title: Enteroviral infections in children with malignant disease: a 5-year study in a single institution.
abstract: 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.
authors.affiliation: 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>
authors.forename: Maria A
authors.initials: MA
authors.lastname: Moschovi
authors.forename: Katerina
authors.initials: K
authors.lastname: Katsibardi
authors.forename: Maria
authors.initials: M
authors.lastname: Theodoridou
authors.forename: Athanassios G
authors.initials: AG
authors.lastname: Michos
authors.forename: Athanassios
authors.initials: A
authors.lastname: Tsakris
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Spanakis
authors.forename: Fotini
authors.initials: F
authors.lastname: Tzortzatou-Stathopoulou
mesh_terms: 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
chemical_list: D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors