How to provide supportive care for hMPV during chemotherapy?

Question

Hi doctor,

My seven-year-old son, who is on maintenance chemotherapy for ALL, tested positive for hMPV. His symptoms are different from his previous viral infections: extreme lethargy, rapid breathing (45 per minute), and a strange barking cough that gets worse at night. His ANC is only 100, and the oncologist is concerned about starting antivirals due to his liver numbers. He has already been off chemotherapy for a week. Should we risk taking him home? What markers should we monitor besides oxygen levels? Also, some seizure-like episodes were noticed during high fever. Is this common with hMPV?

Please help me.

Thanks.

Answer 1

Hi,

Welcome to icliniq.com.

I can understand your concern.

All viral infections are common in immunocompromised people. Your son is under chemotherapy for acute lymphoblastic leukemia (ALL), and it is very common. An absolute neutrophil count (ANC) of 100 indicates severe neutropenia due to either sepsis or ALL. Monitor for saturation or oxygen fall. If oxygen saturation is maintained above 90 percent and the chest X-ray is normal, then you may isolate for some time until relieved from symptoms.

Go for chemotherapy, but it is not advisable to go home. Start Paracetamol or Ibuprofen (antipyretics) twice daily and Levocetirizine syrup for cough. Seizures are due to high fever. Give him tepid sponging and continue Paracetamol 500 mg thrice a day. Regular monitoring of respiratory patterns and saturation is advisable. Hydrate him and give him plenty of oral liquids.

I hope this information helps you.

Feel free to ask further queries.

Thank you.