Age: 0.9
Sex: F
Vaccine: FLUX
Symptoms: Respiratory distress, Respiratory failure, Respiratory syncytial virus infection, Respiratory syncytial virus test positive, Vasopressive therapy
Clinical narrative: Case number PHHY2015US170668, is an initial literature case report received on 24 Dec 2015. The author in the article discussed about acute respiratory infections (ARI) in children and adolescents with acute lymphoblastic leukemia. Patients (less than or equal to 18 years) who were newly diagnosed with acute lymphoblastic leukemia (ALL) and were enrolled on an ALL treatment protocol (total therapy XVI) between Oct 2007 and May 2011 were evaluated. The total therapy XVI therapy consisted of a 6-week remission induction, 8-week consolidation and 120-week continuation phase that included two 3-week periods of more intensive chemotherapy (reinduction I and reinduction II). This report refers to an 11-month-old female patient. Past medical history and concomitant medication was not reported. The patient started therapy with cytarabine (manufacturer: not reported) for acute lymphoblastic leukemia at an unknown dose and route from an unknown date. The patient received palivizumab (manufacturer: not reported) for immunoprophylaxis at an unknown dose and route on an unknown date. The patient was vaccinated with two doses of seasonal influenza vaccine (manufacturer and batch number: not reported) on unknown dates. It was reported that 10 days before developing illness, the patient had received palivizumab. Also it was reported that on an unknown date the patient received high dose of cytarabine for reinduction II chemotherapy. The patient was presented in the hospital with a 3-day history of progressively worsening cough, nasal congestion, fever, respiratory distress with profound neutropenia and lymphopenia for which the patient was hospitalized. Initial evaluation revealed the patient had bilateral peribronchial thickening and respiratory syncytial virus (RSV) was detected on a nasopharyngeal wash specimen by polymerase chain reaction (PCR). Treatment was started with aerosolized ribavirin in addition to oxygen support and broad spectrum antibiotic therapy. However, due to progressive respiratory deterioration and increasing fever, a chest x-ray was repeated on day 5 of hospitalization which demonstrated left lower lobe consolidation pneumonia suggestive of secondary bacterial infection. The patient's treatment regimen included vancomycin, meropenem, azithromycin, voriconazole, palivizumab and aerosolized ribavirin. On day 28 of hospitalization, the patient experienced respiratory and hemodynamic failure which required mechanical ventilation and vasopressor followed by extracorporeal mechanical oxygenation support. The patient died 2 months after onset of the RSV infection. The outcome of events respiratory syncytial virus infection, respiratory failure, circulatory failure and pneumonia bacterial was fatal and outcome of events lymphopenia and neutropenia was not reported. Action taken with palivizumab and cytarabine was unknown. The author stated that despite the low incidence of viral ARI in children with ALL, the associated morbidity, mortality and delay in chemotherapy remain clinically significant. Viral lower respiratory tract infection was especially associated with high morbidity requiring intensive care-level support. The author concluded that in spite of current advances in ALL cure rates, molecular diagnostic techniques, antiviral therapies and active and passive immune prevention approaches, respiratory viral infections remain a significant burden in children with ALL.