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Prospective Detection of Respiratory Pathogens in Symptomatic Children With Cancer

Srinivasan, Ashok MD*‖; Gu, Zhengming PhD; Smith, Teresa BS; Morgenstern, Markus BS; Sunkara, Anusha MS§; Kang, Guolian PhD§; Srivastava, Deo K. PhD§; Gaur, Aditya H. MD¶‖; Leung, Wing MD, PhD*‖; Hayden, Randall T. MD

The Pediatric Infectious Disease Journal: March 2013 - Volume 32 - Issue 3 - p e99–e104
doi: 10.1097/INF.0b013e31827bd619
Original Studies

Background: The data on human rhinovirus, coronavirus, bocavirus, metapneumovirus, Chlamydophila pneumoniae, Mycoplasma pneumoniae and Bordetella pertussis infections in children with cancer is limited.

Methods: We sought to determine prospectively the prevalence of respiratory pathogens in these children, using multiplexed–polymerase chain reaction.

Results: We enrolled 253 children with upper or lower respiratory tract infection (LRTI) during a 1-year period. A respiratory virus was detected in 193 (76%) patients; 156 (81%) patients had upper respiratory tract infection. Human rhinovirus was the most common virus detected in 97 (62%) and 24 (65%) patients with upper respiratory tract infection and LRTI, respectively. Leukemia or lymphoma was the most common underlying diagnosis in 95 (49%) patients followed by solid tumor 47 (24%), posthematopoietic stem cell transplant 28 (15%) and brain tumor in 23 (12%) patients. By multiple logistic regression analysis, human bocavirus was the most commonly detected respiratory virus in patients with LRTI (P = 0.008; odds ratio, 4.52; 95% confidence interval: 1.48–13.79). Coinfection with >1 virus was present in 47 (24%) patients, and did not increase the risk for LRTI. Two (0.7%) patients succumbed to LRTI from parainfluenza virus-3 and respiratory syncytial virus/human rhinovirus infection, respectively. C. pneumoniae and M. pneumoniae were detected in 4 and 3 patients, respectively.

Conclusions: Human rhinovirus was the most common virus detected in children with cancer and posthematopoietic stem cell transplant hospitalized with an acute respiratory illness, and was not associated with increased morbidity. Prospective studies with viral load determination and asymptomatic controls are needed to study the association of these emerging respiratory viruses with LRTI in children with cancer and posthematopoietic stem cell transplant.

From the *Department of Bone Marrow Transplantation and Cellular Therapy; Department of Pathology; Bone Marrow Transplantation and Cellular Therapy Clinical Research Office; §Department of Biostatistics; Department of Infectious Diseases, St. Jude Children’s Research Hospital; and Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN.

Accepted for publication October 30, 2012.

This work was supported by National Cancer Institute Cancer Center CORE Support Grant P30 CA 21765, American Lebanese Syrian Associated Charities and by the Anderson Foundation. The authors have no other funding or conflicts of interest to disclose.

Address for correspondence: Ashok Srinivasan, MD, Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, MS 1130, Memphis, TN 38105. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.