Tantawy Azza A G, Barakat Moustafa M A, Adly Amira A M, Ebeid Fatma S E, Shamaa Manal F El, Yassin Mohamed
Paediatric Department, Faculty of Medicine, Ain Shams University , Cairo , Egypt.
Pediatr Hematol Oncol. 2015;32(5):304-14. doi: 10.3109/08880018.2015.1013230. Epub 2015 Apr 14.
Respiratory viruses are widespread in the community and easily transmitted to immunocompromised patients.
Assess the prevalence of community-acquired respiratory viral infections among children with cancer presenting with clinical picture suggestive of lower respiratory tract infections (LRTIs), and evaluate its risk factors and prognosis.
Over a year, 90 hospitalized children with malignancy and LRTIs recruited, subjected to clinical assessment, investigated through hematology panel, blood culture, chest x-ray, CT chest and PCR for influenza A and B, parainfluenza (PIV) types 1 and 3 viruses, and respiratory syncytial virus (RSV), and prospectively followed up for the clinical outcome.
Viral pathogens were identified in 34 patients (37.7%), with a seasonal peak from April to May. The most frequently detected virus was influenza virus [type A (16 cases; 47%), type B (4 cases; 12%)] followed by parainfluenza virus [PIV1 (9 cases; 26%), PIV3 (3 cases; 15%)], and none had RSV. Bacteria were identified in 26 patients, fungi in four, mixed infections [bacterial/viral and bacterial/fungal] in 13, and 36 cases had unidentified etiology. The majority of patients with influenza and parainfluenza infections had hematological malignancy, presented with fever, and had mild self-limited respiratory illness. Five patients with mixed viral and bacterial infection had severe symptoms necessitating ICU admission. Six patients died from infection-related sequelae; two had mixed PIV and Staphylococcal infections.
Community acquired influenza and parainfluenza infections are common in pediatrics patients with malignancy, either as isolated or mixed viral/bacterial infections. Clinical suspicion is essential as hematological and radiological manifestations are nonspecific. Rapid diagnosis and management are mandatory to improve patients' outcome.
呼吸道病毒在社区广泛传播，易传染给免疫功能低下的患者。
评估临床症状提示下呼吸道感染（LRTIs）的癌症患儿社区获得性呼吸道病毒感染的患病率，并评估其危险因素和预后。
在一年时间里，招募了90名患有恶性肿瘤并出现LRTIs的住院儿童，进行临床评估，通过血液学检查、血培养、胸部X光、胸部CT以及针对甲型和乙型流感病毒、1型和3型副流感病毒（PIV）以及呼吸道合胞病毒（RSV）的PCR检测进行调查，并对临床结果进行前瞻性随访。
在34名患者（37.7%）中鉴定出病毒病原体，4月至5月出现季节性高峰。最常检测到的病毒是流感病毒[甲型（16例；47%），乙型（4例；12%）]，其次是副流感病毒[PIV1（9例；26%），PIV3（3例；15%）]，没有检测到RSV。在26名患者中鉴定出细菌，4名患者中鉴定出真菌，13名患者中鉴定出混合感染[细菌/病毒和细菌/真菌]，36例病因不明。大多数流感和副流感感染患者患有血液系统恶性肿瘤，表现为发热，患有轻度自限性呼吸道疾病。5名混合病毒和细菌感染的患者有严重症状，需要入住重症监护病房。6名患者死于感染相关后遗症；2名患者患有PIV和葡萄球菌混合感染。
社区获得性流感和副流感感染在患有恶性肿瘤的儿科患者中很常见，可为单独感染或病毒/细菌混合感染。由于血液学和放射学表现不具有特异性，临床怀疑至关重要。快速诊断和管理对于改善患者预后必不可少。
