Department of Pediatrics, Division of Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Pediatr Blood Cancer. 2011 Jan;56(1):127-33. doi: 10.1002/pbc.22771.
Pediatric oncology and hematopoietic stem cell transplantation (HSCT) patients are at high risk for influenza infection and its associated complications. Little is known about infection with novel 2009 influenza A (H1N1) in this population.
Prospective laboratory surveillance identified all children with positive influenza test results from 4/27/09-12/5/09. 2009 H1N1 infection was confirmed by PCR subtyping; cases in which subtyping was not performed were considered probable. Medical records of all pediatric oncology and HSCT cases were reviewed.
Thirty children with cancer or HSCT had laboratory-confirmed influenza A. Patients with ALL (18), CNS tumors (4), CML (1), Ewing sarcoma (1), Hodgkin lymphoma (1), LCH (1), severe aplastic anemia (1), and HSCT (3), had confirmed (5) and probable (25) H1N1 by rapid (22; 73%), DFA (4; 13%), or RVP (4; 13%) assays. Most frequent presenting signs and symptoms were fever (93%; median 38.6°C), cough (97%), and rhinorrhea (83%). Ten patients required hospitalization for a median of 5 days, most commonly for fever and neutropenia (8). Imaging demonstrated lower respiratory tract involvement in three patients. There were no concomitant bacteremias; one patient had rhinovirus co-infection. Three patients required ICU care; 1 developed ARDS, multi-organ failure, and died after 5 days. Chemotherapy was delayed in five patients. Oseltamivir was administered to 28 patients; 1 patient developed an oseltamivir-resistant strain and was treated with zanamivir.
2009 influenza A H1N1 infection in children with cancer and HSCT is mild in most patients, but can lead to serious complications.
儿科肿瘤学和造血干细胞移植（HSCT）患者感染流感及其相关并发症的风险较高。目前对该人群中新型 2009 年甲型流感（H1N1）感染知之甚少。
前瞻性实验室监测从 2009 年 4 月 27 日至 12 月 5 日确定了所有流感检测结果阳性的儿童。通过 PCR 亚型鉴定确认了 2009 年 H1N1 感染；未进行亚型鉴定的病例被认为是可能的。回顾了所有儿科肿瘤学和 HSCT 病例的病历。
30 名患有癌症或 HSCT 的儿童实验室确诊患有甲型流感。急性淋巴细胞白血病（ALL）患者（18 例）、中枢神经系统肿瘤（4 例）、慢性髓性白血病（CML）（1 例）、尤因肉瘤（1 例）、霍奇金淋巴瘤（1 例）、朗格汉斯组织细胞增生症（LCH）（1 例）、严重再生障碍性贫血（1 例）和 HSCT（3 例）通过快速检测（22 例；73%）、DFA（4 例；13%）或 RVP（4 例；13%）检测确认（5 例）和可能（25 例）的 H1N1。最常见的表现体征和症状是发热（93%；中位数 38.6°C）、咳嗽（97%）和流涕（83%）。10 名患者需要住院治疗，中位数为 5 天，最常见的是发热和中性粒细胞减少症（8 例）。影像学显示 3 例患者下呼吸道受累。没有同时发生菌血症；1 例患者合并鼻病毒感染。3 例患者需要 ICU 护理；1 例患者发展为 ARDS、多器官功能衰竭，5 天后死亡。5 名患者的化疗被延迟。28 名患者给予奥司他韦治疗；1 名患者出现奥司他韦耐药株，并用扎那米韦治疗。
儿童癌症和 HSCT 患者的 2009 年甲型流感 H1N1 感染在大多数患者中较轻，但可导致严重并发症。
