viruses, a common microbiological finding in neutropenic children with fever. J Clin Virol 2010; 47 (03) 234-237
    CrossrefPubMedGoogle Scholar
  • 7 Soldatou A, Davies EG. Respiratory virus infections in the immunocompromised host. Paediatr Respir Rev 2003; 4 (03) 193-204
    CrossrefPubMedGoogle Scholar
  • 8 Christensen MS, Nielsen LP, Hasle H. Few but severe viral infections in children with cancer: a prospective RT-PCR and PCR-based 12-month study. Pediatr Blood Cancer 2005; 45 (07) 945-951
    CrossrefPubMedGoogle Scholar
  • 9 Koskenvuo M, Möttönen M, Rahiala J. et al. Respiratory viral infections in children with leukemia. Pediatr Infect Dis J 2008; 27 (11) 974-980
    CrossrefPubMedGoogle Scholar
  • 10 Soudani N, Caniza MA, Assaf-Casals A. et al. Prevalence and characteristics of acute respiratory virus infections in pediatric cancer patients. J Med Virol 2019; 91 (07) 1191-1201
    CrossrefPubMedGoogle Scholar
  • 11 Möttönen M, Uhari M, Lanning M, Tuokko H. Prospective controlled survey of viral infections in children with acute lymphoblastic leukemia during chemotherapy. Cancer 1995; 75 (07) 1712-1717
    CrossrefPubMedGoogle Scholar
  • 12 Fazekas T, Eickhoff P, Rauch M. et al. Prevalence and clinical course of viral upper respiratory tract infections in immunocompromised pediatric patients with malignancies or after hematopoietic stem cell transplantation. J Pediatr Hematol Oncol 2012; 34 (06) 442-449
    CrossrefPubMedGoogle Scholar
  • 13 Koskenvuo M, Möttönen M, Rahiala J. et al. Mixed bacterial-viral infections in septic children with leukemia. Pediatr Infect Dis J 2007; 26 (12) 1133-1136
    CrossrefPubMedGoogle Scholar
  • 14 Torres JP, Labraña Y, Ibañez C. et al. Frequency and clinical outcome of respiratory viral infections and mixed viral-bacterial infections in children with cancer, fever and neutropenia. Pediatr Infect Dis J 2012; 31 (09) 889-893
    CrossrefPubMedGoogle Scholar
  • 15 Krause JC, Panning M, Hengel H, Henneke P. The role of multiplex PCR in respiratory tract infections in children. Dtsch Arztebl Int 2014; 111 (38) 639-645
    PubMedGoogle Scholar
  • 16 Castagnola E, Fontana V, Caviglia I. et al. A prospective study on the epidemiology of febrile episodes during chemotherapy-induced neutropenia in children with cancer or after hemopoietic stem cell transplantation. Clin Infect Dis 2007; 45 (10) 1296-1304
    CrossrefPubMedGoogle Scholar
  • 17 Hamidah A, Rizal AM, Nordiah AJ, Jamal R. Piperacillin-tazobactam plus amikacin as an initial empirical therapy of febrile neutropenia in paediatric cancer patients. Singapore Med J 2008; 49 (01) 26-30
    PubMedGoogle Scholar
  • 18 Mahony J, Chong S, Merante F. et al. Development of a respiratory virus panel test for detection of twenty human respiratory viruses by use of multiplex PCR and a fluid microbead-based assay. J Clin Microbiol 2007; 45 (09) 2965-2970
    CrossrefPubMedGoogle Scholar
  • 19 Murali S, Langston AA, Nolte FS, Banks G, Martin R, Caliendo AM. Detection of respiratory viruses with a multiplex polymerase chain reaction assay (MultiCode-PLx Respiratory Virus Panel) in patients with hematologic malignancies. Leuk Lymphoma 2009; 50 (04) 619-624
    CrossrefPubMedGoogle Scholar
  • 20 Benites EC, Cabrini DP, Silva AC. et al. Acute respiratory viral infections in pediatric cancer patients undergoing chemotherapy. J Pediatr (Rio J) 2014; 90 (04) 370-376
    CrossrefPubMedGoogle Scholar
  • 21 Söderman M, Rhedin S, Tolfvenstam T. et al. Frequent respiratory viral infections in children with febrile neutropenia–a prospective follow-up study. PLoS One 2016; 11 (06) e0157398
    CrossrefPubMedGoogle Scholar
  • 22 Srinivasan A, Gu Z, Smith T. et al. Prospective detection of respiratory pathogens in symptomatic children with cancer. Pediatr Infect Dis J 2013; 32 (03) e99-e104
    CrossrefPubMedGoogle Scholar
  • 23 Torres JP, De la Maza V, Kors L. et al. Respiratory viral infections and coinfections in children with cancer, fever and neutropenia. Pediatr Infect Dis J 2016; 35 (09) 949-954
    CrossrefPubMedGoogle Scholar
  • 24 Meena JP, Brijwal M, Seth R. et al. Prevalence and clinical outcome of respiratory viral infections among children with cancer and febrile neutropenia. Pediatr Hematol Oncol 2019; 36 (06) 330-343
    CrossrefPubMedGoogle Scholar
  • 25 Cerdeira Barreiro N, Santiago-García B, Casas I. et al. Detection of respiratory viruses in the clinical outcome of children with fever and neutropenia. Pediatr Infect Dis J 2020; 39 (06) 533-538
    CrossrefPubMedGoogle Scholar
  • 26 Han SB, Shin JA, Kim SK. et al. Respiratory viral infections in children and adolescents with hematological malignancies. Mediterr J Hematol Infect Dis 2019; 11 (01) e2019006
    PubMedGoogle Scholar
  • 27 Shinn K, Wetzel M, DeGroote NP. et al. Impact of respiratory viral panel testing on length of stay in pediatric cancer patients admitted with fever and neutropenia. Pediatr Blood Cancer 2020; 67 (11) e28570
    CrossrefPubMedGoogle Scholar
  • 28 Craft AW, Reid MM, Gardner PS. et al. Virus infections in children with acute lymphoblastic leukaemia. Arch Dis Child 1979; 54 (10) 755-759
    CrossrefPubMedGoogle Scholar
  • 29 Büyükkapu-Bay S, Kebudi R, Görgün Ö, Meşe S, Zülfikar B, Badur S. Respiratory viral infection's frequency and clinical outcome in symptomatic children with cancer: a single center experience from a middle-income country. Turk J Pediatr 2018; 60 (06) 653-659
    CrossrefPubMedGoogle Scholar
  • 30 Wang L, Allen J, Diong C. et al. Respiratory virus infection after allogeneic hematopoietic stem cell transplant in a tropical center: predictive value of the immunodeficiency scoring index. Transpl Infect Dis 2017; 19 (03) e12693
    CrossrefPubMedGoogle Scholar
  • 31 Kebudi R, Kacar D, Ozyoruk D. et al. Non COVID viral respiratory infections in children with cancer during Covid-19 pandemic: a multicentre, observational study. Pediatr Blood Cancer 2021; 68 (06) e28915
    PubMedGoogle Scholar