Respiratory Viral Infections in Febrile Children With Lymphoreticular Malignancies: A Single-Centre Descriptive Study

Children with lymphoreticular malignancies are highly vulnerable to respiratory viral infections (RVIs) because of disease- and chemotherapy-related immunosuppression, yet data on their epidemiology, clinical spectrum, and outcomes from resource-limited settings remain scarce. This study aimed to characterize the seasonal distribution, clinical presentation, and outcomes of RVIs other than SARS-CoV-2 in febrile children with lymphoreticular malignancies at a tertiary care centre in India. In this prospective, descriptive, cross-sectional study (May 2023-November 2024), 33 children under 12 years of age with lymphoreticular malignancies were enrolled at a tertiary care centre in Delhi, India, contributing 70 febrile episodes with respiratory symptoms. All episodes were screened for SARS-CoV-2 by rapid antigen test at admission, independent of the viral PCR panel, and none tested positive. Nasopharyngeal swabs were analyzed by multiplex real-time PCR (TRUPCR® Respiratory Viral Pathogen Panel Kit, 3B BlackBio, Bhopal, India; CFX96™, Bio-Rad, Hercules, CA, USA) targeting 18 other respiratory viral pathogens. Respiratory viruses were detected in 34% of episodes (24/70). The most prevalent viruses identified were human coronavirus (HCoV α/β, 21%), human rhinovirus (HRV, 17%), human parainfluenza virus type 3 (HPIV-3, 13%), influenza A (IAV,13%), and human adenovirus (HAdV, 13%). Co-infections occurred in 13% of virus-positive episodes, with HAdV being the predominant co-pathogen. Upper respiratory tract infections (URTI) predominated (87%). Among virus-positive episodes, breathlessness (p = 0.005), URTI/LRTI classification (p < 0.001), erythrocyte sedimentation rate (ESR; p < 0.001), and abnormal chest radiography (p < 0.001) were significantly associated with viral status. Two patients (6%) died, both attributed to lower respiratory tract infection (LRTI) caused by human parainfluenza virus type 4 (HPIV-4). The remaining 66% of episodes were PCR-negative. No SARS-CoV-2 was detected in this cohort at any point during the study period. In approximately one-third of febrile episodes of children with hematologic malignancies, a viral pathogen could be detected. Both fatalities in this cohort were associated with HPIV-4-related LRTI; although the numbers are small, this finding warrants clinical attention and continued epidemiological surveillance in this population. Multiplex PCR supports targeted management; prospective, multicentre stewardship studies are needed.