Respiratory syncytial virus infection outbreak among pediatric patients with oncologic diseases and/or BMT.
BACKGROUND
Respiratory syncytial virus (RSV) has been reported to cause severe morbidity and mortality among cancer patients receiving chemotherapy with or without autologous/allogeneic hematopoetic stem cell transplantation (HSCT). There have been few reports describing the outcome of RSV infection specifically among pediatric oncology patients.


METHODS
Two RSV infection outbreaks developed between February-April 2006 and January-March 2009 in hospitalized pediatric patients for various hemato-oncological diseases + or - HSCT. A survey of respiratory viruses was done using direct immunofluorescent antibody assay from nasopharyngeal washing aspirate.


RESULTS
In two RSV infection outbreaks (2006 and 2009), RSV antigen was detected in 6/30 patients. Five of six patients with RSV antigen were all treated with 0.2-0.4 g/kg intravenous immune globulin (IVIG) and specific antiviral therapy, oral ribavirin (20-25 mg/kg/day in three doses). Five patients recovered fully, although two were retreated due to recurrent (+) RSV antigen and respiratory symptoms within 2 weeks. We did not give oral ribavirin to one patient with (+) RSV antigen due to mild symptoms. All patients are alive and well.


CONCLUSIONS
In contrast with the outcome of RSV infection in adult oncology patients, the mortality associated with RSV infection in pediatric oncology patients even in post bone marrow transplantation (BMT) period, is low when diagnosed and treated early enough. Oral ribavirin might be an option together with IVIG in the treatment of RSV especially when other forms of antivirals could not be obtained. This approach will make it possible to give the scheduled anti-neoplastic therapy on time.
Department of Pediatric Hematology/Oncology/BMT, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.
Sema
S
Anak
Didem
D
Atay
Aysegul
A
Unuvar
Mesut
M
Garipardic
Leyla
L
Agaoglu
Gulyuz
G
Ozturk
Zeynep
Z
Karakas
Omer
O
Devecioglu
D000998:Antiviral Agents / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000276:immunology*; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology*; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000276:immunology*; D018357:Respiratory Syncytial Virus Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology; D012254:Ribavirin / Q000627:therapeutic use; D014421:Turkey / Q000453:epidemiology
D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D012254:Ribavirin