Title Frequent Respiratory Viral Infections in Children with Febrile Neutropenia - A Prospective Follow-Up Study.
Author Soderman, Martina; Rhedin, Samuel; Tolfvenstam, Thomas; Rotzen-Ostlund, Maria; Albert, Jan; Broliden, Kristina; Lindblom, Anna
Journal PLoS One Publication Year/Month 2016
PMID 27309354 PMCID PMC4911076
Affiliation + expend 1.Department of Medicine Solna, Infectious Diseases Unit, Center for Molecular Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.

OBJECTIVE: Febrile neutropenia is common in children undergoing chemotherapy for the treatment of malignancies. In the majority of cases, the cause of the fever is unknown. Although respiratory viruses are commonly associated with this condition, the etiologic significance of this finding remains unclear and is therefore the subject of this study. STUDY DESIGN: Nasopharyngeal aspirates were collected during 87 episodes of febrile neutropenia in children age 0-18 years, being treated at a children\'s oncology unit between January 2013 and June 2014. Real-time polymerase chain reaction was used to determine the presence of 16 respiratory viruses. Follow-up samples were collected from children who tested positive for one or more respiratory viruses. Rhinoviruses were genotyped by VP4/VP2 sequencing. Fisher\'s exact test and Mann-Whitney U test were used for group comparisons. RESULTS: At least one respiratory virus was detected in samples from 39 of 87 episodes of febrile neutropenia (45%), with rhinoviruses the most frequently detected. Follow-up samples were collected after a median of 28 days (range, 9-74 days) in 32 of the 39 virus-positive episodes. The respiratory viral infection had resolved in 25 episodes (78%). The same virus was detected at follow-up in one coronavirus and six rhinovirus episodes. Genotyping revealed a different rhinovirus species in two of the six rhinovirus infections. CONCLUSION: The frequency of respiratory viral infections in this group of patients suggests an etiologic role in febrile neutropenia. However, these findings must be confirmed in larger patient cohorts.

StrainID RV Species Serotype Length(nt) Country Year Strain Name
ANC04659 A None 435 Sweden 2014 Sweden_2014_014_RVA28
ANC04664 A None 435 Sweden 2013 Sweden_2013_009_RVA67
ANC04669 A None 435 Sweden 2013 Sweden_2013_004_RVA101
ANM04660 A None 435 Sweden 2014 Sweden_2014_013_RVA28
ANM04665 A None 435 Sweden 2013 Sweden_2013_008_RVA65
ANM04670 A None 435 Sweden 2013 Sweden_2013_003_RVA61
ANP04662 A None 435 Sweden 2014 Sweden_2014_011_RVA39
ANP04667 A None 435 Sweden 2013 Sweden_2013_006_RVA34
ANP04672 A None 435 Sweden 2013 Sweden_2013_001_RVA54
ANS04663 A None 435 Sweden 2013 Sweden_2013_010_RVA67
ANS04668 A None 435 Sweden 2013 Sweden_2013_005_RVA101
ANZ04661 A None 435 Sweden 2014 Sweden_2014_012_RVA39
ANZ04666 A None 435 Sweden 2013 Sweden_2013_007_RVA65
ANZ04671 A None 435 Sweden 2013 Sweden_2013_002_RVA61
CNC03364 C None 429 Sweden 2014 Sweden_2014_006_RVC42
CNC03369 C None 429 Sweden 2013 Sweden_2013_001_RVC15
CNM03365 C None 429 Sweden 2014 Sweden_2014_005_RVC18
CNP03367 C None 429 Sweden 2013 Sweden_2013_003_RVC38
CNS03363 C None 429 Sweden 2014 Sweden_2014_007_RVC15
CNS03368 C None 429 Sweden 2013 Sweden_2013_002_RVC16
CNZ03366 C None 429 Sweden 2013 Sweden_2013_004_RVC28
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