Investigation of respiratory viruses in febrile neutropenic children with acute lymphoblastic leukemia, neuroblastoma and lymphoma after chemotherapy

Investigation of Respiratory Viruses in Febrile Neutropenic Children with Acute Lymphoblastic Leukemia, Neuroblastoma and Lymphoma After Chemotherapy Objectives: Febrile neutropenia is a common complication in patients receiving chemotherapy for cancer treatment and is one of the major causes of mortality. The aim of this study is to determine the prevalence of respiratory tract viruses and their role in the development of neutropenic fever in children with acute lymphoblastic leukemia, neuroblastoma and lymphoma. Materials and Methods: In the scope of this study, nasopharyngeal swab samples were taken from 55 patients (each episode of a patient was evaluated as a new case), who were referred to Pediatric Oncology Clinics of Medical Faculty of Cukurova University and City Hospital of Adana from February 2018 to February 2019. Nasopharyngeal sample was obtained for the detection of respiratory viruses which are respiratory syncytial virus (RSV), influenza A and B, parainfluenzavirus (PIV), metapneumovirus (hMPV), bocavirus, coronavirus, rhinovirus, adenovirus, at Virology Laboratory within the body of Department of Medical Microbiology by using real-time PCR tests. Cases' symtoms, laboratory and microbiological findings, treatments and detected respiratory viruses were recorded. Results: Most of the patients had acute lymphoblastic leukemia (%45,4), and then neuroblastoma had the most frequency in patients (%40). Lymphoma was the least common (%14,6). The overall median length of hospital stay was 14,85±10,43 days and median duration of neutropenia was 8,71±4,27 days. Microbiologically documented infections were found in 69,1% episodes. Overall, respiratory viral infections were associated with 52,7% of febrile neutropenia of which 20,6% were viral coinfections. Rhinovirus was the most frequently detected virus then adenovirus was the most. High risk patients had longer median duration of neutropenia and respiratory virus frequency was higher in these patients. Respiratory symptoms were present at admission in 86,2% of the episodes. The frequency of respiratory viruses was found to be statistically significant in patients with lung infection. The frequency of respiratory virus was significantly higher in patients receiving combination therapy. 5 patients died and all of them presented febrile neutropenic episodes during hospitalization. These 5 patients had microbiologically documented infections. Conclusions: Respiratory viruses are shown to be important causative agents in children with cancer and an episode of febrile neutropenia. Therefore, we are of the opinion that the ability to detect respiratory viruses in a short time by using real-time PCR tests may be helpful in reduce the extensive use of antibacterial and antifungal treatment in patients with febrile neutropenia. Keyword: Cancer, febrile neutropenia, respiratory viruses.