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Barnbrock A, Berger A, Lauten M, Demmert M, Klusmann JH, Ciesek S, Bochennek K, Lehrnbecher T. Frequency and clinical impact of viraemia in paediatric patients undergoing therapy for cancer. Sci Rep 2024; 14:14867. [PMID: 38937530 PMCID: PMC11211494 DOI: 10.1038/s41598-024-65641-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 06/21/2024] [Indexed: 06/29/2024] Open
Abstract
In contrast to transplant recipients, there is a paucity of data regarding frequency and clinical significance of viraemia in children receiving conventional chemotherapy. In a prospective observational study, we assessed the frequency of and clinical impact of viraemia with cytomegalovirus (CMV), Epstein-Barr virus (EBV), adenovirus, human herpesvirus-6 (HHV6) and herpes-simplex virus 1/2 (HSV1/2) in paediatric cancer patients at diagnosis, at a routine examination during intensive chemotherapy, and during febrile neutropenia (FN). Seventy-nine patients (median age 6 years; 66 children with haematological malignancies) were included in the study. Overall, 362 blood samples were analysed, 72 from the time at diagnosis (11.1% with positive PCR result), 118 during a regular control after chemotherapy (11.0% positive), and 159 during FN (8.8% positive). The overall positivity rate was 9.6% (CMV 3.3%, HHV6 2.7%, HSV 2.2%, EBV 0.8% and adenovirus 0.3%). There were no significant differences between FN episodes with and without viraemia in terms of duration of fever or neutropenia/lymphopenia, severity of mucositis (> II0), incidence of diarrhea and ICU admission. Our results indicate that viraemia in paediatric cancer patients generally does not have a major clinical impact, and may help in the decision regarding the indication of routine evaluation for viraemia in febrile neutropenic, but otherwise asymptomatic children.
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Affiliation(s)
- Anke Barnbrock
- Department of Paediatrics, Division of Haematology, Oncology and Haemostaseology, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - Annemarie Berger
- Institute for Medical Virology, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Melchior Lauten
- Department of Paediatric Haematology and Oncology, Hospital for Children and Adolescents, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Martin Demmert
- Department of Paediatric Haematology and Oncology, Hospital for Children and Adolescents, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Jan-Henning Klusmann
- Department of Paediatrics, Division of Haematology, Oncology and Haemostaseology, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - Sandra Ciesek
- Institute for Medical Virology, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Konrad Bochennek
- Department of Paediatrics, Division of Haematology, Oncology and Haemostaseology, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - Thomas Lehrnbecher
- Department of Paediatrics, Division of Haematology, Oncology and Haemostaseology, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany.
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Lehrnbecher T, Groll AH. Infectious complications in the paediatric immunocompromised host: a narrative review. Clin Microbiol Infect 2024:S1198-743X(24)00279-9. [PMID: 38851426 DOI: 10.1016/j.cmi.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 05/30/2024] [Accepted: 06/01/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Infections are a major cause of morbidity in children with primary or secondary immunodeficiency, and have a negative impact on overall outcome. OBJECTIVES This narrative review presents select paediatric-specific aspects regarding the clinical impact, diagnosis, management, and follow-up of infectious complications in patients with primary and secondary immunodeficiencies. SOURCES PubMed until January 2024 and searched references in identified articles including the search terms: infection, immunodeficiency or cancer, diagnostics, antimicrobial agents, bacteria or fungus or virus, and follow-up. CONTENT Major advances have been made in the early detection and management of patients with primary immunodeficiency, and multiple analyses report in children with cancer on risk groups and periods of risk for infectious complications. Although many diagnostic tools are comparable between children and adults, specific considerations have to be applied, such as minimizing the use of radiation. Antimicrobial drug development remains a major challenge in the paediatric setting, which includes the establishment of appropriate dosing and paediatric approval. Last, long-term follow-up and the impact of late effects are extremely important to be considered in the management of immunocompromised paediatric patients. IMPLICATIONS Although infectious disease supportive care of immunocompromised children and adolescents has considerably improved over the last three decades, close international collaboration is needed to target the specific challenges in this special population.
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Affiliation(s)
- Thomas Lehrnbecher
- Department of Paediatrics, Division of Haematology, Oncology and Hemostaseology, Goethe University Frankfurt, Frankfurt Am Main, Germany.
| | - Andreas H Groll
- Infectious Disease Research Program, Centre for Bone Marrow Transplantation and Department of Paediatric Haematology/Oncology, University Children's Hospital Muenster, Muenster, Germany
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Schulz E, Grumaz S, Hatzl S, Gornicec M, Valentin T, Huber-Kraßnitzer B, Kriegl L, Uhl B, Deutsch A, Greinix H, Krause R, Neumeister P. Pathogen detection by metagenomic next generation sequencing during neutropenic fever in patients with hematological malignancies. Open Forum Infect Dis 2022; 9:ofac393. [PMID: 36004313 PMCID: PMC9394763 DOI: 10.1093/ofid/ofac393] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/29/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Febrile neutropenia (FN) following chemotherapy is a major cause of morbidity during cancer treatment. The performance of metagenomic next-generation sequencing (mNGS) of circulating cell-free DNA from plasma may be superior to blood culture (BC) diagnostics for identification of causative pathogens. The aim of this study was to validate mNGS (DISQVER test) for the detection of pathogens in hematologic patients with FN.
Methods
We collected paired whole blood specimens from central venous catheter and peripheral vein during FN for BC and mNGS testing. We repeated paired sampling at the earliest after 3 days of fever, which was defined as one FN episode. All clinical data were retrospectively reviewed by an infectious disease expert panel. We calculated percent positive agreement (PPA), percent negative agreement (PNA), percent overall agreement (POA), and sensitivity and specificity.
Results
We analyzed a total of 98 unselected FN episodes in 61 patients who developed predominantly FN after conditioning therapy for allogeneic (n = 22) or autologous (n = 21) hematopoietic stem cell transplantation. Success rate of mNGS was 99% (97/98). Positivity rate of mNGS was 43% (42/97) overall and 32% (31/97) excluding viruses compared to 14% (14/98) in BC. PPA, PNA and POA between mNGS and BC were 84.6% (95% CI, 54.6% to 98.1%), 63.1% (51.9% to 73.4%) and 66% (55.7% to 75.3%), respectively. Sensitivity for bacteria or fungi was 40% (28.0% to 52.9%) and 18.5% (9.9% to 30.0%), respectively.
Conclusion
Pathogen detection by mNGS (DISQVER) during unselected FN episodes shows twofold higher sensitivity and a broader pathogen spectrum than BC.
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Affiliation(s)
- Eduard Schulz
- Division of Hematology, Department of Internal Medicine, Medical University of Graz , Graz , Austria
- Center for Cancer Research, National Cancer Institute, National Institutes of Health , Bethesda, Maryland , USA
| | | | - Stefan Hatzl
- Division of Hematology, Department of Internal Medicine, Medical University of Graz , Graz , Austria
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz , Graz , Austria
| | - Maximilian Gornicec
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz , Graz , Austria
| | - Thomas Valentin
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz , Graz , Austria
| | - Bianca Huber-Kraßnitzer
- Division of Hematology, Department of Internal Medicine, Medical University of Graz , Graz , Austria
| | - Lisa Kriegl
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz , Graz , Austria
| | - Barbara Uhl
- Division of Hematology, Department of Internal Medicine, Medical University of Graz , Graz , Austria
| | - Alexander Deutsch
- Division of Hematology, Department of Internal Medicine, Medical University of Graz , Graz , Austria
| | - Hildegard Greinix
- Division of Hematology, Department of Internal Medicine, Medical University of Graz , Graz , Austria
| | - Robert Krause
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz , Graz , Austria
| | - Peter Neumeister
- Division of Hematology, Department of Internal Medicine, Medical University of Graz , Graz , Austria
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