title: Viral findings in adult hematological patients with neutropenia.
abstract: BACKGROUND
  Until recently, viral infections in patients with hematological malignancies were concerns primarily in allogeneic hematopoietic stem cell transplant (HSCT) recipients. During the last years, changed treatment regimens for non-transplanted patients with hematological malignancies have had potential to increase the incidence of viral infections in this group. In this study, we have prospectively investigated the prevalence of a broad range of respiratory viruses in nasopharyngeal aspirate (NPA) as well as viruses that commonly reactivate after allogeneic HSCT.
  
  
  RESULTS
  Patients with hematological malignancies and therapy induced neutropenia (n = 159) were screened regarding a broad range of common respiratory viruses in the nasopharynx and for viruses commonly detected in severely immunosuppressed patients in peripheral blood. Quantitative PCR was used for detection of viruses. A viral pathogen was detected in 35% of the patients. The detection rate was rather similar in blood (22%) and NPA (18%) with polyoma BK virus and rhinovirus as dominating pathogens in blood and NPA, respectively. Patients with chronic lymphocytic leukemia (CLL) (p<0.01) and patients with fever (p<0.001) were overrepresented in the virus-positive group. Furthermore, viral findings in NPA were associated with upper respiratory symptoms (URTS) (p<0.0001).
  
  
  CONCLUSIONS
  Both respiratory viral infections and low titers of viruses in blood from patients with neutropenia were common. Patients with CLL and patients with fever were independently associated to these infections, and viral findings in NPA were associated to URTS indicating active infection. These findings motivate further studies on viruses' impact on this patient category and their potential role as causative agents of fever during neutropenia.
authors.affiliation: Department of Medicine, Solna, Infectious Disease Unit, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. lars.ohrmalm@ki.se
authors.forename: Lars
authors.initials: L
authors.lastname: Ohrmalm
authors.forename: Michelle
authors.initials: M
authors.lastname: Wong
authors.forename: Carl
authors.initials: C
authors.lastname: Aust
authors.forename: Per
authors.initials: P
authors.lastname: Ljungman
authors.forename: Oscar
authors.initials: O
authors.lastname: Norbeck
authors.forename: Kristina
authors.initials: K
authors.lastname: Broliden
authors.forename: Thomas
authors.initials: T
authors.lastname: Tolfvenstam
mesh_terms: D019337:Hematologic Neoplasms / Q000150:complications* / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D009305:Nasopharynx / Q000821:virology; D009503:Neutropenia / Q000175:diagnosis / Q000209:etiology*; D015995:Prevalence; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology; D014184:Transplantation, Homologous; D014777:Virus Diseases / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology