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Prevalence and Clinical Course of Viral Upper Respiratory Tract Infections in Immunocompromised Pediatric Patients With Malignancies or After Hematopoietic Stem Cell Transplantation

Fazekas, Tamas MD; Eickhoff, Philipp MD; Rauch, Margit MS; Verdianz, Maria MSc; Attarbaschi, Andishe MD; Dworzak, Michael MD; Peters, Christina MD; Hammer, Karin MD; Vecsei, Andreas MD; Pötschger, Ulrike MSc; Lion, Thomas MD, PhD

Journal of Pediatric Hematology/Oncology: August 2012 - Volume 34 - Issue 6 - p 442–449
doi: 10.1097/MPH.0b013e3182580bc8
Original Articles

Background: Respiratory tract infections (RTI) in immunosuppressed pediatric patients with malignancies or after hematopoietic stem cell transplantation (HSCT) are associated with significant morbidity and mortality. Prospective data on the incidence and clinical role of infections by respiratory viruses in this population have been lacking.

Methods: In this prospective study, 191 children between 0 and 18 years of age were investigated by real-time polymerase chain reaction for the presence of 8 common respiratory virus types in transnasal aspirations. The study included 110 children with leukemia, lymphoma, or solid tumors (subgroup 1); 31 children after HSCT (subgroup 2); and 50 immunocompetent control patients.

Results: In comparison with the control group, immunocompromised children showed a significantly higher incidence of positive virus tests (subgroup 1: 53%; subgroup 2: 81%; controls: 24%; P<0.0001), and more frequently experienced ensuing viral infections in the lower respiratory tract (subgroup 1: 74%; subgroup 2: 88%; controls: 25%; P<0.0001). Sixteen percent of these children had coinfections by 2 or more viruses and revealed more severe respiratory illness.

Conclusions: The present epidemiologic study on viral upper RTI in immunocompromised children revealed a high virus-associated morbidity which was particularly prominent in HSCT recipients. In these children, detection of viral coinfections was identified as a risk factor for a severe course of lower RTI.

*Department of Pediatrics, St Anna Children’s Hospital, Medical University Vienna

Children’s Cancer Research Institute, Vienna, Austria

T.F.: guarantor of the entire manuscript; T.F., P.E., A.A.: conception and design; M.R., M.V., U.P.: analysis and interpretation; A.V., K.H., M.D., C.P., T.L.: drafting the manuscript for important intellectual content.

The authors declare no conflict of interest.

The first draft of the manuscript was written by T.F. No honorarium, grant, or other form of payment was given to anyone to produce the manuscript.

Reprints: Thomas Lion, MD, PhD, Children’s Cancer Research Institute, Zimmermannplatz 10, A-1090 Vienna, Austria (e-mail:

Received November 6, 2011

Accepted March 29, 2012

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.