Viral Respiratory Panel Analysis in Pediatric Hematology Patients in the Period of Febrile Neutropenia

Purpose: This retrospective clinical study aimed to delineate the burden and spectrum of respiratory viruses during febrile neutropenia (FN) in children with hematologic malignancies, and to explore clinical-laboratory correlates with potential implications for early management and antimicrobial stewardship.Methods: A retrospective single-center cohort study was conducted, including pediatric patients followed at the Pediatric Infectious Diseases and Pediatric Hematology–Oncology clinics between 2014 and 2015. Nasopharyngeal swabs previously collected at the onset of FN episodes were analyzed using multiplex real-time PCR (FTD® Respiratory Pathogens 21; Rotor-Gene Q). Demographic, clinical, laboratory, and imaging data were retrieved from patient records and institutional databases. Primary outcomes were viral detection rate and its association with clinical severity markers.Results: Fifty-two patients (32/52 male, 61.5%; median age 7.24±4.10 years) contributed to FN episodes. Underlying diagnoses were ALL 20/52 (38.5%), AML 13/52 (25.0%), NHL 4/52 (7.7%), and other hematologic malignancies 15/52 (28.8%). Respiratory viruses were detected in 30/52 (57.7%) episodes; coinfections occurred in 8/52 (15.4%). Frequently identified viruses included influenza A/B (7 detections), parainfluenza (types 2–4; 9 detections), seasonal coronaviruses NL63/OC43/HKU1/229E (10 detections), and rhinovirus (7 detections); multiple detections reflect coinfections. An elevated ESR > 30 mm/h was associated with viral detection (p<0.05); CRP, PCT, ferritin, and Ig isotypes did not. Imaging showed pneumonia in 16/52 (30.8%) and thoracic fungal disease in 10/52 (19.2%). Inpatients had longer durations of neutropenia and fever (both p≤0.01), without differences in neutrophil counts or viral detection rates.Conclusion: Over half of FN episodes harbored detectable respiratory viruses, often in the absence of focal respiratory signs. Early, routine nasopharyngeal PCR at FN onset, including in asymptomatic patients, may refine diagnosis and support antibiotic de-escalation within stewardship frameworks in pediatric hematology populations.