title: Influenza-associated morbidity in children with cancer.
abstract: BACKGROUND
  The clinical impact of influenza in children undergoing therapy for cancer is not well-described in the literature.
  
  
  METHODS
  Laboratory-documented influenza infection in pediatric oncology patients cared for in a single regional pediatric medical center between July 2000 and June 2005 was identified by review of medical and laboratory records.
  
  
  RESULTS
  Twenty-seven clinical encounters were identified in 24 pediatric oncology patients with influenza infection. Eighty-three percent of patients were receiving chemotherapy for hematologic or solid malignancies. Two-thirds of patients were hospitalized for a median duration of 7.4 days; 40% of patients experienced a delay in scheduled chemotherapy as result of influenza infection. Most children (67%) were not neutropenic, although 63% were lymphopenic. Importantly, 15% of children with influenza had simultaneously diagnosed bacteremia. Concomitant pathogens included Pseudomonas aeruginosa, Enterobacter cloacae, Enterococcus faecalis, and coagulase-negative Staphylococcus. Primary influenza pneumonia and/or respiratory failure occurred in three children, and ventilatory support was required in four clinical encounters. Antiviral medications were administered to 63% of patients within 2 days of influenza diagnosis.
  
  
  CONCLUSIONS
  Pediatric oncology patients experienced significant influenza-associated morbidities. Influenza infection should be considered in febrile children with respiratory symptoms during the respiratory viral season, as well as concurrent bacterial or fungal infections.
authors.affiliation: Department of Pediatrics, University of Washington and Children's Hospital & Regional Medical Center, Seattle, Washington 98105, USA. tasians@peds.ucsf.edu
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Tasian
authors.forename: Julie R
authors.initials: JR
authors.lastname: Park
authors.forename: Emily T
authors.initials: ET
authors.lastname: Martin
authors.forename: Janet A
authors.initials: JA
authors.lastname: Englund
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009980:Influenza A virus / Q000235:genetics / Q000302:isolation & purification; D009981:Influenza B virus / Q000235:genetics / Q000302:isolation & purification; D007251:Influenza, Human / Q000453:epidemiology* / Q000821:virology; D008297:Male; D009369:Neoplasms / Q000453:epidemiology* / Q000628:therapy / Q000821:virology; D012333:RNA, Messenger / Q000235:genetics / Q000378:metabolism; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D000998:Antiviral Agents; D012333:RNA, Messenger