One-Year Prospective Study of Community Acquired Influenza and Parainfluenza Viral Infections in Hospitalized Egyptian Children with Malignancy: Single Center Experience

• Published in: Pediatric hematology and oncology 2015-07, Vol.32 (5), p.304-314
• Main Authors: Tantawy, Azza A.G., Barakat, Moustafa M.A., Adly, Amira A.M., Ebeid, Fatma S.E., Shamaa, Manal F. El, Yassin, Mohamed
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Child, Preschool; childhood cancer; Communicable Diseases - diagnosis; Communicable Diseases - epidemiology; Communicable Diseases - therapy; Egypt - epidemiology; Female; Hematologic Neoplasms - epidemiology; Humans; Infant; influenza; Influenza, Human - diagnosis; Influenza, Human - epidemiology; Influenza, Human - therapy; Male; parainfluenza; Paramyxoviridae Infections - diagnosis; Paramyxoviridae Infections - epidemiology; Paramyxoviridae Infections - therapy; Prospective Studies; respiratory infections
• ISSN: 0888-0018; 1521-0669
• DOI: 10.3109/08880018.2015.1013230

Background: Respiratory viruses are widespread in the community and easily transmitted to immunocompromised patients. Aims: 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. Methods: 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. Results: 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. Conclusions: 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.