El-Mahallawy Hadir A, Ibrahim Mohamed Hassan, Shalaby Lobna, Kandil Amira
Clinical Pathology, National Cancer Institute, Cairo University.
J Egypt Natl Canc Inst. 2005 Jun;17(2):121-6.
Community respiratory viruses are an important cause of respiratory disease in the immunocompromised patients with cancer. To evaluate the occurrence and clinical significance of respiratory virus infections in hospitalized cancer patients at National Cancer Institute, Cairo University, during anticancer treatment, we studied cases that developed episodes of lower respiratory tract infections (LRTI).
Thirty patients with LRTI were studied clinically, radiologically, and microbiologically. Sputum cultures were done and an immunofluorescence search for IgM antibodies of influenza A and B, parainfluenza serotypes 1, 2 and 3, adenovirus, respiratory syncytial virus, Legionella pneumophila, Coxiella burnettii, Chlamydia pneumoniae, and Mycoplasma pneumoniae were performed on serum samples of patients.
The main presenting symptom was cough and expectoration. Hematologic malignancy was the underlying disease in 86.6% of cases. Blood cultures were positive in 11 patients (36.6%) only. Sputum cultures revealed a bacterial pathogen in 13 cases and fungi in 3; whereas viral and atypical bacterial IgM antibodies were detected in 13 and 4 patients; respectively. Influenza virus was the commonest virus detected, being of type B in 4 cases, type A in one case and mixed A and B in another 5 cases; followed by RSV in 5 patients. Taken together, bacteria were identified as a single cause of LRTI in 10 cases, viruses in 6, fungi in 3 and mixed causes in 7. Still, there were 4 undiagnosed cases.
This study showed that respiratory viruses are common in LRTI, either as a single cause or mixed with bacterial pathogens, in hospitalized cancer patients receiving chemotherapy. Diagnostic tests for respiratory viruses should be incorporated in the routine diagnostic study of patients with hematologic malignancies. Also, it must be emphasized that early CT chest is crucial as a base-line prior to initiation of anti-fungal or anti-viral therapy. In cancer patients with a febrile episode and LRTI, tailored therapy is recommended according to the clinical findings of the patient.
社区呼吸道病毒是免疫功能低下的癌症患者发生呼吸道疾病的重要原因。为评估开罗大学国家癌症研究所住院癌症患者在抗癌治疗期间呼吸道病毒感染的发生率及临床意义，我们研究了发生下呼吸道感染（LRTI）的病例。
对30例LRTI患者进行了临床、放射学及微生物学研究。进行了痰培养，并对患者血清样本进行免疫荧光检测，以查找甲型和乙型流感、1、2和3型副流感、腺病毒、呼吸道合胞病毒、嗜肺军团菌、伯氏考克斯体、肺炎衣原体及肺炎支原体的IgM抗体。
主要表现症状为咳嗽和咳痰。86.6%的病例基础疾病为血液系统恶性肿瘤。仅11例患者（36.6%）血培养呈阳性。痰培养显示13例有细菌病原体，3例有真菌；而分别在13例和4例患者中检测到病毒及非典型细菌的IgM抗体。检测到的最常见病毒为流感病毒，4例为B型，1例为A型，另5例为A和B混合型；其次是呼吸道合胞病毒，有5例患者感染。总体而言，确定10例LRTI的单一病因是细菌，6例是病毒，3例是真菌，7例是混合病因。仍有4例未确诊病例。
本研究表明，在接受化疗的住院癌症患者中，呼吸道病毒在LRTI中很常见，可作为单一病因或与细菌病原体混合存在。呼吸道病毒诊断检测应纳入血液系统恶性肿瘤患者的常规诊断研究中。此外，必须强调的是，在开始抗真菌或抗病毒治疗之前，早期胸部CT作为基线检查至关重要。对于有发热发作和LRTI的癌症患者，建议根据患者的临床检查结果进行针对性治疗。
