IMPACT OF RESPIRATORY VIRUSES IN IMMUNOCOMPROMISED PEDIATRIC HEMATOLOGY PATIENTS
(Abstract release date: 05/19/16)
EHA Library. Rompola M. 06/09/16; 132730; E1181
Disclosure(s): Research fellowship funded by the UK charity "Candlelighters"
Dr. Melpomeni Rompola
Contributions
Contributions
Abstract
Abstract: E1181
Type: Eposter Presentation
Background
Respiratory viral infections are very common in children. Children immunocompromised (IC) by treatment for haematological malignancies or following stem cell transplant (SCT) are at increased risk, although the morbidity and mortality are not well understood.
Aims
To assess the impact of respiratory viruses in IC pediatric hematology patients aged 0-18 analysed by diagnosis, intensity of treatment, rates of admission, Pediatric Intensive Care Unit (PICU) and outcomes, including the effect of influenza H1N1 pandemic (swine flu).
Methods
Retrospective review of PCR positive viral isolates of respiratory secretions of children with hematological diseases or post SCT, sent between Jan 2009-Dec 2014. Review of patient records with regards to concurrent neutropenia, blood culture growth, admission, PICU and outcome.
Results
952 specimens from respiratory secretions were sent, 465 were positive (48.8%), with total 528 viral isolates (63 specimens had multiple isolates) representing 171 patients. 232/465 (50%) were from nose swabs; 134/465 (29%) were nose and throat swabs; 71 /465 (15%) were throat swabs; 9/465 (1.9%) were from bronchio-alveolar lavage. Patients: 141 acute leukemias (AL), 27 SCT, 3 other haematological diseases. 96 boys, 75 girls. Mean age at diagnosis: 4.9 years. Mean age at sample: 6 years.Viral isolates overall: Of the total 528 viral isolates the majority, 52%, were rhinovirus, 14.2% Respiratory Syncitial Virus (RSV), 6.8% parainfluenza 3, 4.6% adenovirus, 4.6% parainfluenza 1, 4.2% metapneumovirus, 3.6% parainfluenza 4, 3.4% influenza B and 3.4% H1N1.385/465 (83%) positive swabs were from AL patients (mean age at sample 6 years) 70/465 (15%) from SCT patients (mean age at sample 6.8 years) and 10/465 from patients with other disorders (mean age at sample 1.7 years).Treatment intensity: positive results in AL patients occurred at the following phases of treatment 10/385 induction; 164/385 at other phases of treatment; 211/385 in maintenance. In the UK males with ALL are treated for 3 years (compared with 2 years for girls). Of the total of 211 positive samples taken in maintenance, 42 (20%) were from boys in their 3rd year of treatment and resulted in 24 admissions.H1N1 was solated from 18 patients associated with 14 admissions. 1 PICU and subsequent death. Mean age at sample 8.18. 10 maintenance AL, 6 other phases AL and 2 SCT. (4 mixed isolates: 2 rhinovirus, 1 parainfluenza 1 and 1 RSV.)Overall, 301 admissions at the time of respiratory viral isolate. Of the 528 viral isolates, 64.7% during admission (mean age 5.7 years). 32.6% with concurrent neutropenia and only 1.9% with blood culture growth.10 patients required PICU during their admission, 8 of which were all/partly attributed to the respiratory virus. 4 patients were in AL induction (1 died with RSV and parainfluenza 4). 1 in AL consolidation. 1 with relapsed ALL who died with rhinovirus and metapneumovirus. 2 were SCT patients (1 died with rhinovirus).
Conclusion
There was a surprisingly high (48.8%) positive rate in the respiratory secretion samples. 64.7% of positive viral isolates coincided with admission.Respiratory viruses are a cause of significant morbidity, including hospital admission and mortality. 38% of patients admitted to PICU all or partly as a consequence of a respiratory virus; 3 patients died.Rhinovirus, often dismissed as irrelevant, was present in 75% patients admitted to PICU and 33% PICU deaths.Although the data reflects a time of H1N1 outbreak: it was isolated in few patients, however 78% of patients with H1N1 isolate required admission and 1 patient died.
Session topic: E-poster
Keyword(s): Acute leukemia, Hematological malignancy, Infection, Stem cell transplant
Type: Eposter Presentation
Background
Respiratory viral infections are very common in children. Children immunocompromised (IC) by treatment for haematological malignancies or following stem cell transplant (SCT) are at increased risk, although the morbidity and mortality are not well understood.
Aims
To assess the impact of respiratory viruses in IC pediatric hematology patients aged 0-18 analysed by diagnosis, intensity of treatment, rates of admission, Pediatric Intensive Care Unit (PICU) and outcomes, including the effect of influenza H1N1 pandemic (swine flu).
Methods
Retrospective review of PCR positive viral isolates of respiratory secretions of children with hematological diseases or post SCT, sent between Jan 2009-Dec 2014. Review of patient records with regards to concurrent neutropenia, blood culture growth, admission, PICU and outcome.
Results
952 specimens from respiratory secretions were sent, 465 were positive (48.8%), with total 528 viral isolates (63 specimens had multiple isolates) representing 171 patients. 232/465 (50%) were from nose swabs; 134/465 (29%) were nose and throat swabs; 71 /465 (15%) were throat swabs; 9/465 (1.9%) were from bronchio-alveolar lavage. Patients: 141 acute leukemias (AL), 27 SCT, 3 other haematological diseases. 96 boys, 75 girls. Mean age at diagnosis: 4.9 years. Mean age at sample: 6 years.Viral isolates overall: Of the total 528 viral isolates the majority, 52%, were rhinovirus, 14.2% Respiratory Syncitial Virus (RSV), 6.8% parainfluenza 3, 4.6% adenovirus, 4.6% parainfluenza 1, 4.2% metapneumovirus, 3.6% parainfluenza 4, 3.4% influenza B and 3.4% H1N1.385/465 (83%) positive swabs were from AL patients (mean age at sample 6 years) 70/465 (15%) from SCT patients (mean age at sample 6.8 years) and 10/465 from patients with other disorders (mean age at sample 1.7 years).Treatment intensity: positive results in AL patients occurred at the following phases of treatment 10/385 induction; 164/385 at other phases of treatment; 211/385 in maintenance. In the UK males with ALL are treated for 3 years (compared with 2 years for girls). Of the total of 211 positive samples taken in maintenance, 42 (20%) were from boys in their 3rd year of treatment and resulted in 24 admissions.H1N1 was solated from 18 patients associated with 14 admissions. 1 PICU and subsequent death. Mean age at sample 8.18. 10 maintenance AL, 6 other phases AL and 2 SCT. (4 mixed isolates: 2 rhinovirus, 1 parainfluenza 1 and 1 RSV.)Overall, 301 admissions at the time of respiratory viral isolate. Of the 528 viral isolates, 64.7% during admission (mean age 5.7 years). 32.6% with concurrent neutropenia and only 1.9% with blood culture growth.10 patients required PICU during their admission, 8 of which were all/partly attributed to the respiratory virus. 4 patients were in AL induction (1 died with RSV and parainfluenza 4). 1 in AL consolidation. 1 with relapsed ALL who died with rhinovirus and metapneumovirus. 2 were SCT patients (1 died with rhinovirus).
Conclusion
There was a surprisingly high (48.8%) positive rate in the respiratory secretion samples. 64.7% of positive viral isolates coincided with admission.Respiratory viruses are a cause of significant morbidity, including hospital admission and mortality. 38% of patients admitted to PICU all or partly as a consequence of a respiratory virus; 3 patients died.Rhinovirus, often dismissed as irrelevant, was present in 75% patients admitted to PICU and 33% PICU deaths.Although the data reflects a time of H1N1 outbreak: it was isolated in few patients, however 78% of patients with H1N1 isolate required admission and 1 patient died.
Session topic: E-poster
Keyword(s): Acute leukemia, Hematological malignancy, Infection, Stem cell transplant
Abstract: E1181
Type: Eposter Presentation
Background
Respiratory viral infections are very common in children. Children immunocompromised (IC) by treatment for haematological malignancies or following stem cell transplant (SCT) are at increased risk, although the morbidity and mortality are not well understood.
Aims
To assess the impact of respiratory viruses in IC pediatric hematology patients aged 0-18 analysed by diagnosis, intensity of treatment, rates of admission, Pediatric Intensive Care Unit (PICU) and outcomes, including the effect of influenza H1N1 pandemic (swine flu).
Methods
Retrospective review of PCR positive viral isolates of respiratory secretions of children with hematological diseases or post SCT, sent between Jan 2009-Dec 2014. Review of patient records with regards to concurrent neutropenia, blood culture growth, admission, PICU and outcome.
Results
952 specimens from respiratory secretions were sent, 465 were positive (48.8%), with total 528 viral isolates (63 specimens had multiple isolates) representing 171 patients. 232/465 (50%) were from nose swabs; 134/465 (29%) were nose and throat swabs; 71 /465 (15%) were throat swabs; 9/465 (1.9%) were from bronchio-alveolar lavage. Patients: 141 acute leukemias (AL), 27 SCT, 3 other haematological diseases. 96 boys, 75 girls. Mean age at diagnosis: 4.9 years. Mean age at sample: 6 years.Viral isolates overall: Of the total 528 viral isolates the majority, 52%, were rhinovirus, 14.2% Respiratory Syncitial Virus (RSV), 6.8% parainfluenza 3, 4.6% adenovirus, 4.6% parainfluenza 1, 4.2% metapneumovirus, 3.6% parainfluenza 4, 3.4% influenza B and 3.4% H1N1.385/465 (83%) positive swabs were from AL patients (mean age at sample 6 years) 70/465 (15%) from SCT patients (mean age at sample 6.8 years) and 10/465 from patients with other disorders (mean age at sample 1.7 years).Treatment intensity: positive results in AL patients occurred at the following phases of treatment 10/385 induction; 164/385 at other phases of treatment; 211/385 in maintenance. In the UK males with ALL are treated for 3 years (compared with 2 years for girls). Of the total of 211 positive samples taken in maintenance, 42 (20%) were from boys in their 3rd year of treatment and resulted in 24 admissions.H1N1 was solated from 18 patients associated with 14 admissions. 1 PICU and subsequent death. Mean age at sample 8.18. 10 maintenance AL, 6 other phases AL and 2 SCT. (4 mixed isolates: 2 rhinovirus, 1 parainfluenza 1 and 1 RSV.)Overall, 301 admissions at the time of respiratory viral isolate. Of the 528 viral isolates, 64.7% during admission (mean age 5.7 years). 32.6% with concurrent neutropenia and only 1.9% with blood culture growth.10 patients required PICU during their admission, 8 of which were all/partly attributed to the respiratory virus. 4 patients were in AL induction (1 died with RSV and parainfluenza 4). 1 in AL consolidation. 1 with relapsed ALL who died with rhinovirus and metapneumovirus. 2 were SCT patients (1 died with rhinovirus).
Conclusion
There was a surprisingly high (48.8%) positive rate in the respiratory secretion samples. 64.7% of positive viral isolates coincided with admission.Respiratory viruses are a cause of significant morbidity, including hospital admission and mortality. 38% of patients admitted to PICU all or partly as a consequence of a respiratory virus; 3 patients died.Rhinovirus, often dismissed as irrelevant, was present in 75% patients admitted to PICU and 33% PICU deaths.Although the data reflects a time of H1N1 outbreak: it was isolated in few patients, however 78% of patients with H1N1 isolate required admission and 1 patient died.
Session topic: E-poster
Keyword(s): Acute leukemia, Hematological malignancy, Infection, Stem cell transplant
Type: Eposter Presentation
Background
Respiratory viral infections are very common in children. Children immunocompromised (IC) by treatment for haematological malignancies or following stem cell transplant (SCT) are at increased risk, although the morbidity and mortality are not well understood.
Aims
To assess the impact of respiratory viruses in IC pediatric hematology patients aged 0-18 analysed by diagnosis, intensity of treatment, rates of admission, Pediatric Intensive Care Unit (PICU) and outcomes, including the effect of influenza H1N1 pandemic (swine flu).
Methods
Retrospective review of PCR positive viral isolates of respiratory secretions of children with hematological diseases or post SCT, sent between Jan 2009-Dec 2014. Review of patient records with regards to concurrent neutropenia, blood culture growth, admission, PICU and outcome.
Results
952 specimens from respiratory secretions were sent, 465 were positive (48.8%), with total 528 viral isolates (63 specimens had multiple isolates) representing 171 patients. 232/465 (50%) were from nose swabs; 134/465 (29%) were nose and throat swabs; 71 /465 (15%) were throat swabs; 9/465 (1.9%) were from bronchio-alveolar lavage. Patients: 141 acute leukemias (AL), 27 SCT, 3 other haematological diseases. 96 boys, 75 girls. Mean age at diagnosis: 4.9 years. Mean age at sample: 6 years.Viral isolates overall: Of the total 528 viral isolates the majority, 52%, were rhinovirus, 14.2% Respiratory Syncitial Virus (RSV), 6.8% parainfluenza 3, 4.6% adenovirus, 4.6% parainfluenza 1, 4.2% metapneumovirus, 3.6% parainfluenza 4, 3.4% influenza B and 3.4% H1N1.385/465 (83%) positive swabs were from AL patients (mean age at sample 6 years) 70/465 (15%) from SCT patients (mean age at sample 6.8 years) and 10/465 from patients with other disorders (mean age at sample 1.7 years).Treatment intensity: positive results in AL patients occurred at the following phases of treatment 10/385 induction; 164/385 at other phases of treatment; 211/385 in maintenance. In the UK males with ALL are treated for 3 years (compared with 2 years for girls). Of the total of 211 positive samples taken in maintenance, 42 (20%) were from boys in their 3rd year of treatment and resulted in 24 admissions.H1N1 was solated from 18 patients associated with 14 admissions. 1 PICU and subsequent death. Mean age at sample 8.18. 10 maintenance AL, 6 other phases AL and 2 SCT. (4 mixed isolates: 2 rhinovirus, 1 parainfluenza 1 and 1 RSV.)Overall, 301 admissions at the time of respiratory viral isolate. Of the 528 viral isolates, 64.7% during admission (mean age 5.7 years). 32.6% with concurrent neutropenia and only 1.9% with blood culture growth.10 patients required PICU during their admission, 8 of which were all/partly attributed to the respiratory virus. 4 patients were in AL induction (1 died with RSV and parainfluenza 4). 1 in AL consolidation. 1 with relapsed ALL who died with rhinovirus and metapneumovirus. 2 were SCT patients (1 died with rhinovirus).
Conclusion
There was a surprisingly high (48.8%) positive rate in the respiratory secretion samples. 64.7% of positive viral isolates coincided with admission.Respiratory viruses are a cause of significant morbidity, including hospital admission and mortality. 38% of patients admitted to PICU all or partly as a consequence of a respiratory virus; 3 patients died.Rhinovirus, often dismissed as irrelevant, was present in 75% patients admitted to PICU and 33% PICU deaths.Although the data reflects a time of H1N1 outbreak: it was isolated in few patients, however 78% of patients with H1N1 isolate required admission and 1 patient died.
Session topic: E-poster
Keyword(s): Acute leukemia, Hematological malignancy, Infection, Stem cell transplant
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