Assessment of respiratory tract viruses in febrile neutropenic etiology in children and comparison with healthy children with upper/lower respiratory tract infection

OBJECTIVE: This study aims to compare the frequency of respiratory viruses using real-time and multiplex polymerase chain reaction technology and nasopharyngeal swabs taken during exacerbation of patients aged 0–18 years followed for febrile neutropenia (FN) with non-FN children.
METHODS: This prospective study included a total of 40 patients with FN and malignancies followed at Eskisehir Osmangazi University, Department of Pediatric Hematology and Oncology. The control group (n=76) consisted of age-matched patients with upper respiratory tract infections (URTIs) or lower respiratory tract infections (LRTIs) who were admitted to the emergency service due to fever.
RESULTS: Viral agents were detected in 16 of 53 FN attacks (30.1%). The most commonly isolated viruses were coronavirus (23.7%, n=9), influenza B (18.4%, n=7), and adenovirus (18.4%, n=7). Of 76 children diagnosed with URTI with fever (52.6%) had viral agents, and only 28 of them had a single agent. The most commonly isolated virus was adenovirus (28.6%, n=14). Viral factors were found in 32 of 42 patients (76.1%) patients diagnosed with LRTI, while respiratory syncytial virus was the most common virus in 27 patients (21.7%, n=5).
CONCLUSION: Our study results show that viral agents play an important role in the etiology of FN. This is the first study to show that viral agents play an important role in the etiology of this disease and viral factors in non-neutropenic febrile children at the same time period by detecting respiratory viruses in 30% of FN cases. More similar studies provide antiviral therapy in selected patients, as well as these studies lead to reduce the use of antimicrobial agents or allow more selective use of antibiotics and/or the earlier discontinuation of these antibiotics in febrile neutropenic children who have been shown to have viral cause of respiratory tract infection based on clinical and microbiological/molecular diagnostic criteria.

Çocuklarda Febril Nötropeni Etiyolojisinde Solunum Yolu Virüslerinin Sýklýðýnýn Deðerlendirilmesi ve Üst/Alt Solunum Yolu Enfeksiyonu Olan Saðlýklý Çocuklar ile Karþýlaþtýrýlmasý

Giriþ: Bu çalýþma, febril nötropeni nedeni ile takip edilen 0-18 yaþ arasýndaki hastalarýn atak sýrasýnda alýnan nazofaringeal sürüntülerden, Luminex xTAG teknolojisi kullanarak solunum yolu virüslerinin sýklýðýnýn belirlenmesi ve eþ zamanlý olarak nötropenik olmayan ateþli çocuklar ile karþýlaþtýrýlmasýný amaçlayan bir yýllýk prospektif araþtýrmadýr.
Materyal and Metod: Çalýþmaya Eskiþehir Osmangazi Üniversitesi Týp Fakültesi Çocuk Hematoloji-Onkoloji Bölümünde izlenen malignensili nötropenik ateþ hastalarý (n=40) dahil edildi. Kontrol grubu (n=76) olarak acil servise ateþ nedeni ile baþvuran benzer yaþ grubundaki üst/alt solunum yolu enfeksiyonu (ÜSYE/ASYE) olan çocuklar alýndý.
Bulgular: Toplam 53 febril nötropenik ataðýn 16’sýnda (%30.1) viral etkenler gösterildi. En sýk saptanan virüsler sýrasýyla coronavirüs (%23.7, n=9), influenza B (%18.4, n=7) ve adenovirüs (%18.4, n=7) olarak belirlendi. ÜSYE’si olan ateþli 76 çocuktan 40’ýnda (%52.6) viral etkenlerin olduðu ve bunlardan 28’inde tek bir etkenin olduðu saptandý. En sýk saptanan virüsün adenovirüs (%28.6, n=14) olduðu görüldü. ASYE’si olan 42 hastanýn 32’sinde (%76.1) viral etkenler görülürken, 27’sinde tek etken saptanan bu hastalarda en sýk saptanan virüs RSV’ydi (%21.7, n=5).
Sonuç: Bu çalýþma, FEN’li olgularýn %30’unda solunum yolu virüslerini saptayarak etyolojide viral ajanlarýn önemli rolü olduðunu gösteren, ayný zaman periyodunda nötropenik olmayan ateþli çocuklardaki viral etkenleri de dökümante eden ilk çalýþmadýr. Bu çalýþmalarýn artmasý ile birlikte, seçilmiþ hastalarda antiviral tedavi vermenin yanýsýra, sýký klinik ve mikrobiyolojik/moleküler taný kriterlerine dayanarak solunum yolu enfeksiyonunun viral nedenli olduðu gösterilen febril nötropenili çocuklarda antimikrobiyal ajan kullanýmýn azaltýlmasýný, antibiyotiklerin daha seçici kullanýlmasýný ve/veya daha erken kesilmesini saðlayabilir. (NCI-2020-0249.R1)