title: Respiratory viruses, a common microbiological finding in neutropenic children with fever.
abstract: BACKGROUND
  Febrile neutropenia is a common complication in children undergoing chemotherapy for malignancies. A microbial agent is only identified in 15-30% of the fever episodes and corresponds mostly to bacterial findings.
  
  
  OBJECTIVE
  To investigate viral infections as possible etiologic agents in episodes of febrile neutropenia.
  
  
  METHODS
  Nasopharyngeal aspirates (NPAs) from patients presenting with neutropenic fever at two pediatric oncology wards in Sweden and Australia were analyzed with a conventional virus-diagnostic approach and RT-PCR. Coupled blood samples were analyzed for the detection of CMV, EBV, adenovirus and erythrovirus. Bacterial blood culture was performed routinely.
  
  
  RESULTS
  Conventional virus-diagnostic approach coupled to routinely performed bacterial analyzes revealed an infectious agent in 29% compared to 60% when using PCR. By adding PCR, a viral pathogen was detected in 46% of the NPAs and in 4% of the blood samples collected. In half of the patients with bacteremia, respiratory tract viruses were co-detected.
  
  
  CONCLUSIONS
  Respiratory viruses were frequently detected in NPAs suggesting a significant role of viral infections in children presenting with neutropenic fever. The meaning of these findings needs to be further evaluated but has the potential to individualize infection treatment and to reduce the extensive use of antibiotics in immunocompromised children with neutropenia.
authors.affiliation: Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. anna.lindblom@ki.s
authors.forename: Anna
authors.initials: A
authors.lastname: Lindblom
authors.forename: Vivek
authors.initials: V
authors.lastname: Bhadri
authors.forename: Stefan
authors.initials: S
authors.lastname: Söderhäll
authors.forename: Lars
authors.initials: L
authors.lastname: Ohrmalm
authors.forename: Michelle
authors.initials: M
authors.lastname: Wong
authors.forename: Oscar
authors.initials: O
authors.lastname: Norbeck
authors.forename: Cecilia
authors.initials: C
authors.lastname: Lindau
authors.forename: Maria
authors.initials: M
authors.lastname: Rotzén-Ostlund
authors.forename: Tobias
authors.initials: T
authors.lastname: Allander
authors.forename: Daniel
authors.initials: D
authors.lastname: Catchpoole
authors.forename: Luciano
authors.initials: L
authors.lastname: Dalla-Pozza
authors.forename: Kristina
authors.initials: K
authors.lastname: Broliden
authors.forename: Thomas
authors.initials: T
authors.lastname: Tolfvenstam
mesh_terms: D000293:Adolescent; D001315:Australia; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000209:etiology*; D006801:Humans; D007223:Infant; D008297:Male; D009305:Nasopharynx / Q000821:virology; D009503:Neutropenia / Q000209:etiology*; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000473:pathology*; D020133:Reverse Transcriptase Polymerase Chain Reaction; D013548:Sweden; D014776:Virus Cultivation; D014777:Virus Diseases / Q000175:diagnosis* / Q000473:pathology*; D014780:Viruses / Q000235:genetics / Q000254:growth & development / Q000302:isolation & purification*