PB2025 ACUTE RESPIRATORY VIRAL INFECTIONS IN CHILDREN WITH ACUTE LEUKEMIA
Authors: Ö. Tüfekçi, S. Uysal, B. Baysal, N. Belet, S. Yılmaz, H. Ören
Journal: HemaSphere (2019)

Background: Although major advances have been made in the treatment of leukemia in recent years, infections that develop during treatment still cause significant morbidity and mortality in children with acute leukemias. The general approach in febrile neutropenia is to initiate empirical antibacterial therapy for possible bacterial infections and to add antifungal therapy when necessary. On the other hand, considering that viral respiratory infections are the most common cause of febrile infections in all children, one might expect that they are also among the possible causes of infections in children with acute leukemia. Aims: In this study, we aimed to investigate the frequency, etiology and clinical features of viral infections in children with acute leukemia. Methods: This single‐center retrospective study was conducted in children with diagnosis of acute leukemia in Dokuz Eylül University Pediatric hematology Clinic. Patients who presented with symptoms of respiratory tract infection and in whom positive causative viral agents were detected enrolled in the study. Respiratory virus panel including 20 respiratory viruses was studied by real‐time multiplex polymerase chain reaction analysis of nasopharyngeal aspirates. Results: A total of 201 samples of nasopharyngeal aspirates were sent from 84 patients between June 2011 and June 2018. At least one viral causative agent was detected in 108 samples that were sent from 55 patients. More than one nasophayngeal aspirate was positive in 28 of 55 (51%) patients at different times. Forty‐seven patients (91%) had acute lymphoblastic leukemia (ALL) and 8 (9%) had acute myeloid leukemia (AML). The median age at diagnosis was 52 months (5‐193). Infections were most common during the induction period (57%). The most common complaints during the infections were cough (74%), runny nose (68%) and fever (65%). The absolute neutrophil count was below 500 / mm3 in 55 (50%) of 108 incidents. The most frequently detected factors were human rhinovirus (48%), parainfluenza virus (14%), respiratory syncytial virus (RSV) (12%), influenza virus (10%) and adenovirus (10%). Blood culture‐proven bacterial infection was detected simultaneously in 23 (21%) and probable invasive aspergillosis was detected simultaneously in 7 (6%) of 108 incidents. All patients with influenza A received oseltamivir treatment. The clinical findings were completely resolved on the median 7th day (2‐20 days) after the onset of symptoms. Six patients required invasive/ noninvasive respiratory support, three of whom were followed up in the intensive care unit. Of the three patients in the intensive care unit, two had RSV and one had parainfluenza virus. Death occurred in one patient due to RSV pneumonia. Summary/Conclusion: In this study; one or more viral agents were detected in half of respiratory tract infections in patients with acute leukemia. Detection of viral agents in this patient group will enable the use of existing antiviral drugs such as oseltamivir, and will enable treatment and follow‐up more effectively. In addition, identification of a viral agent may help explain the clinical situation in febrile neutropenia cases where a bacterial /fungal agent cannot be detected and there is no response to empirical antibacterial/antifungal treatment.