Enteroviral infections in children with malignant disease: a 5-year study in a single institution.
OBJECTIVE
The clinical presentation, severity and outcome of enteroviral infections in children with malignancy were studied.


METHODS
All cases of enteroviral infections in a University Pediatric Hematology-Oncology Unit were assessed, during a 5-year period. RT-PCR, immunohistochemistry and indirect immunofluorescence assay were performed to document the enteroviral infection and the type of virus.


RESULTS
Fifty-five children had documented enteroviral infection among 104 patients evaluated for possible enteroviral infection. Severe manifestations occurred in 11/55 (20%) patients, such as encephalitis 5/55, cardiac involvement 3/55 (1/55 myocarditis, 1/55 dilated cardiomyopathy, 1/55 ventricular fibrillation) and infection associated hemophagocytic syndrome 3/55. Children with lymphoid malignancy had increased incidence of enteroviral infections (87%) compared to children with solid tumors (13%). All patients received supportive care, intravenous immunoglobulin (IVIG) (30/55 low dose 400 mg/kg or 25/55 high dose 2 gr/kg) and/or pleconaril (2/55). All patients who received high dose of IVIG developed early negative viral load. However, 4 of them succumbed. Infection related fatality rate was 14.5% (N=8).


CONCLUSIONS
Enteroviruses caused more severe and lethal manifestations especially in children with lymphoid malignancy. The administration of high dose of IVIG was beneficial in viremia. Thus, the early therapeutic intervention with high dose of IVIG may improve the outcome.
Moschovi
Maria A
MA
Hematology-Oncology Unit, First Department of Pediatrics, University of Athens, Aghia Sophia Children's Hospital, Thivon & Levadias Ave, Athens 11527, Greece. mmoschov@med.uoa.gr <mmoschov@med.uoa.gr>
Katsibardi
Katerina
K
Theodoridou
Maria
M
Michos
Athanassios G
AG
Tsakris
Athanassios
A
Spanakis
Nikolaos
N
Tzortzatou-Stathopoulou
Fotini
F
D002648:Child; D004770:Enterovirus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D004769:Enterovirus Infections / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy / Q000821:virology; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007150:Immunohistochemistry; D007155:Immunologic Factors / Q000627:therapeutic use*; D015994:Incidence; D007938:Leukemia / Q000150:complications; D008297:Male; D009369:Neoplasms / Q000150:complications*; D020133:Reverse Transcriptase Polymerase Chain Reaction; D016896:Treatment Outcome
D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors