Prospective controlled survey of viral infections in children with acute lymphoblastic leukemia during chemotherapy

Abstract

Background. Infections cause significant morbidity in children with acute lymphoblastic leukemia (ALL). The incidence of viral infections commonly occurring in children with ALL receiving chemotherapy was compared with viral infections in control children and the spread of infections in families was traced. Methods. Fifteen families of children with ALL receiving chemotherapy (62 members) and 26 matched control families (106 members) were monitored for a total of 36,197 and 36,583 days, respectively, from November/1987 to December/1989 for the occurrence of infections. Results. The children with ALL had more infections than their control counterparts (P < 0.01) with respiratory infections the most common in both groups. Viral etiology was verified for 47 episodes [5.2/1000 days at risk, 95% confidence interval (CI) 3.9‐7.0] in the children with ALL and 22 (2.4/1000 days at risk, 95% CI 1.5‐3.7) in the control subjects (P < 0.01 for the difference). Parain‐fluenza viruses, enteroviruses, and adenoviruses were the most common agents in both groups. The infections of the other members of the patients' families were similar to those of their controls. The children most commonly fell ill first, and although children with ALL had more infections, they did not appear to spread the infections to their family members. Conclusions. The children with ALL had more infections than their controls, but they managed to recover well from viral infections caused by common respiratory viruses. The children with ALL did not change the spread of infections among family members.

Mixed Bacterial-Viral Infections in Septic Children With Leukemia

“…7 Rhinovirus, RSV, parainfluenza viruses, and adenovirus have been the most frequent viruses causing respiratory infections in children with cancer. 6,7 In our study, rhinovirus and RSV were also the most common viruses detected. The clinical importance of a positive rhinovirus PCR test can be questioned, because several studies have identified rhinovirus RNA in 12-35% of asymptomatic subjects.…”

“…6,7,11 Some of these patients have had only upper respiratory tract infections with an uneventful recovery, but others have had infections progressing to severity, such as pneumonia with mortality rates as high as 50 -70%. 11 In a previous study done in Turku, 37% of febrile episodes of leukemic children were associated with a respiratory virus.…”

“…5 The role of respiratory viral infection as a risk factor for septicemia in children with cancer is largely undetermined, although these children often suffer from respiratory disease. 6,7 The aim of this prospective survey was to study viruses in leukemic children with septicemia. Each time a blood culture was taken from a febrile child, viruses were searched for from nasal swab and stool samples by virus culture, virus antigen detection, and polymerase chain reaction (PCR) techniques.…”

Parainfluenza Virus Infections in Children With Hematologic Malignancies

“…19 Studies of RV infections in children with cancer have focused on febrile neutropenic patients. 18,20 However, only 34% of the patients with PIV infection in our series had fever with neutropenia. Hence, PIV infections in children with cancer may be relatively underestimated if only febrile neutropenic episodes are studied.…”

Surveillance nosokomialer Infektionen in der pädiatrischen Hämatologie/Onkologie

“…Virale Infektionserreger sind in der Pädiatrie signifikant häufiger Auslöser von NI [6,9,36], so dass Surveillancestudien, in denen virale Infektionen nicht systematisch erfasst werden, die Inzidenzdichte von NI in der Pädiatrie unterschätzen. Saisonal auftretende nosokomiale Infektionen mit dem Respiratory Syncytial Virus [31,53] und Rotavirus [52] können bei immunsupprimierten Patienten schwer und prolongiert verlaufen [59].…”