Skip to main content
Top
Published in: Virology Journal 1/2013

Open Access 01-12-2013 | Short report

Febrile neutropenia: significance of elaborated screening for respiratory viruses, and the comparison of different sampling methods, in neutropenic patients with hematological malignancies

Authors: Rogier R Jansen, Bart J Biemond, Janke Schinkel, Sylvie M Koekkoek, Richard Molenkamp, Menno D de Jong, Caroline E Visser

Published in: Virology Journal | Issue 1/2013

Login to get access

Abstract

Background

During febrile neutropenia in only 30 to 60 percent an infectious agent is identified. This diagnostic gap could hypothetically be reduced with the broad implementation of molecular detection techniques like PCR, which has revolutionized the detection of infectious diseases during the last two decades.

Findings

We performed a longitudinal prospective study (N = 81) of neutropenic patients to assess the role of respiratory viruses in neutropenic fever and to determine the clinical relevance of blind screening for these viruses. Respiratory viruses were recovered in 14% of the patients prior to neutropenia. In 13% of neutropenic patients without fever and in 19% of those with fever, a respiratory virus was detected. Comparing different sample types; nasal swabs performed significantly better (16/117 = 43%), than throat swabs (6/106 = 6%). Throat gurgles did not show significant differences from the latter sample types.

Conclusions

Blind diagnostic screening for respiratory viruses before or during neutropenia is not useful. Nasal swabs are sensitive and practical option for screening on respiratory viruses.
Literature
1.
go back to reference Sipsas NV, Bodey GP, Kontoyiannis DP: Perspectives for the management of febrile neutropenic patients with cancer in the 21st century. Cancer 2005,103(6):1103-1113. 10.1002/cncr.20890PubMedCrossRef Sipsas NV, Bodey GP, Kontoyiannis DP: Perspectives for the management of febrile neutropenic patients with cancer in the 21st century. Cancer 2005,103(6):1103-1113. 10.1002/cncr.20890PubMedCrossRef
2.
go back to reference Gupta A, Singh M, Singh H, Kumar L, Sharma A, Bakhshi S, Raina V, Thulkar S: Infections in acute myeloid leukemia: an analysis of 382 febrile episodes. Med Oncol 2010,27(4):1037-1045. 10.1007/s12032-009-9330-9PubMedCrossRef Gupta A, Singh M, Singh H, Kumar L, Sharma A, Bakhshi S, Raina V, Thulkar S: Infections in acute myeloid leukemia: an analysis of 382 febrile episodes. Med Oncol 2010,27(4):1037-1045. 10.1007/s12032-009-9330-9PubMedCrossRef
3.
go back to reference Pizzo PA: Management of fever in patients with cancer and treatment-induced neutropenia. N Engl J Med 1993,328(18):1323-1332. 10.1056/NEJM199305063281808PubMedCrossRef Pizzo PA: Management of fever in patients with cancer and treatment-induced neutropenia. N Engl J Med 1993,328(18):1323-1332. 10.1056/NEJM199305063281808PubMedCrossRef
4.
go back to reference Viscoli C, Varnier O, Machetti M: Infections in patients with febrile neutropenia: epidemiology, microbiology, and risk stratification. Clin Infect Dis 2005,40(Suppl 4):S240-S245.PubMedCrossRef Viscoli C, Varnier O, Machetti M: Infections in patients with febrile neutropenia: epidemiology, microbiology, and risk stratification. Clin Infect Dis 2005,40(Suppl 4):S240-S245.PubMedCrossRef
5.
go back to reference Maschmeyer G, Beinert T, Buchheidt D, Cornely OA, Einsele H, Heinz W, Heussel CP, Kahl C, Kiehl M, Lorenz J, Hof H, Mattiuzzi G: Diagnosis and antimicrobial therapy of lung infiltrates in febrile neutropenic patients: Guidelines of the infectious diseases working party of the German Society of Haematology and Oncology. Eur J Cancer 2009,45(14):2462-2472. 10.1016/j.ejca.2009.05.001PubMedCrossRef Maschmeyer G, Beinert T, Buchheidt D, Cornely OA, Einsele H, Heinz W, Heussel CP, Kahl C, Kiehl M, Lorenz J, Hof H, Mattiuzzi G: Diagnosis and antimicrobial therapy of lung infiltrates in febrile neutropenic patients: Guidelines of the infectious diseases working party of the German Society of Haematology and Oncology. Eur J Cancer 2009,45(14):2462-2472. 10.1016/j.ejca.2009.05.001PubMedCrossRef
6.
go back to reference Lindblom A, Bhadri V, Soderhall S, et al.: Respiratory viruses, a common microbiological finding in neutropenic children with fever. J Clin Virol 2010,47(3):234-237. 10.1016/j.jcv.2009.11.026PubMedCrossRef Lindblom A, Bhadri V, Soderhall S, et al.: Respiratory viruses, a common microbiological finding in neutropenic children with fever. J Clin Virol 2010,47(3):234-237. 10.1016/j.jcv.2009.11.026PubMedCrossRef
7.
go back to reference Täger FM, Zolezzi RP, Folatre BI, Navarrete CM, Rojas PJ: Respiratory virus infections in children with acute lymphoblastic leukemia and febrile neutropenia: a prospective study. Rev Chilena Infectol 2006,23(2):118-123.CrossRef Täger FM, Zolezzi RP, Folatre BI, Navarrete CM, Rojas PJ: Respiratory virus infections in children with acute lymphoblastic leukemia and febrile neutropenia: a prospective study. Rev Chilena Infectol 2006,23(2):118-123.CrossRef
8.
go back to reference Martino R, Porras RP, Rabella N, Williams JV, Rámila E, Margall N, Labeaga R, Crowe JE Jr, Coll P, Sierra J: Prospective study of the incidence, clinical features, and outcome of symptomatic upper and lower respiratory tract infections by respiratory viruses in adult recipients of hematopoietic stem cell transplants for hematologic malignancies. Biol Blood Marrow Transplant 2005,11(10):781-796. 10.1016/j.bbmt.2005.07.007PubMedPubMedCentralCrossRef Martino R, Porras RP, Rabella N, Williams JV, Rámila E, Margall N, Labeaga R, Crowe JE Jr, Coll P, Sierra J: Prospective study of the incidence, clinical features, and outcome of symptomatic upper and lower respiratory tract infections by respiratory viruses in adult recipients of hematopoietic stem cell transplants for hematologic malignancies. Biol Blood Marrow Transplant 2005,11(10):781-796. 10.1016/j.bbmt.2005.07.007PubMedPubMedCentralCrossRef
9.
go back to reference Martino R, Rámila E, Rabella N, Muñoz JM, Peyret M, Portos JM, Laborda R, Sierra J: Respiratory virus infections in adults with hematologic malignancies: a prospective study. Clin Infect Dis 2003,36(1):1-8. 10.1086/344899PubMedCrossRef Martino R, Rámila E, Rabella N, Muñoz JM, Peyret M, Portos JM, Laborda R, Sierra J: Respiratory virus infections in adults with hematologic malignancies: a prospective study. Clin Infect Dis 2003,36(1):1-8. 10.1086/344899PubMedCrossRef
10.
go back to reference Schiffer JT, Kirby K, Sandmaier B, Storb R, Corey L, Boeckh M: Timing and severity of community acquired respiratory virus infections after myeloablative versus non-myeloablative hematopoietic stem cell transplantation. Haematologica 2009,94(8):1101-1108. 10.3324/haematol.2008.003186PubMedPubMedCentralCrossRef Schiffer JT, Kirby K, Sandmaier B, Storb R, Corey L, Boeckh M: Timing and severity of community acquired respiratory virus infections after myeloablative versus non-myeloablative hematopoietic stem cell transplantation. Haematologica 2009,94(8):1101-1108. 10.3324/haematol.2008.003186PubMedPubMedCentralCrossRef
11.
go back to reference van Kraaij MG, van Elden LJ, van Loon AM, Hendriksen KA, Laterveer L, Dekker AW, Nijhuis M: Frequent detection of respiratory viruses in adult recipients of stem cell transplants with the use of real-time polymerase chain reaction, compared with viral culture. Clin Infect Dis 2005,40(5):662-669. 10.1086/427801PubMedCrossRef van Kraaij MG, van Elden LJ, van Loon AM, Hendriksen KA, Laterveer L, Dekker AW, Nijhuis M: Frequent detection of respiratory viruses in adult recipients of stem cell transplants with the use of real-time polymerase chain reaction, compared with viral culture. Clin Infect Dis 2005,40(5):662-669. 10.1086/427801PubMedCrossRef
12.
go back to reference Freymuth F, Vabret A, Cuvillon-Nimal D, Simon S, Dina J, Legrand L, Gouarin S, Petitjean J, Eckart P, Brouard J: Comparison of multiplex PCR assays and conventional techniques for the diagnostic of respiratory virus infections in children admitted to hospital with an acute respiratory illness. J Med Virol 2006,78(11):1498-1504. 10.1002/jmv.20725PubMedCrossRef Freymuth F, Vabret A, Cuvillon-Nimal D, Simon S, Dina J, Legrand L, Gouarin S, Petitjean J, Eckart P, Brouard J: Comparison of multiplex PCR assays and conventional techniques for the diagnostic of respiratory virus infections in children admitted to hospital with an acute respiratory illness. J Med Virol 2006,78(11):1498-1504. 10.1002/jmv.20725PubMedCrossRef
13.
go back to reference van de Pol AC, van Loon AM, Wolfs TF, Jansen NJ, Nijhuis M, Breteler EK, Schuurman R, Rossen JW: Increased detection of respiratory syncytial virus, influenza viruses, parainfluenza viruses, and adenoviruses with real-time PCR in samples from patients with respiratory symptoms. J Clin Microbiol 2007,45(7):2260-2262. 10.1128/JCM.00848-07PubMedPubMedCentralCrossRef van de Pol AC, van Loon AM, Wolfs TF, Jansen NJ, Nijhuis M, Breteler EK, Schuurman R, Rossen JW: Increased detection of respiratory syncytial virus, influenza viruses, parainfluenza viruses, and adenoviruses with real-time PCR in samples from patients with respiratory symptoms. J Clin Microbiol 2007,45(7):2260-2262. 10.1128/JCM.00848-07PubMedPubMedCentralCrossRef
14.
go back to reference van Elden LJ, van Kraaij MG, Nijhuis M, Hendriksen KA, Dekker AW, Rozenberg-Arska M, van Loon AM: Polymerase chain reaction is more sensitive than viral culture and antigen testing for the detection of respiratory viruses in adults with hematological cancer and pneumonia. Clin Infect Dis 2002,34(2):177-183. 10.1086/338238PubMedCrossRef van Elden LJ, van Kraaij MG, Nijhuis M, Hendriksen KA, Dekker AW, Rozenberg-Arska M, van Loon AM: Polymerase chain reaction is more sensitive than viral culture and antigen testing for the detection of respiratory viruses in adults with hematological cancer and pneumonia. Clin Infect Dis 2002,34(2):177-183. 10.1086/338238PubMedCrossRef
15.
go back to reference van Elden LJ, van Loon AM, van der Beek A, Hendriksen KA, Hoepelman AI, van Kraaij MG, Schipper P, Nijhuis M: Applicability of a real-time quantitative PCR assay for diagnosis of respiratory syncytial virus infection in immunocompromised adults. J Clin Microbiol 2003,41(9):4378-4381. 10.1128/JCM.41.9.4378-4381.2003PubMedPubMedCentralCrossRef van Elden LJ, van Loon AM, van der Beek A, Hendriksen KA, Hoepelman AI, van Kraaij MG, Schipper P, Nijhuis M: Applicability of a real-time quantitative PCR assay for diagnosis of respiratory syncytial virus infection in immunocompromised adults. J Clin Microbiol 2003,41(9):4378-4381. 10.1128/JCM.41.9.4378-4381.2003PubMedPubMedCentralCrossRef
16.
go back to reference Molenkamp R, van der Ham A, Schinkel J, Beld M: Simultaneous detection of five different DNA targets by real-time Taqman PCR using the Roche LightCycler480: application in viral molecular diagnostics. J Virol Methods 2007,141(2):205-211. 10.1016/j.jviromet.2006.12.007PubMedCrossRef Molenkamp R, van der Ham A, Schinkel J, Beld M: Simultaneous detection of five different DNA targets by real-time Taqman PCR using the Roche LightCycler480: application in viral molecular diagnostics. J Virol Methods 2007,141(2):205-211. 10.1016/j.jviromet.2006.12.007PubMedCrossRef
17.
go back to reference Jansen RR, Schinkel J, Koekkoek S, Pajkrt D, Beld M, de Jong MD, Molenkamp R: Development and evaluation of a four-tube real time multiplex PCR assay covering fourteen respiratory viruses, and comparison to its corresponding single target counterparts. J Clin Virol 2011,49(7):2631-2636. Jansen RR, Schinkel J, Koekkoek S, Pajkrt D, Beld M, de Jong MD, Molenkamp R: Development and evaluation of a four-tube real time multiplex PCR assay covering fourteen respiratory viruses, and comparison to its corresponding single target counterparts. J Clin Virol 2011,49(7):2631-2636.
18.
go back to reference Hammitt LL, Kazungu S, Welch S, Bett A, Onyango CO, Gunson RN, Scott JA, Nokes DJ: Added value of an oropharyngeal swab in detection of viruses in children hospitalized with lower respiratory tract infection. J Clin Microbiol 2011,49(6):2318-2320. 10.1128/JCM.02605-10PubMedPubMedCentralCrossRef Hammitt LL, Kazungu S, Welch S, Bett A, Onyango CO, Gunson RN, Scott JA, Nokes DJ: Added value of an oropharyngeal swab in detection of viruses in children hospitalized with lower respiratory tract infection. J Clin Microbiol 2011,49(6):2318-2320. 10.1128/JCM.02605-10PubMedPubMedCentralCrossRef
19.
go back to reference Hernes SS, Quarsten H, Hagen E, Lyngroth AL, Pripp AH, Bjorvatn B, Bakke PS: Swabbing for respiratory viral infections in older patients: a comparison of rayon and nylon flocked swabs. Eur J Clin Microbiol Infect Dis 2011,30(2):159-165. 10.1007/s10096-010-1064-2PubMedPubMedCentralCrossRef Hernes SS, Quarsten H, Hagen E, Lyngroth AL, Pripp AH, Bjorvatn B, Bakke PS: Swabbing for respiratory viral infections in older patients: a comparison of rayon and nylon flocked swabs. Eur J Clin Microbiol Infect Dis 2011,30(2):159-165. 10.1007/s10096-010-1064-2PubMedPubMedCentralCrossRef
20.
go back to reference Kim YJ, Boeckh M, Englund JA: Community respiratory virus infections in immunocompromised patients: hematopoietic stem cell and solid organ transplant recipients, and individuals with human immunodeficiency virus infection. Semin Respir Crit Care Med 2007,28(2):222-242. 10.1055/s-2007-976494PubMedCrossRef Kim YJ, Boeckh M, Englund JA: Community respiratory virus infections in immunocompromised patients: hematopoietic stem cell and solid organ transplant recipients, and individuals with human immunodeficiency virus infection. Semin Respir Crit Care Med 2007,28(2):222-242. 10.1055/s-2007-976494PubMedCrossRef
21.
go back to reference Falsey AR, Formica MA, Walsh EE: Yield of sputum for viral detection by reverse transcriptase PCR in adults hospitalized with respiratory illness. J Clin Microbiol 2012,50(1):21-24. 10.1128/JCM.05841-11PubMedPubMedCentralCrossRef Falsey AR, Formica MA, Walsh EE: Yield of sputum for viral detection by reverse transcriptase PCR in adults hospitalized with respiratory illness. J Clin Microbiol 2012,50(1):21-24. 10.1128/JCM.05841-11PubMedPubMedCentralCrossRef
Metadata
Title
Febrile neutropenia: significance of elaborated screening for respiratory viruses, and the comparison of different sampling methods, in neutropenic patients with hematological malignancies
Authors
Rogier R Jansen
Bart J Biemond
Janke Schinkel
Sylvie M Koekkoek
Richard Molenkamp
Menno D de Jong
Caroline E Visser
Publication date
01-12-2013
Publisher
BioMed Central
Published in
Virology Journal / Issue 1/2013
Electronic ISSN: 1743-422X
DOI
https://doi.org/10.1186/1743-422X-10-212

Other articles of this Issue 1/2013

Virology Journal 1/2013 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine