Background: Upper respiratory tract infections (URTI) are common during episodes of febrile neutropenia (FN) in children receiving chemotherapy. Identification of viral organisms in children with FN and URTI may aid in reducing the duration of antibiotics.
Materials and methods: The prospective study was conducted over 1½ years (July 2012–December 2013). Nasopharyngeal aspirates (NPA) of children (age ≤14 years) with acute leukemia or non-Hodgkin lymphoma with FN and symptoms of URTI (rhinorrhea with/without cough) were obtained. Reverse transcription polymerase chain reaction (RT-PCR) was utilized to identify respiratory syncytial virus (RSV), human parainfluenza virus 3 (HPIV-3), and human metapneumovirus (HMPV). Real-time PCR was performed for the detection of influenza A and B.
Results: A total of 57 patients with a mean age of 6 years (range: 0.5–14) were included. The majority (89.5%) had acute lymphoblastic leukemia (ALL). About 21 viral isolates were identified in 19 (33%) patients. Influenza A and B (62%) topped the list, followed by RSV and HPIV-3 (14% each) and HMPV (10%). Blood cultures returned sterile from all. All patients recovered uneventfully from the episode of FN. Age (p = 0.35), absolute neutrophil count (ANC) (p = 0.68), or phase of chemotherapy (p = 0.36) were not identified as risk factors for the identification of the viral etiology. A higher proportion of samples collected during winter/spring were PCR-positive as compared to summer/autumn (56.7% vs 14.8%; p = 0.036).
Conclusion: One-third of children with FN and URTI had an identifiable viral etiology. Future trials may be conducted to explore if antibiotics can be stopped early in patients with low-risk FN and URTI with an identifiable viral etiology.
Clinical significance: The study contributes to data for antibiotic stewardship for managing children with low-risk FN and URTI.