Respiratory viral infections in pediatric hematology/oncology patients

Abstract

Respiratory viral infections (RVIs) are the most frequent type of infection in the pediatric population, and are identified in up to 57 % of episodes of febrile neutropenia (FN). Nevertheless, they are frequently overlooked and have been historically considered inconsequential in infection treatment strategies for FN patients. Over the past two decades, a rekindled interest has provided insights into the epidemiology and clinical impact of RVIs in FN settings. This, along with the SARS-CoV-2 pandemic and its impact on molecular testing, as well as breakthroughs in immunology host-pathogen interactions, has set up the stage for re-instating the debate on RVIs role in FN. Capitalizing on these milestones, we propose a path to optimize diagnosis and treatment in RVIs afflicted FN patients, which could minimize hospitalizations and antimicrobial use. We also delve into the innate immunity's distinguishing features in response to RVIs, highlighting the importance of grounding therapeutic strategies in this understanding, while exploring the most recent research breakthroughs proposing immune-guided approaches that examine the impact of RVIs on host outcomes and susceptibility to co-infections. In conclusion, we call for future research to be geared toward enhancing RVIs diagnosis, understanding host-microorganism interactions more deeply, incorporating RVIs considerations into antimicrobial stewardship, and evaluating the cost-effectiveness of routine RVIs testing. This multifaceted approach could reduce antimicrobial resistance, as well as direct and indirect mortality rates in pediatric oncology.