VIRAL INFECTIONS: THE MOST COMMONLY IDENTIFIED CAUSE OF FEVER IN CHILDREN WITH CHEMOTHERAPY-INDUCED NEUTROPENIA † 1041

There are few data on the prevalence of viral infections and their distinguishing features in children with cancer who are hospitalized for fever and chemotherapy-induced neutropenia. Between August, 1994 and August, 1995 we prospectively followed 40 such children hospitalized for fever and neutropenia. Nasal and pharyngeal swabs for viral culture and pre- and post-convalescent sera were obtained on all the children. There were 76 episodes of fever and neutropenia in the 40 children. Viral infection was documented in 26 of the 76 episodes (34%) (6 rhinovirus, 6 parainfluenza, 5 RSV, 3 VZV, 2 coronavirus, 2 influenza B, 1 enterovirus, and 1 rhinovirus + parainfluenza). Culture-proved bacterial or fungal infections were found in an additional 14 episodes (18%). There were no significant differences in exposure to illness, site of childcare, respiratory signs and symptoms, height of fever, days of fever, absolute neutrophil count, days to recovery of the absolute neutrophil count, or days hospitalized for the children with viral infections versus those children with culture-proved bacterial or fungal infections or those with no documented source of infection. Viral infection was the most common identifiable cause of infection in children hospitalized For fever and neutropenia. There were no clinical features which distinguished this group of children from those children with bacterial/fungal infection or no culture-proved infection. Laboratory diagnosis with nasopharyngeal cultures is essential to identify these children and may be helpful in the management of their febrile illnesses.