Viral infections in children receiving anticancer chemotherapy

Abstract

Fever is a frequent and serious complication in paediatric oncology patients, and often related to infection. The absolute neutrophil and lymphocyte count may be significantly diminished due to cytotoxic chemotherapy and occasionally the neoplastic disease itself, resulting in a host more vulnerable to infections. Symptoms and signs of infection may be minimal or absent in patients with neutropenia as a decrease in the number of neutrophils is associated with a diminished inflammatory response. Arola et al. found proof of a respiratory virus infection in 37% of febrile children with cancer while the clinical diagnosis of respiratory tract infection was only 17%. 1 Outcome measures. Viruses were isolated or antigens detected on venous blood samples, nasopharyngeal aspirates (NPAs), throat swabs, urine and faeces, where possible. Blood for aerobic and anaerobic culture was obtained from an indwelling intravenous catheter and/or a peripheral vein. Results. Thirty-four patients were analysed for a total of 102 febrile episodes. Evidence of a viral and bacterial infection was found in 31 (30%) and 24 (24%) episodes, respectively. Within these, a combined viral and bacterial infection was demonstrated in 6 (6%) episodes. A total of 35 viral isolates were identified in 31 febrile episodes: herpes simplex virus 1 (HSV-1) ( N=14), HSV-2 (N=2), cytomegalovirus (CMV) (N=10), rotavirus (N=5), adenovirus (N=2), para-influenza type 3 ( N=1) and hepatitis B (N=1). The blood culture was positive in 24 febrile episodes. The absolute neutrophil count (ANC) on admission was below 0.5 x 10 9 /l in 57 (56%) episodes and thus considered neutropenic. Infectious agents were more frequently identified in neutropenic (54%) than in non-neutropenic (40%) episodes and were more likely to be of bacterial (30%) than viral (15.5%) origin. However, this difference was not significant. Conclusions. In addition to bacterial infections, viruses are clearly an important cause of fever in children receiving anticancer chemotherapy. Diagnostic tests for viral infections should be used more frequently, and could be of considerable value in evaluating fever and establishing appropriate therapy in these patients.