Christensen Merete Stubkjaer, Nielsen Lars Peter, Hasle Henrik
Department of Pediatric Oncology, Skejby Hospital, Aarhus University Hospital, Denmark.
Pediatr Blood Cancer. 2005 Dec;45(7):945-51. doi: 10.1002/pbc.20469.
Treatment of low-risk febrile episodes with oral administered antibiotics at home is a new approach in pediatric oncology and protective isolation is loosened in more centers. The impact of viral respiratory infections in febrile diseases in this population is still unclear in terms of occurrence and morbidity.
A prospective follow-up study of all febrile episodes during 12 months in a pediatric oncology department with a high level of protective isolation was set-up with expanded molecular viral examinations. Reverse transcriptase polymerase chain reaction (RT-PCR) and PCR diagnostics of ten viruses, two atypical bacteria, and one fungus were performed and clinical information on all infections was registered.
A total of 250 febrile episodes in 66 patients were registered. In all, 198 respiratory secretions, predominantly oral washes, and 165 anal swabs were analyzed. Twenty-two infections were diagnosed: 7 rhinovirus infections, 4 respiratory syncytial virus (RSV) infections, 2 herpes simplex virus (HSV) infections, 2 varicella-zoster-virus (VZV) infections, 1 influenza B virus infection, 1 parainfluenza virus type 3 infection (PIV3), 1 human metapneumovirus (HMPV) infection, 1 enterovirus infection, 0 adenovirus infections, 0 influenza A virus infections, and 3 non-viral pneumonias: 1 M. Pneumonia, 1 C. Pneumonia, and 1 P. Carinii. The detected pathogens correlated well to the clinical disease. Patients with viral infections were as affected as patients with bacteria in the blood. One of 19 viral infections was lethal, a RSV pneumonia. C-reactive protein concentrations were not able to distinguish viral infections from bacteremias.
The applied sampling method was acceptable and molecular diagnosis of viruses, atypical bacteria and P. Carinii increased the microbiological verification of infections by 35%. Viral infections were few in our protected population but caused severe infectious complications in these patients.
在家口服抗生素治疗低风险发热性疾病是儿科肿瘤学中的一种新方法，越来越多的中心放宽了保护性隔离措施。就发病率和发病情况而言，病毒呼吸道感染在该人群发热性疾病中的影响仍不明确。
在一个保护性隔离水平较高的儿科肿瘤科室，开展了一项对12个月内所有发热性疾病的前瞻性随访研究，并进行了扩展的分子病毒检测。对十种病毒、两种非典型细菌和一种真菌进行了逆转录聚合酶链反应（RT-PCR）和PCR诊断，并记录了所有感染的临床信息。
共记录了66例患者的250次发热性疾病。总共分析了198份呼吸道分泌物，主要是口腔冲洗液，以及165份肛门拭子。诊断出22例感染：7例鼻病毒感染、4例呼吸道合胞病毒（RSV）感染、2例单纯疱疹病毒（HSV）感染、2例水痘带状疱疹病毒（VZV）感染、1例乙型流感病毒感染、1例3型副流感病毒（PIV3）感染、1例人偏肺病毒（HMPV）感染、1例肠道病毒感染、0例腺病毒感染、0例甲型流感病毒感染，以及3例非病毒性肺炎：1例肺炎支原体、1例肺炎衣原体和1例卡氏肺孢子虫。检测到的病原体与临床疾病相关性良好。病毒感染患者与血液中细菌感染患者受影响程度相同。19例病毒感染中有1例致死，为RSV肺炎。C反应蛋白浓度无法区分病毒感染和菌血症。
所采用的采样方法是可接受的，对病毒、非典型细菌和卡氏肺孢子虫的分子诊断使感染的微生物学验证率提高了35%。在我们受保护的人群中病毒感染较少，但这些患者会出现严重的感染并发症。
