Respiratory Viral Infections in Children and Adolescents With Hematological Malignancies

Abstract

BackgroundDespite the introduction of a polymerase chain reaction (PCR) test for the diagnosis of respiratory viral infection (RVI), guidance on the application of this test and the management of RVI in immunocompromised children is lacking. This study evaluated the clinical characteristics of RVI and established strategies for the PCR test in children and adolescents with hematological malignancies.MethodsThis study included children and adolescents with underlying hematological malignancies and respiratory symptoms, in whom a multiplex PCR test was performed. Patients in whom RVI was identified and not identified were categorized into Groups I and II, respectively. Group I was sub-divided into patients with upper and lower respiratory infections. The medical records of the enrolled patients were retrospectively reviewed.ResultsA total of 93 respiratory illnesses were included. Group I included 46 (49.5%) cases of RVI, including 31 (67.4%) upper and 15 (32.6%) lower respiratory infections. Rhinovirus (37.0%) was the most common viral pathogen. Significantly more patients in Group I had community-acquired respiratory illnesses (p=0.003) and complained of rhinorrhea (p<0.001) and sputum (p=0.008) than those in Group II. In Group I, significantly more patients with lower respiratory infections had uncontrolled underlying malignancies (p=0.038) and received re-induction or palliative chemotherapy (p=0.006) than those with upper respiratory infections.ConclusionsA multiplex PCR test should be considered for RVI diagnosis in immunocompromised children and adolescents with respiratory symptoms, especially in those with rhinorrhea or sputum prominent over a cough. The early application of the PCR test in patients with uncontrolled underlying malignancies may improve outcomes.

Viral Respiratory Infections in Hematological Patients

“…Other very well known pathogens such as herpes viruses [cytomegalovirus (CMV), Epstein-Barr virus (EBV), varicella-zoster virus (VZV), herpes simplex 1 and 2 (HSV1-2) and herpesvirus-6] frequently cause serious diseases in these patients but rarely affect the respiratory system. These diseases can follow a first contact with the virus or a viral reactivation related to immunosuppressive conditions [3,4].…”

“…At onset, reported symptoms are therefore unspecific and related to an initial involvement of the upper respiratory tract: cough, rhinorrhea, otitis media, wheezing, and sore throat with or without fever [4,12].…”

“…From these premises, it is clear that infections in general still represent a frequent complication, and in some cases the main cause of death in these patients; it is therefore important to establish methods to prevent these problems [4]. In this review we will deal with respiratory viral infections in pediatric and adult hematological patients, describing epidemiological aspects, available diagnostic tools, treatment options and preventive measures.…”

HMPV in Immunocompromised Patients: Frequency and Severity in Pediatric Oncology Patients

“…Second to rhinovirus, the most represented virus is HRSV, found in 2.1-46% of cases. HMPV has been found in 3.3-13.5% of cases, being classified as the third [19], fourth [18,[20][21][22][23], fifth [24] and tenth [25,26] most frequent respiratory virus, according to the literature reviewed. Interestingly, HMPV has been reported as the only viral agent that was responsible for an outbreak in a pediatric oncology population [27] (Table 1).…”

“…Co-infections were reported in most of the papers reviewed, but, in some cases, HMPV has been found as the only agent that caused respiratory illness in pediatric cancer patients, being 2.0-7.4% of the total virus distribution [25,[28][29][30]. In some cases, bacteria or other pathogens have been detected along with HMPV [21,26,[30][31][32] (Table 2).…”