Enteroviral infections in children with malignant disease: A 5-year study in a single institution

doi:10.1016/j.jinf.2006.07.002

Journal of Infection

Volume 54, Issue 4, April 2007, Pages 387-392

https://doi.org/10.1016/j.jinf.2006.07.002 Get rights and content

Summary

Objectives

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.

Introduction

Children with malignancy are at a particular risk of developing infectious complications.¹ Enteroviruses may cause a variety of symptoms in immunocompromised patients. Some of them are easily recognized clinically as typical enteroviral infections and others are diagnosed as non-specific viral syndromes.² Furthermore, the same viruses may cause severe or life-threatening infections, such as myocarditis, meningitis and encephalitis.3, 4

Enteroviruses, small RNA viruses, include coxsackie viruses A and B, echoviruses, enteroviruses 68–71 and polioviruses. Enterovirus spread occurs predominantly by the fecal-oral route. The variety of enteroviral disease depends on the somatotopic localization after primary replication in gastrointestinal tract and subsequent blood born dissemination.2, 3

Enteroviral cultures are a helpful diagnostic tool for the detection of enteroviruses, but nowadays the more sensitive Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) assay is preferably performed. Enteroviral RT-PCR can provide prompt results within 5 to 25 h of sample receipt and thus, significantly alter the medical care offered to infected patients.3, 5

The aim of the present study is to evaluate the severity of the clinical manifestations, the therapeutic approach and the outcome of the enteroviral infections that occurred in a Pediatric Hematology-Oncology Unit, within a 5-year period.

Section snippets

Materials and methods

We retrospectively studied the medical records of all patients with malignancy, with clinical presentation of possible enteroviral infection, during the period from June 2000 to April 2005. In addition, the microbiology laboratory records of these patients were assessed.

Patients with possible enteroviral infection had symptoms such as, fever (axillary temperature of more than 37.8 °C), skin rash, upper respiratory illness, vomiting, gastroenteritis, pancreatitis, seizures or other neurologic

Results

Fifty-five children (53%, 37 girls and 18 boys) out of the 104 children assessed for possible enteroviral infection, had enteroviral infection documented with RT-PCR. Children that were RT-PCR negative for enterovirus (N = 49) were excluded from the present study. Fifty-one (93%) among the total 55 patients with documented enteroviral infection had one infectious episode, 2 patients had two episodes, while 2 other patients had three infectious episodes. Increased incidence of enteroviral

Discussion

In the present study, the clinical presentation of the enteroviral infections among patients with malignancy was analyzed. Increased incidence of enteroviral infections occurred in our patient cohort, during the years 2002 and 2005, and it was associated with high morbidity and mortality. During the year 2002, two patients succumbed to IAHS, while during the year 2005 two patients succumbed to ventricular fibrillation and to dilated cardiomyopathy, respectively. During the study period, the

Acknowledgments

This study was supported in part by the project “Kapodistrias 2004”, of Athens' University.

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Enteroviral infections in children with malignant disease: A 5-year study in a single institution

Summary

Objectives

Methods

Results

Conclusions

Introduction

Section snippets

Materials and methods

Results

Discussion

Acknowledgments

Ann Fr Anesth Reanim

J Infect

Infectious complications in pediatric cancer patients

Non-polio Enteroviruses and the febrile young infant: epidemiologic, clinical and diagnostic aspects

Pediatr Infect Dis J

Enterovirus infections: diagnosis and treatment

Pediatr Infect Dis J

Acute flaccid paralysis syndrome associated with echovirus 19, managed with pleconaril and intravenous immunoglobulin

Clin Infect Dis

Diagnosis of enteroviral central nervous system infection by polymerase chain reaction during a large community outbeak

Pediatr Infect Dis J

Laboratory diagnosis of common viral infections of the central nervous system by using a single multiplex PCR screening assay

J Clin Microbiol

Adenoviruses and entroviruses as pathogens in myocarditis and dilated cardiomyopathy

Acta Cardiol

Diagnosis, surveillance, and epidemiologic evaluation of viral infections in pediatric cardiac transplant recipients with the use of the polymerase chain reaction

J Heart Lung Transplant

Coxsackievirus B3 sequences in the myocardium of fatal cases in a cluster of acute myocarditis in Greece

J Clin Pathol

Real or media-mediated outbreak of coxsackie infections in 2002 in Greece?

Euro Surveill

Enterovirus infections in England and Wales: laboratory surveillance data: 1975 to 1994

Commun Dis Public Health

Few but severe viral infections in children with cancer: a prospective RT-PCR and PCR-based 12-month study

Pediatr Blood Cancer

Encephalitis and myocarditis in a child with acute lymphoblastic leukemia: Role of coxsackievirus B5?

Pediatr Hematol Oncol

Disseminated coxsackie A9 infection complicating bone marrow transplantation

Pediatr Infect Dis J

Enteroviral meningoencephalitis in immunocompromised children after matched unrelated donor bone marrow transplantation

Pediatr Med Oncol