ABSTRACT before and through chemotherapy in children be

ABSTRACT

Background: Rotaviruses
is very common disease cause human infantile gastroenteritis . Children with cancer ( through chemotherapy) are the generality

prevalent infected by Rotaviruses account for approximately 50%of
all cases of diarrhea in children  .

Objectives: We explore of
Rotaviruses in children with cancer in Basrah town amongst children  be admitted to Pediatric Oncology center in
Specialist Basrah Children’s Hospital.

Method: Used immunochromatographic test  in study 
, in two groups before and through chemotherapy in children be admitted to Pediatric
Oncology center in Specialist Basrah Children’s Hospital during May to November
2015, their age ranged from two month to 14 year.

Results: One hundred and
six stool samples were assa from malignant children found in IC test show (12) positive samples before chemotherapy  and (38 ) 
during chemotherapy .

Conclusion: This study showed
that age group between 1-4 years was the most liable for the infection among
the age groups studied. Both genders were liable to infection with Rotaviruses
, a higher rate of infection was showed in male as compared with female
results. 

Keywords: Diarrhea in
children, Rotaviruses ,
Chemotherapy .

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Introduction :

     Rotaviruses is the most
common cause of diarrheal disease among infants and young children (1). It is a
genus of double- stranded RNA viruses in family Reoviridae (2).Have an
icosahedral morphology with a double layered capsid (60-80 nm in diameter
)(3).The name Rotavirus  is derived from
the Latin rota, meaning “wheel” which refers to the virion appearance in
negative stained electron micrographs(4).Found out of eight species of this
virus but the most common species is Rotavirus A(4).Rotaviruses (Rvs)were first
discovered in 1973 Bishop et al. studied intestinal
biopsies of children with Acute 
Gastroenteritis (AGE) in electron microscopy (5). Rotaviruses transmitted
by fecal –oral route ,person to person contact and fomities ,water and
respiratory droplets (2).The symptoms of disease illness ranges from mild
watery diarrhea of limited duration to severe ,dehydration ,diarrhea with
vomiting and fever (6).Rotaviruses  may
result in mortality for infant ,Immuncompromised patients and may produce a
chronic infection in Immunodeficient children (7).

 

MATERIALS AND METHODS

SUBJECTS AND METHODS

 

      Aggregate of 106 fecal specimens were
collected from children with malignant diseases aged 2 months to 14 years
before and through (6 to 8 weeks) chemotherapy in  Pediatric Oncology Center at  Specialist Basra children’s hospital during
May  to November  2015.Stool samples were collected and
examined using   Immunochromatographic
test (IC). Stool samples must be collected in clean containers without any
additives.

 

Immunochromatographic Test (IC)

Procedure as recommended by ABON Rotavirus
test Device (feces)                                                                    kit  instructions.

A-  Procedure :

1-Collect sufficient quantity of feces (1-2
ml or 1-2 g) in a clean and dry container

2- To process fecal specimens :

For solid
specimens  For solid specimens thrust the specimen collecting
applicator into the fecal specimen in at minimal three different sites to
collect 50 mg of feces.

For liquid
specimens  transfer 2 drops (50 µl) into the into the specimen
collection tubing contain buffer extraction

3- Tighten the lid on the sample collection
tube  then shake the sample collection
tube strongly  to mix the sample and  extract the buffer 

4- Transfer 2 complete  droplets from the extracted sample (80 ?l)to
the sample well of the test device and start the timer.

5- Read the results in 10 minutes after
dispensing the sample.

B-  
Interpretation of Results :

Positive : Two distinct colored lines appear both control (  C ) and test ( T ).

Negative : One colored line appears in the control line ( C ) . No line
appears in the test ( T ) .

 

Statistical
Analysis:

Statistical package of social science (SPSS) version 20 was used
for  data analysis ,Chi-square (X2) test
was used to assess the significance of the difference between groups and
variables, P-value less than is  considered  statistically significant.

 

 

 

 

Results :

        In Table(1) , among 106 children
suffering from malignant diseases , 12 (11.3%)were found to be positive for Rotavirus
infection before chemotherapy in comparison with 38 ( 35.8%) during
chemotherapy. Statistically, the difference between   groups were significant(X2  = 2.975 , df =1, P <0.05).          In Table (2) , The highest rate of Rotavirus infection is between  the three types of malignant diseases groups was found in patients with Leukemia; 9.4% before and 20.7% during chemotherapy .Statistically, the difference was  significant (X2  = 2.972 , df =1 , P <0.05).          Other infection rates were 0.9% among patients with Lymphoma before chemotherapy and 3.8% during chemotherapy, thus, statistically  the difference was not significant (X²  = 0.356  , df =1 , P >0.05 ). While 0.9% were found in those with Solid Tumor before
chemotherapy and 11.3% through chemotherapy, thus, statistically the difference
was significant (X2  = 1.467 , df =1 , P <0.05).                While in Table (3) , The highest rate occurred in the two age group of (1- 4 and 5-9) years of age, and about (15%,8.8%) before chemotherapy and (35%,35.3%) through chemotherapy. Statistically, there was significant difference. However, statistically, there was no significant difference in the other age groups .       In Table (4), the rate of infection was found in urban areas before chemotherapy was 11.6% and 30.2% during chemotherapy. Statistically, the relationship was not significant (?² =0.256 ,df=1, P>0.05). In rural
areas,the incidence rate was found of patients before chemotherapy was 11.1%
and 39.7% for those during chemotherapy. So, there as a very significant
difference statistically (?² = 3.316 ,df =1, P<0.05).       In Table (5) shows Rotavirus  infections in patients before and during chemotherapy were 15% found in males before chemotherapy and 36.7% during chemotherapy. Statistically,  the difference was significant (?² = 4.104 , df = 1, P<0.05). However, infections found in females were only 6.5% before chemotherapy compared to the 34.8% during chemotherapy. Thus, the difference was not  significantly different among females (?² = 0.003 , df = 1, P>0.05).

Patient  group
 

Rotavirus
infection

Total

Positive*

Negative

Before
chemotherapy

12      (11.3%)

94  (88.7%)

106

During
chemotherapy

38     (35.8%)

68    (64.2%)

106

Table (1) Rotavirus infection among
children with malignances before and during chemotherapy

 

*X2
 = 2.975       , df =1     
, P <0.05     Figure (1) Rotavirus infection positive  before and during chemotherapy.       Table (2) Presence  of Rotaviruses infection   among various  types of malignant diseases  before and during chemotherapy   Patient  group   Type of malignant cases Total   Leukemia * Lymphoma** Solid tumor*** Before chemotherapy   10 (9.4%)   1(0.9%)   1(0.9%)   12 During chemotherapy   22 (20.7%)   4 (3.8%)   12 (11.3%)   38 * X2  = 2.972       , df =1      , P <0.05 ** X2  = 0.356     , df =1      , P >0.05

***X2
 = 1.467    , df =1     
, P <0.05   1.      Leukemia include 🙁 Acute lyphocytic leukemia, Acute myelocytic leukemia and Chronic myelocytic leukemia).   2.      Lymphoma include 🙁 Hodgkin lymphoma and Non-Hodgkin lymphoma).   3.      Solid tumor include: (Neuroblastoma ,Osteogenic sarcoma ,Hepatoblastoma ,Adenocarcinoma, Ewing's sarcoma ,Rhabdomyosarcoma and Brain tumor).         Table (3) Rotavirus  infection according to the age groups before and during chemotherapy     Age  group Before chemotherapy During chemotherapy x² P value No. examined +ve % No. examined +ve % >1

8

1
 

12.5
 

8

3

37.5

1.905

Ns

1-4
 

40

6

15.0

40

14

35.0

0.698

0.030

5-9
 

34

3

8.8

34

12

35.3

1.418

0.020

10-14
 

24

2

8.3

24

9

37.5

0.145

Ns

Total

106

12

11.3

106

38

35.8

2.975

0.008

 

 

 

Table (4) Rotaviruses in relation to residence before and during
chemotherapy

 

+ve

P value

Urban
 

Before
chemotherapy

No.

5

0.256

Ns

%

11.6

During
chemotherapy

No.

13

%

30.2

Rural
 

Before
chemotherapy

No.

7

3.316

0.001

%

11.1

During
chemotherapy

No.

25

%

39.7

 

 

 

 

 

Table (5) Rotaviruses according 
to gender before and during chemotherapy

Patients
(gender)

Test

+ve
cases

P
value

Male

Before
chemotherapy

No.

9

4.104

0.050

%

15

During
chemotherapy

No.

22

%

36.7

Female

Before
chemotherapy

No.

3

0.003

Ns

%

6.5

During
chemotherapy

No.

16

%

34.8

 

 

 

 

 

Discussion :

      Rotavirus is endemic worldwide , the
infection is associated with high rates of morbidity and high rates of
mortality in developing countries (8).

       Rotavirus was found in (11.3%)  in patients with malignant diseases before
chemotherapy compared with(35.8%) in the same groups of patient during
chemotherapy  in Table 1. These results
are different for some studies , as in city of 
Basra  which found   Rotaviruses 
about  3.5%  (9) , while in Mid Iraq 42.45% was reported
by   Abood et al., (2013) (10),  in Babylon 51.98% (11),in AL-Ramadi  39.26 % (12),in  Diyla 20.3%  (13), 
in  Sulaimani 22% (14).

 

        Patients  were divided from  this study 
into three groups according the types of cancer. The highest rate of
Rotavirus infection btween  the three
types of malignant diseases groups was found in patients with Leukemia(9.4%)
before and(20.7% )through chemotherapy ,this result is   incompatible with  other 
studies  in Basra with(5.2%) found
in patients with leukemia  infected with
Rotavirus (9).

        Rotaviruses has been reported that in
cases of Lymphoma(0.9%) before chemotherapy and (3.8% )  through chemotherapy ,this result  is differentially to studies in Basra
(6.8%)(9). But  in solid tumor (0.9%)
before chemotherapy and(11.3%) through chemotherapy, this result  is different 
to studies in Basra not detect 
cases of Rotaviruses  infection (9).

      Patients in this study were divided into
four age groups.Infection was observed before chemotherapy  among age group of (1-4 and 5-9 years)
was  (15%,8.8%) compared with children
during chemotherapy of (35%,35.3% ) which showed a clear  increase . These results are similar  to some studies, as  in USA in 2003 (15), in basrah (17).And these
results are diferrient to some studies in England in 2015 (16). These results
might be in linked to different risk factors including the physiological and
immunological status of the patients examined . However, there is no published report
about the relationship between age and Rotavirus  infection in patient with malignant.

        
In this  study  we found Rotaviruses   in rural areas more than in urban areas and
also more important. In urban  areas  the percent found  before chemotherapy was (11.6% ) and through
chemotherapy was (30.2%), but in rural areas 
(11.1%) was  found before
chemotherapy and(39.7%) during chemotherapy. 
Insignificant difference between urban and rural residents of
before  and during chemotherapy was
noticed that , also significant difference between before and during
chemotherapy group in rural area  ,
which  might be due to the geographical
distribution of incidence of malignant diseases among children in Basra . This
finding is in approval with that recorded   in Basra (9) , and in Baghdad (18).

         
The group of male patients was more affected  ( 15% and 36.7%) before and through
chemotherapy than female  (6.5 % and
34.8%) .This result is  different  for 
studies in Basra  (9) ,but This
finding is in approval with that recorded  
in Yemen(19)and in India(20).

           In conclusion, This study
reported that age group between 1-4 years was the most susceptible for the
infection among the age groups studied. Both genders were susceptible to
infection with Rotaviruses  , a higher rate of infection was reported in male as compared
with female results.  

          
Acknowledgment We acknowledge with a deep sense of gratitude, the
support of the staff of Basrah Children’s Specialty Hospital
especially Dr. Ali A. Sabri, Dr. Hussam M. Saleh.

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