Prevalence and clinical outcome of respiratory viral infections among children with cancer and febrile neutropenia

Meena, Jagdish Prasad; Brijwal, Megha; Seth, Rachna; Gupta, Aditya; Jethani, Jyoti; Kapil, Arti; Jat, Kana Ram; Choudhary, Aashish; Kabra, Sushil Kumar; Dwivedi, Sadanand; Dar, Lalit

doi:10.1080/08880018.2019.1631920

Cited by 22 publications

(34 citation statements)

References 29 publications

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“…Our study found that, consistent with prior research, 5‐8 the prevalence of diagnosed RVI was high, with 58% of patients who had RVP testing having positive results. Further, the high prevalence of rhinovirus /Enterovirus is also consistent with prior research, although the epidemiology of respiratory virus type varies by setting and time of year 10,13,18,19 …”

Section: Discussionsupporting

confidence: 83%

Impact of respiratory viral panel testing on length of stay in pediatric cancer patients admitted with fever and neutropenia

Shinn

Wetzel

DeGroote

et al. 2020

Pediatric Blood & Cancer

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Background: Polymerase chain reaction (PCR) respiratory viral panel (RVP) testing is often used in evaluation of pediatric cancer patients with febrile neutropenia (FN), but correlation with adverse outcomes has not been well characterized. Procedure: A retrospective cohort of all children ages 0-21 years with cancer admitted to Children's Healthcare of Atlanta for FN from January 2013 to June 2016 was identified. Patient demographic and clinical variables such as age, RVP results, length of stay (LOS), and deaths were abstracted. Relationship between RVP testing and positivity and LOS, highest temperature (Tmax), hypotension and intensive care unit (ICU) admission were compared using Wilcoxon rank sums, chi-square, or Fisher's exact tests adjusting for age, sex, bacteremia, and diagnosis. Results: The 404 patients identified had 787 total FN admissions. RVPs were sent in 38% of admissions and were positive in 59%. Patients with RVPs sent were younger (median 5.5 vs 8.0 years, P < .0001) with higher Tmax (39.2 • vs 39.1 • , P = .016). The most common virus identified was rhinovirus/Enterovirus (61%). There were no significant differences in highest temperature or lowest blood pressure based on RVP positivity. Patients admitted to the ICU were more likely to have RVPs sent (odds ratio [OR] = 3.19, P < .002); however, neither having RVP testing nor RVP positivity were significantly associated with increased LOS or death. Coinfection with bacteremia and a respiratory virus was identified in 9.1% of patients. Conclusions: These data raise the question of the utility of sending potentially costly RVP testing as RVP positivity during febrile neutropenia does not impact LOS, degree of hypotension, or ICU admission.

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Section: Discussionsupporting

confidence: 83%

Impact of respiratory viral panel testing on length of stay in pediatric cancer patients admitted with fever and neutropenia

Shinn

Wetzel

DeGroote

et al. 2020

Pediatric Blood & Cancer

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“…The authors reported that overall prevalence of RV infection was 76.5% in case group which differed significantly from the control group. The most commonly detected virus was RhV (40%; 25/62) followed by RSV seen in 17% of cases and influenza A and enteroviruses (seen in 14% of patients each) [33]. Similarly, high RhV prevalence among neutropenic children with FN has been reported by Barreiro et al and Torres et al [14,17].…”

Section: Identified Causesmentioning

confidence: 61%

Pulmonary Infectious Complications in Children with Hematologic Malignancies and Chemotherapy-Induced Neutropenia

Voulgaridou

Athanasiadou

et al. 2020

Diseases

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Infections frequently complicate the treatment course in children with hematologic malignancies undergoing chemotherapy. Febrile neutropenia (FN) remains a major cause of hospital admissions in this population, and respiratory tract is often proven to be the site of infection even without respiratory signs and symptoms. Clinical presentation may be subtle due to impaired inflammatory response. Common respiratory viruses and bacteria are widely identified in these patients, while fungi and, less commonly, bacteria are the causative agents in more severe cases. A detailed history, thorough clinical and basic laboratory examination along with a chest radiograph are the first steps in the evaluation of a child presenting signs of a pulmonary infection. After stratifying patient’s risk, prompt initiation of the appropriate empirical antimicrobial treatment is crucial and efficient for the majority of the patients. High-risk children should be treated with an intravenous antipseudomonal beta lactam agent, unless there is suspicion of multi-drug resistance when an antibiotic combination should be used. In unresponsive cases, more invasive procedures, including bronchoalveolar lavage (BAL), computed tomography (CT)-guided fine-needle aspiration or open lung biopsy (OLB), are recommended. Overall mortality rate can reach 20% with higher rates seen in cases unresponsive to initial therapy and those under mechanical ventilation.

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“…8 In India, in an analysis of 81 febrile neutropenia episodes occurring in oncologic children <18 years during 2017, acute respiratory infections were diagnosed in 76.5% of the patients, with rhinoviruses (36.8%) and RSV (13.6%) being the most commonly detected viruses. 9 The median duration of the febrile period and of antibiotic days was longer in cases with detection of respiratory viruses compared with those without a diagnosis of respiratory infection.…”

Section: Introductionmentioning

confidence: 92%

The etiologic, microbiologic, clinical and outcome characteristics of immunocompetent young children <2 years of age hospitalized with acute neutropenia

Tschernin

Fruchtman

Sergienko

et al. 2021

Pediatrics & Neonatology

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Background: To describe the etiologic, microbiologic, clinical and outcome characteristics of acute neutropenia (absolute neutrophil count, ANC, <1.5 Â 10 9 /L) in hospitalized immunocompetent children. Methods: Serious bacterial infections (SBI) were defined as culture-positive blood, urine, cerebrospinal fluid, articular fluid or stool infections, alveolar pneumonia, Brucellosis and Rickettsiosis. Results: 431/671 (64.2%) healthy infants and children hospitalized with acute neutropenia were <2 years of age; 176 (40.8%), 167 (38.8%) and 88 (20.4%) patients were aged 0e3, 4 e12 and 13e24 months, respectively. There were 19 (4.4%), 53 (12.3%), 140 (32.5%) and 209 (50.8%) patients with ANC count <200, 200e500, 501e1000 and 1001e1500 Â 10 9 cells/L, respectively. Severe neutropenia (<500 Â 10 9 /L) was recorded in 72 (16.7%) patients. Fever >38 C was present in 208/431 (48.3%) patients. Blood cultures were positive in 10 (2.3%), with Brucella melitensis, Staphylococcus aureus and Enterobacter spp. identified in 4, 3 and 2 patients, respectively; 5/10 patients with positive blood cultures were <3 months of age. Overall, 55/431 (12.7%) and 65/431 (15.1%) patients were diagnosed with SBIs and bacterial infections, respectively. Nasal washings-PCR for respiratory viruses was positive in 139/293 (47.4%) patients tested. An infectious etiology (bacterial and/or viral) was diagnosed in 190/

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Prevalence and clinical outcome of respiratory viral infections among children with cancer and febrile neutropenia

Cited by 22 publications

References 29 publications

Impact of respiratory viral panel testing on length of stay in pediatric cancer patients admitted with fever and neutropenia

Impact of respiratory viral panel testing on length of stay in pediatric cancer patients admitted with fever and neutropenia

Pulmonary Infectious Complications in Children with Hematologic Malignancies and Chemotherapy-Induced Neutropenia

The etiologic, microbiologic, clinical and outcome characteristics of immunocompetent young children <2 years of age hospitalized with acute neutropenia

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