14 In children Epigenetics activator with cancer, Koskenvuo et al.4 found a co-detection rate of 19.7%, especially between HRV and RSV. In the present cohort, co-detection was not associated with case severity, as the initial clinical presentation of patients was mild, most children were initially in good general health status, with rare complications in the lower airways, and there were no deaths. De Paulis et al.28 observed no impact on clinical severity with co-infection in hospitalized

infants. In contrast, other studies also carried out in hospitalized infants without immunosuppression showed that an increase in the number of co-detections may result in increased clinical severity in young children.14 This fact may be attributed to the accidental finding of these viruses in the materials, without important clinical

significance in the severity of cancer patients that excrete the virus for long periods. A viral infection may increase susceptibility to bacterial co-infection. In a multicenter study of children with leukemia and fever, Koskenvuo et al.4 found 13% bacterial sepsis in patients with ARI. In a study of febrile neutropenia, Avadhanula et al.29 found an association with bacterial infection in one-third of cases, suggesting that the RSV infection can increase the expression of receptors for Streptococcus pneumoniae and Haemophilus influenza in primary bronchial epithelial cells, facilitating bacterial colonization and disease. In the present study, no bacterial this website complications at clinical examination were observed, with favorable outcome similar to those patients without cancer. The authors emphasize the finding of hypothermia in 15% of children, but without progression to sepsis. Blood cultures were positive in only 9.1% of cases, similar to other studies.18 and 30 Therefore, the detection of a viral pathogen may provide the physician with a safer therapeutic approach, appropriate antimicrobial use, reducing unnecessary costs imposed on the health system, and providing direct improvement in morbidity and

mortality Mannose-binding protein-associated serine protease of children with cancer. Although seasonality for respiratory viruses showed more prevalence in the fall and winter, it was observed that this pattern was not homogeneous for all studied viruses, and a longer period of observation would be necessary to establish a seasonal pattern for this group of children. Respiratory viruses are pathogens found in most pediatric cancer patients receiving chemotherapy, demonstrating that their presence may be a causative factor for the infectious episode. Their co-detections were frequent in cancer patients with ARI. It was not possible to identify whether the severe acute infection was directly related to the type of cancer or viral pathogen. Projeto Regular de Pesquisa Fapesp No. 2009/17326-0. The authors declare no conflicts of interest.