Herpesvirus infections in pediatric oncology patients with episodes of fever
Daniel Thomé Catalan1,2, Saulo Duarte Passos2, Sandra Cecília Botelho Costa1; Sandra Helena Alves Bonon1
1University of Campinas, Faculty of Medical Sciences, Department of Internal Medicine/UNICAMP, Campinas/SP/Brazil
2Laboratory of Clinical Analyzes – Group in Defeat of Children with Cancer - GRENDACC, Jundiaí/SP/Brazil.
Patients with malignancies have long periods of severe neutropenia and are particularly vulnerable to infectious complications. Treatment with chemotherapy along with underlying disease promotes greater depletion of immune system activity. Most episodes with febrile neutropenia are treated with empiric broad-spectrum antibacterial therapy without identifying the site of infection or agent, such as an unexplained fever. Through the conventional diagnostic methods, a small number of etiologic agents are identified; blood cultures are usually negative and time-consuming to identify the source of infection. Given the urgency of care associated with cancer patients, fever necessitates the rapid diagnosis of infections in these particular cases. In order to promote higher accuracy in the identification of pathogens in these patients, the search for new laboratory tests is incredibly important. The aim of this study is to identify active infections caused by herpesvirus (EBV, CMV, HHV-6 and HHV-7) in pediatric oncology patients experiencing episodes of fever. Until now, 128 samples of blood and serum which were collected from 61 patients experiencing episodes of fever were analyzed using Nested-PCR (N-PCR) methods while cytomegalovirus was analyzed by antigenemia (AGM) and N-PCR. Active infection caused by Epstein-Barr virus occurred in 3/168 (1.8%), cytomegalovirus 16/168 (9,5%), HHV-6 27/168 (16,0%) and HHV-7 24/168 (14,3%). These results show that active infections caused by EBV, CMV, HHV-6 and HHV-7 are frequent in children who receive cancer treatment, representing approximately 39,2% of the cases of fever (positive for at least one herpesvirus), with or without neutropenia. Further studies with Nested-PCR and new methods, like an introduction of quantitative PCR (qPCR), are needed to quantify these pathogens.