To the Editors:
We read with interest the report by Torres et al1 recently published, which reported clinical outcome and pathogen description of children with cancer, fever and neutropenia. This study showed that only respiratory viruses were detected in 350 of 1044 (34%) episodes, of which 66 (19%) were classified as a viral coinfections. They found that human metapneumovirus (hMPV) was predominantly associated with viral coinfections (single/coinfection: 4/7).
We prospectively collected nasal swabs from our children with cancer who presented with acute respiratory symptoms with or without fever and undergoing chemotherapy at Istanbul University Oncology Institüte, Istanbul, Turkey, between January 2014 and January 2015. Samples of 72 episodes of acute respiratory symptoms in 48 patients were evaluated. Respiratory viral pathogens were detected in 57% (41/72) of the analyzed samples and among these, 19.5% (8/41) of episodes were viral coinfections. In our study, hMPV infection was predominantly a single viral infection (single/coinfection: 2/1). Our results are similar to those of Chu et al2 (single/coinfection: 43/12) and Söderman et al,3 (single/coinfection: 2/0), showing that hMPV was predominantly associated with single viral infection in immunocompromised children with respiratory viral infections.
We speculate that the differentiation in hMPV coinfection incidence may be due to different years of the studies or to different geographic and social structures of the population. Further studies in different geographic areas are necessary to determine the agents and the description of the patients.
Sema Büyükkapu Bay, MD
Department of Pediatric
Hematology-Oncology
Istanbul University
Oncology Institute Pediatric
Hematology-Oncology
Istanbul, Turkey
Rejin Kebudi
Department of Pediatric
Hematology-Oncology
Istanbul University
Cerrahpasa Medical Faculty and Oncology
Institute Pediatric Hematology-Oncology
Istanbul, Turkey
Selim Badur
Department of Microbiology and Clinical Microbiology
Istanbul University Faculty of Medicine
Istanbul, Turkey
REFERENCES
1. Torres JP, De la Maza V, Kors L, et al. Respiratory viral infections and coinfections in children with cancer, fever and neutropenia: clinical outcome of infections caused by different respiratory viruses. Pediatr Infect Dis J. 2016;35:949954.
2. Chu HY, Renaud C, Ficken E, et al. Respiratory tract infections due to human metapneumovirus in immunocompromised children. J Pediatric Infect Dis Soc. 2014;3:286293.
3. Söderman M, Rhedin S, Tolfvenstam T, et al. Frequent respiratory viral infections in children with febrile neutropenia—A prospective follow-up study. PLoS One. 2016;16:11.
