1
|
Sarfraz M, Sarfraz A, Sarfraz Z, Nadeem Z, Khalid J, Butt SZ, Thevuthasan S, Felix M, Cherrez-Ojeda I. Contributing factors to pediatric COVID-19 and MIS-C during the initial waves: A systematic review of 92 case reports. Ann Med Surg (Lond) 2022; 81:104227. [PMID: 35937636 PMCID: PMC9339082 DOI: 10.1016/j.amsu.2022.104227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background As the coronavirus disease 2019 (COVID-19) pandemic continues to sweep the world with unprecedented speed and devastation, data has shown that cases in the pediatric population have been significantly lower than in the adult population. We conducted a systematic review of case reports to identify the contributing factors of confirmed pediatric COVID-19 patients. Methods Using the PubMed platform, and Cochrane Central, we searched for primary studies alone. All database searches were performed between December 2019 and December 2020. We incorporated keywords including “pediatrics,” “Case reports,” “Cases,” “Covid-19″ into all searches. Results A total of 92 records were included in this novel review. Of all patients, 58% were male and the mean age of the patients was 6.2 years (SD: 5.9). Contributing factors to MIS-C infections were G6PD deficiency (17.6%), Group A streptococcus co-infection (17.6%), infancy (11.8%), whereas those in COVID-19 pediatric patients included congenital (18.5%), and genetic defects (13.8%), in addition to vertical transmission or during infancy (16.9%). Data of baseline demographic characteristics and clinical sequelae of included COVID-19 pediatric and MIS-C patients is presented. Conclusion With schools reopening and closing, the pediatric age group is susceptible to high rates of COVID-19 community transmission. We provide insights into potential contributing factors to pediatric COVID-19 and MIS-C patients. These insights are critical to guide future guidelines on the management and potential vaccination efforts. COVID-19 continues to devastate communities worldwide. The pediatric population has faced the ups and downs of the many variants of disease. This systematic review includes a total of 92 studies and identifies key contributing factors from developmental, maternal and pediatric. We provide insights into potential contributing factors to pediatric COVID-19 and MIS-C patients. These insights are critical to guide future guidelines on the management and potential vaccination efforts.
Collapse
|
2
|
Tekle-Yohannes GH, Mann E, Miller MA. Multisystem Inflammatory Syndrome in Children During Induction Chemotherapy in a Newly Diagnosed Pediatric Acute Myeloid Leukemia and Concurrent COVID-19. J Pediatr Hematol Oncol 2022; 44:e532-e536. [PMID: 34133374 DOI: 10.1097/mph.0000000000002236] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/16/2021] [Indexed: 11/26/2022]
Abstract
A 15-year-old male presented with fatigue and weight loss for 1 month, petechiae and bruising for 2 weeks. He was diagnosed with concurrent new acute myeloid leukemia and coronavirus disease 2019. He was febrile and chest computed tomography scan showed ground glass opacities. Fever resolved after 4 days. Polymerase chain reaction test for coronavirus disease 2019 became negative after 2 days. Induction chemotherapy was initiated on day 8 and was complicated by multisystem inflammatory syndrome in children. The multisystem inflammatory syndrome in children was managed with symptomatic treatment and continued chemotherapy. Patient recovered and end of induction bone marrow showed remission of the leukemia.
Collapse
Affiliation(s)
| | - Esther Mann
- Pediatrics, Janet Weis Children's Hospital, Danville, PA
| | | |
Collapse
|
3
|
Schlage S, Lehrnbecher T, Berner R, Simon A, Toepfner N. SARS-CoV-2 in pediatric cancer: a systematic review. Eur J Pediatr 2022; 181:1413-1427. [PMID: 35006377 PMCID: PMC8744033 DOI: 10.1007/s00431-021-04338-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/05/2021] [Accepted: 11/30/2021] [Indexed: 12/20/2022]
Abstract
UNLABELLED The outbreak of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in December 2019 in Wuhan challenges pediatric oncologists in an unexpected way. We provide a comprehensive overview, which systematically summarizes and grades evidence (QoE) on SARS-CoV-2 infections in pediatric cancer patients at 1.5 years of pandemic. A systematic literature search in PubMed combined with an additional exploratory literature review in other international databases was conducted to identify studies on children (aged < 18 years) with a malignant disease and COVID-19 infections. In total, 45 reports on 1003 pediatric cancer patients with SARS-CoV-2 infections were identified out of 1397 reports analyzed. The clinical course of COVID-19 was reported mild or moderate in 358 patients (41.7%), whereas 11.1% of patients showed severe COVID-19. In 12.7% of patients, chemotherapy was postponed, whereas 19% of patients with different underlying malignancies received chemotherapy during SARS-CoV-2 infection. Twenty-five patients with SARS-CoV-2 infections died, potentially related to COVID-19. CONCLUSION Despite a favorable COVID-19 outcome in most pediatric cancer patients, the morbidity is reported higher than in children without comorbidities. However, no severe COVID-19 complications were associated to the continuation of chemotherapy in some cohort studies and reports on two patients. Therefore, the risk of cancer progress or relapse due to interruption of chemotherapy has carefully to be weighed against the risk of severe COVID-19 disease with potentially fatal outcome. WHAT IS KNOWN • Most of pediatric patients with malignant diseases show an asymptomatic, mild or moderate clinical course of SARS-CoV-2 infection. • Current need for a basis for decision-making, whether to stop or interrupt cancer treatment in a patient infected with SARS-CoV-2, and when to continue chemotherapy. WHAT IS NEW • Review results comprising over 1000 pediatric COVID-19 cancer patients confirm mild courses of SARS-CoV-2 infection in most patients but also show the attributable mortality is at least 10 times higher compared to reports on hospitalized children without comorbidities. • Review identifies that chemotherapy was continued despite SARS-CoV-2 positivity in 18% of patients with individual chemotherapy modification according to the clinical course of SARS-CoV-2 infection and existing comorbidities. On this basis, no severe COVID-19 complications were associated to the continuation of chemotherapy in several cohort studies and two case reports.
Collapse
Affiliation(s)
- Sandy Schlage
- Department of Pediatrics, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - Thomas Lehrnbecher
- Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Reinhard Berner
- Department of Pediatrics, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - Arne Simon
- Pediatric Oncology and Hematology, University Children’s Hospital, Homburg, Saar, Germany
| | - Nicole Toepfner
- Department of Pediatrics, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany.
| |
Collapse
|
4
|
Fırat M, Kobat SG. How are central foveal and choroidal thickness affected in patients with mild COVID-19 infection? Bosn J Basic Med Sci 2021; 21:782-786. [PMID: 34157253 PMCID: PMC8554697 DOI: 10.17305/bjbms.2021.5840] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 05/01/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to evaluate the effects of COVID-19 on central foveal and choroidal thicknesses. Thirty-two patients with a positive SARS-CoV-2 PCR test who received outpatient treatment within the previous two months and 32 healthy controls were included in the study. Patients requiring hospitalization due to COVID-19 as well as the patients who received either intensive care support and/or antiplatelet therapy, smokers, or patients with systemic or ocular diseases were excluded from the study. After full ophthalmological examination, central foveal and choroidal thicknesses were evaluated by using optical coherence tomography. Statistical analysis of the study data demonstrated no significant difference between the groups in terms of age or gender (p>0.05). There was also no statistically significant difference between the groups in terms of central foveal thickness, central choroidal thickness, or nasal 500, nasal 1500, temporal 500, or temporal 500-micron distances (p>0.05 for all parameters). Choroidal and retinal thicknesses were not affected in patients with recent mild COVID 19 without comorbidities.
Collapse
Affiliation(s)
- Müge Fırat
- Department of Ophthalmology, Elazığ City Hospital, Elazığ, Turkey
| | | |
Collapse
|
5
|
Ebeid FSE, Ragab IA, Elsherif NHK, Makkeyah S, Mostafa S, Eltonbary K, Matbouly S, Mostafa A, Goma H, Agwa SH, Hafez HM, Girgis S, El Gendy YG, El-Sayed MH. COVID-19 in Children With Cancer: A Single Low-Middle Income Center Experience. J Pediatr Hematol Oncol 2021; 43:e1077-e1081. [PMID: 33290293 DOI: 10.1097/mph.0000000000002025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/29/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Coronavirus disease-2019 (COVID-19) could be associated with morbidity and mortality in immunocompromised children. OBJECTIVE The objective of this study was to measure the frequency of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among hospitalized children with cancer and to detect the associated clinical manifestations and outcomes. METHODOLOGY A prospective noninterventional study including all hospitalized children with cancer conducted between mid-April and mid-June 2020 in Ain Shams University Hospital, Egypt. Clinical, laboratory, and radiologic data were collected. SARS-CoV-2 infection was diagnosed by reverse transcription polymerase chain reaction tests in nasopharyngeal swabs. RESULTS Fifteen of 61 hospitalized children with cancer were diagnosed with SARS-CoV-2. Their mean age was 8.3±3.5 years. Initially, 10 (66.7%) were asymptomatic and 5 (33.3%) were symptomatic with fever and/or cough. Baseline laboratory tests other than SARS-CoV-2 reverse transcription polymerase chain reaction were not diagnostic; the mean absolute lymphocyte count was 8.7±2.4×109/L. C-reactive protein was mildly elevated in most of the patients. Imaging was performed in 10 (66.7%) patients with significant radiologic findings detected in 4 (40%) patients. Treatment was mainly supportive with antibiotics as per the febrile neutropenia protocol and local Children Hospital guidance for management of COVID-19 in children. CONCLUSIONS Pediatric cancer patients with COVID-19 were mainly asymptomatic or with mild symptoms. A high index of suspicion and regular screening with nasopharyngeal swab in asymptomatic hospitalized cancer patients is recommended.
Collapse
Affiliation(s)
- Fatma S E Ebeid
- Pediatric Hematology Oncology Department
- Faculty of Medicine, Ain Shams University Research Institute-Clinical Research Center (MASRI-CRC)
| | | | | | | | | | | | | | - Aya Mostafa
- Community, Environmental, and Occupational Medicine
| | - Heba Goma
- Pediatric Hematology Oncology Department
| | | | | | | | | | - Manal H El-Sayed
- Pediatric Hematology Oncology Department
- Faculty of Medicine, Ain Shams University Research Institute-Clinical Research Center (MASRI-CRC)
| |
Collapse
|
6
|
Palanques-Pastor T, Megías-Vericat JE, Martínez P, López Lorenzo JL, Cornago Navascués J, Rodriguez Macias G, Cano I, Arnan Sangerman M, Vidriales Vicente MB, Algarra Algarra JL, Foncillas MÁ, Herrera P, Botella Prieto C, Vives S, Figuera Álvarez Á, Cuevas Palomares L, Sobas M, Contento Gonzalo A, Cuello García R, Amutio Diez ME, De Miguel Llorente D, Navas Elorza B, Bergua Burgues JM, Bernal Del Castillo T, Mateos Rodríguez MC, de Cabo López E, Franco Villegas AC, García Boyero R, Escolano Escobar C, Seri Merino C, Cervero C, Roldán Pérez A, Hermosín Ramos L, Cervera Calvo M, Olave MT, Villafuerte Gutiérrez P, de Laiglesiai A, Serrano J, Najera Irazu MJ, Piñana JL, Sanz MÁ, Martínez-López J, Montesinos P. Characteristics, clinical outcomes, and risk factors of SARS-COV-2 infection in adult acute myeloid leukemia patients: experience of the PETHEMA group. Leuk Lymphoma 2021; 62:2928-2938. [PMID: 34292118 DOI: 10.1080/10428194.2021.1948031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection produces higher morbidity and mortality in hematological malignancies, but evidence in acute myeloid leukemia (AML) is scarce. A multicenter observational study was conducted to determine the clinical outcomes and assess the impact of therapeutic approaches in adult AML patients with SARS-CoV-2 infection in the first wave (March-May 2020). Overall, 108 patients were included: 51.9% with active leukemia and 70.4% under therapeutic schedules for AML. Signs and symptoms of SARS-CoV-2 were present in 96.3% of patients and 82.4% received specific treatment for SARS-CoV-2. The mortality rate was 43.5% and was correlated with age, gender, active leukemia, dyspnea, severe SARS-CoV-2, intensive care measures, neutrophil count, and D-dimer levels. A protective effect was found with azithromycin, lopinavir/ritonavir, and normal liver enzyme levels. During the SARS-CoV-2 first wave, our findings suggested an increased mortality in AML in a short period. SARS-CoV-2 management could be guided by risk factors in AML patients.
Collapse
Affiliation(s)
| | | | - Pilar Martínez
- Hematology and Hemotherapy Department, Hospital Universitario, Madrid, Spain
| | - José Luis López Lorenzo
- Hematology and Hemotherapy Department, Hospital Universitario Fundación Jiménez Díaz, Valencia, Spain
| | - Javier Cornago Navascués
- Hematology and Hemotherapy Department, Hospital Universitario Fundación Jiménez Díaz, Valencia, Spain
| | - Gabriela Rodriguez Macias
- Hematology and Hemotherapy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Isabel Cano
- Hematology and Hemotherapy Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | | | | | | | - Pilar Herrera
- Hematology and Hemotherapy Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Carmen Botella Prieto
- Hematology and Hemotherapy Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Susana Vives
- Clinic Hematology Department, Instituto Catalán de Oncología, Badalona, Spain
| | - Ángela Figuera Álvarez
- Hematology and Hemotherapy Department, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Marta Sobas
- Haematology, Blood Neoplasms, and Bone Marrow Transplantation, Wroclaw Medical University, Wrocław, Poland
| | | | - Rebeca Cuello García
- Hematology and Hemotherapy Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | - Begoña Navas Elorza
- Hematology and Hemotherapy Department, Hospital HLA Universitario Moncloa, Madrid, Spain
| | | | | | | | - Erik de Cabo López
- Hematology Department, Hospital Universitario del Bierzo, Ponferrada, Spain
| | | | - Raimundo García Boyero
- Hematology and Hemotherapy Department, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | | | - Cristina Seri Merino
- Hematology and Hemotherapy Department, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain
| | - Carlos Cervero
- Hematology Department, Hospital Virgen de la Luz, Cuenca, Spain
| | - Alicia Roldán Pérez
- Hematology and Hemotherapy Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain
| | - Lourdes Hermosín Ramos
- Hematology and Hemotherapy Department, Hospital Jerez de la Frontera, Jerez de la Frontera, Spain
| | | | - María Telesa Olave
- Hematology and Hemotherapy Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Almudena de Laiglesiai
- Hematology and Hemotherapy Department, Hospital Universitario Puerta del Hierro, Majadahonda, Spain
| | - Josefina Serrano
- Hematology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
| | | | - José Luis Piñana
- Hematology and Hemotherapy Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Miguel Ángel Sanz
- Hematology and Hemotherapy Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Pau Montesinos
- Hematology and Hemotherapy Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| |
Collapse
|
7
|
Gurlek Gokcebay D, Akcabelen YM, Yarali N, Ozbek NY. A Survey of Parents on the Effects of COVID-19 Pandemic on Children Receiving Antileukemic Therapy. J Pediatr Hematol Oncol 2021; 43:e740-1. [PMID: 33093350 DOI: 10.1097/MPH.0000000000001969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
8
|
Meena JP, Kumar Gupta A, Tanwar P, Ram Jat K, Mohan Pandey R, Seth R. Clinical presentations and outcomes of children with cancer and COVID-19: A systematic review. Pediatr Blood Cancer 2021; 68:e29005. [PMID: 33719167 PMCID: PMC8251055 DOI: 10.1002/pbc.29005] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 01/29/2021] [Accepted: 02/19/2021] [Indexed: 12/21/2022]
Abstract
Information regarding the novel coronavirus disease (COVID-19) in pediatric oncology is limited. We conducted a systematic review of the available published literature on children with cancer affected by COVID-19. The last date of the study search was October 20, 2020, and 33 studies comprising 226 children were included for the final analysis. Data were extracted in a predefined data collection form, and the variables were extracted and analyzed. Patients with hematological malignancies were more in number. Males and children on intensive treatment were more frequently affected. Fever was the commonest symptom. The disease was asymptomatic/mild in 48% and severe in 9.6%. Consolidation, peribronchial cuffing, and consolidation with ground glass opacities were the common imaging findings. Hydroxychloroquine was the most frequently used drug for COVID-19. About 10% of children required intensive care, and about 32% had oxygen requirements. The percentage of children who died due to COVID-19 was 4.9%. The severity, morbidity, and mortality of COVID-19 in pediatric oncology were more compared to the general pediatric population. This information can help in risk stratification for the management of COVID-19.
Collapse
Affiliation(s)
- Jagdish Prasad Meena
- Division of Pediatric OncologyDepartment of PediatricsAll India Institute of Medical SciencesNew DelhiIndia
| | - Aditya Kumar Gupta
- Division of Pediatric OncologyDepartment of PediatricsAll India Institute of Medical SciencesNew DelhiIndia
| | - Pranay Tanwar
- Department of Laboratory OncologyDr. BRA Institute Research Cancer HospitalAll India Institute of Medical SciencesNew DelhiIndia
| | - Kana Ram Jat
- Division of Pediatric PulmonologyDepartment of PediatricsAll India Institute of Medical SciencesNew DelhiIndia
| | | | - Rachna Seth
- Division of Pediatric OncologyDepartment of PediatricsAll India Institute of Medical SciencesNew DelhiIndia
| |
Collapse
|
9
|
Rouger-Gaudichon J, Bertrand Y, Boissel N, Brethon B, Ducassou S, Gandemer V, Halfon-Domenech C, Leblanc T, Leverger G, Michel G, Petit A, Ray-Lunven AF, Rohrlich PS, Schneider P, Sirvent N, Strullu M, Baruchel A. COVID19 and acute lymphoblastic leukemias of children and adolescents: Updated recommendations (Version 2) of the Leukemia Committee of the French Society for the fight against Cancers and leukemias in children and adolescents (SFCE). Bull Cancer 2021; 108:490-500. [PMID: 33781551 PMCID: PMC7951944 DOI: 10.1016/j.bulcan.2021.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 02/21/2021] [Indexed: 12/12/2022]
Abstract
Since the emergence of the SARS-CoV-2 infection, many recommendations have been made. However, the very specific nature of acute lymphoblastic leukemias and their treatment in children and adolescents led the Leukemia Committee of the French Society for the fight against Cancers and leukemias in children and adolescents (SFCE) to propose more specific recommendations. Here is the second version of these recommendations updated according to the evolution of knowledge on COVID19.
Collapse
Affiliation(s)
- Jérémie Rouger-Gaudichon
- Unité d'hémato-oncologie pédiatrique, CHU Caen, avenue de la Côte de Nacre, 14033 Caen cedex 9, France
| | - Yves Bertrand
- Institut d'hémato-oncologie pédiatrique, CHU Lyon, 3, quai des Célestins, 69002 Lyon, France
| | - Nicolas Boissel
- Université de Paris, unité adolescents et jeunes adultes, hôpital Saint-Louis (APHP), 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - Benoit Brethon
- Université de Paris, service d'hémato-immunologie pédiatrique, hôpital universitaire Robert-Debré (APHP), boulevard Sérurier, 75019 Paris, France
| | - Stéphane Ducassou
- Groupe hospitalier Pellegrin, unité d'hémato-oncologie pédiatrique, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Virginie Gandemer
- Service d'hémato-oncologie pédiatrique, CHU Rennes, 16, boulevard de Bulgarie, 35200 Rennes, France
| | - Carine Halfon-Domenech
- Institut d'hémato-oncologie pédiatrique, CHU Lyon, 3, quai des Célestins, 69002 Lyon, France
| | - Thierry Leblanc
- Université de Paris, service d'hémato-immunologie pédiatrique, hôpital universitaire Robert-Debré (APHP), boulevard Sérurier, 75019 Paris, France
| | - Guy Leverger
- Hôpital Armand-Trousseau (APHP) et Sorbonne Université, service d'hémato-oncologie pédiatrique, 26, avenue du Docteur-Arnold-Netter, 75571 Paris cedex 12, France
| | - Gérard Michel
- CHU la Timone, service d'hématologie pédiatrique, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
| | - Arnaud Petit
- Hôpital Armand-Trousseau (APHP) et Sorbonne Université, service d'hémato-oncologie pédiatrique, 26, avenue du Docteur-Arnold-Netter, 75571 Paris cedex 12, France
| | - Anne-France Ray-Lunven
- Université de Paris, service d'hémato-immunologie pédiatrique, hôpital universitaire Robert-Debré (APHP), boulevard Sérurier, 75019 Paris, France
| | - Pierre-Simon Rohrlich
- CHU l'Archet, service d'hémato-oncologie pédiatrique, 151, route de Saint-Antoine, 06200 Nice, France
| | - Pascale Schneider
- CHU Charles-Nicolle, service d'hématologie pédiatrique, 37, boulevard Gambetta, 76038 Rouen, France
| | - Nicolas Sirvent
- CHU Arnaud-de-Villeneuve, service d'hématologie et oncologie pédiatrique, 191, avenue du Doyen-Giraud, 34295 Montpellier cedex 5, France
| | - Marion Strullu
- Université de Paris, service d'hémato-immunologie pédiatrique, hôpital universitaire Robert-Debré (APHP), boulevard Sérurier, 75019 Paris, France
| | - André Baruchel
- Université de Paris, service d'hémato-immunologie pédiatrique, hôpital universitaire Robert-Debré (APHP), boulevard Sérurier, 75019 Paris, France.
| |
Collapse
|
10
|
Nicastro E, Verdoni L, Bettini LR, Zuin G, Balduzzi A, Montini G, Biondi A, D'Antiga L. COVID-19 in Immunosuppressed Children. Front Pediatr 2021; 9:629240. [PMID: 33996683 PMCID: PMC8116542 DOI: 10.3389/fped.2021.629240] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/03/2021] [Indexed: 12/15/2022] Open
Abstract
Following the spread of the SARS-CoV-2 infection and coronavirus disease 2019 (COVID-19) to a global pandemic, concerns have arisen for the disease impact in at-risk populations, especially in immunocompromised hosts. On the other hand, clinical studies have clarified that the COVID-19 clinical burden is mostly due to over-inflammation and immune-mediated multiorgan injury. This has led to downsizing the role of immunosuppression as a determinant of outcome, and early reports confirm the hypothesis that patients undergoing immunosuppressive treatments do not have an increased risk of severe COVID-19 with respect to the general population. Intriguingly, SARS-CoV-2 natural reservoirs, such as bats and mice, have evolved mechanisms of tolerance involving selection of genes optimizing viral clearance through interferon type I and III responses and also dampening inflammasome response and cytokine expression. Children exhibit resistance to COVID-19 severe manifestations, and age-related features in innate and adaptive response possibly explaining this difference are discussed. A competent recognition by the innate immune system and controlled pro-inflammatory signaling seem to be the pillars of an effective response and the premise for pathogen clearance in SARS-CoV-2 infection. Immunosuppression-if not associated with other elements of fragility-do not represent per se an obstacle to this competent/tolerant phenotype in children. Several reports confirm that children receiving immunosuppressive medications have similar clinical involvement and outcomes as the pediatric general population, indicating that maintenance treatments should not be interrupted in suspect or confirmed SARS-CoV-2 infection.
Collapse
Affiliation(s)
- Emanuele Nicastro
- Pediatric Hepatology, Gastroenterology and Transplantation Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Lucio Verdoni
- Pediatric Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Laura Rachele Bettini
- MBBM Foundation, Pediatric Department, Hospital San Gerardo, University of Milano Bicocca, Monza, Italy
| | - Giovanna Zuin
- MBBM Foundation, Pediatric Department, Hospital San Gerardo, University of Milano Bicocca, Monza, Italy
| | - Adriana Balduzzi
- MBBM Foundation, Pediatric Department, Hospital San Gerardo, University of Milano Bicocca, Monza, Italy
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Andrea Biondi
- MBBM Foundation, Pediatric Department, Hospital San Gerardo, University of Milano Bicocca, Monza, Italy
| | - Lorenzo D'Antiga
- Pediatric Hepatology, Gastroenterology and Transplantation Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy
- Pediatric Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy
| |
Collapse
|
11
|
Abstract
The coronavirus disease 2019 (COVID-19) is an emerging infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Within a matter of months, this highly contagious novel virus has led to a global outbreak and is still spreading rapidly across continents. In patients with COVID-19, underlying chronic diseases and comorbidities are associated with dismal treatment outcomes. Owing to their immunosuppressive status, patients with hematological malignancies (HMs) are at an increased risk of infection and have a worse prognosis than patients without HMs. Accordingly, intensive attention should be paid to this cohort. In this review, we summarize and analyze specific clinical manifestations for patients with coexisting COVID-19 and HMs. Furthermore, we briefly describe customized management strategies and interventions for this susceptible cohort. This review is intended to guide clinical practice.
Collapse
Affiliation(s)
- Lin-Qin Wang
- Bone Marrow Transplantation Center, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.,Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou 310058, China.,Institute of Hematology, Zhejiang University, Hangzhou 310058, China.,Zhejiang Laboratory for Systems & Precision Medicine, Zhejiang University Medical Center, Hangzhou 310058, China
| | - Elaine Tan Su Yin
- Bone Marrow Transplantation Center, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.,Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou 310058, China.,Institute of Hematology, Zhejiang University, Hangzhou 310058, China.,Zhejiang Laboratory for Systems & Precision Medicine, Zhejiang University Medical Center, Hangzhou 310058, China
| | - Guo-Qing Wei
- Bone Marrow Transplantation Center, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.,Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou 310058, China.,Institute of Hematology, Zhejiang University, Hangzhou 310058, China.,Zhejiang Laboratory for Systems & Precision Medicine, Zhejiang University Medical Center, Hangzhou 310058, China
| | - Yong-Xian Hu
- Bone Marrow Transplantation Center, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.,Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou 310058, China.,Institute of Hematology, Zhejiang University, Hangzhou 310058, China.,Zhejiang Laboratory for Systems & Precision Medicine, Zhejiang University Medical Center, Hangzhou 310058, China
| | - Arnon Nagler
- Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel
| | - He Huang
- Bone Marrow Transplantation Center, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.,Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou 310058, China.,Institute of Hematology, Zhejiang University, Hangzhou 310058, China.,Zhejiang Laboratory for Systems & Precision Medicine, Zhejiang University Medical Center, Hangzhou 310058, China
| |
Collapse
|
12
|
Olson LB, Naqvi IA, Turner DJ, Morrison SA, Kraft BD, Chen L, Sullenger BA, Nair SK, Que LG, Levy JH. Key Pathogenic Factors in Coronavirus Disease 2019-Associated Coagulopathy and Acute Lung Injury Highlighted in a Patient With Copresentation of Acute Myelocytic Leukemia: A Case Report. A A Pract 2021; 15:e01432. [PMID: 33783367 PMCID: PMC8330627 DOI: 10.1213/xaa.0000000000001432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2021] [Indexed: 01/02/2023]
Abstract
The role of concurrent illness in coronavirus disease 2019 (COVID-19) is unknown. Patients with leukemia may display altered thromboinflammatory responses. We report a 53-year-old man presenting with acute leukemia and COVID-19 who developed thrombotic complications and acute respiratory distress syndrome. Multiple analyses, including rotational thromboelastometry and flow cytometry on blood and bronchoalveolar lavage, are reported to characterize coagulation and immune profiles. The patient developed chemotherapy-induced neutropenia that may have protected his lungs from granulocyte-driven hyperinflammatory acute lung injury. However, neutropenia also alters viral clearing, potentially enabling ongoing viral propagation. This case depicts a precarious equilibrium between leukemia and COVID-19.
Collapse
Affiliation(s)
- Lyra B. Olson
- From the Duke Medical Scientist Training Program, Department of Pharmacology and Cancer Biology and
| | - Ibtehaj A. Naqvi
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Daniel J. Turner
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Sarah A. Morrison
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Bryan D. Kraft
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Lingye Chen
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Bruce A. Sullenger
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Smita K. Nair
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Loretta G. Que
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Jerrold H. Levy
- Departments of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, North Carolina
| |
Collapse
|
13
|
Cuzzubbo D, Pegoraro F, Frenos S, Casini T, Galli L, Gambineri E, Bambi F, Tintori V, Favre C. Planned hematopoietic stem cell transplantation in a 17-month-old patient with high-risk acute myeloid leukemia and persistent SARS-CoV-2 infection. Transfusion 2021; 61:1657-1659. [PMID: 33682137 PMCID: PMC8251374 DOI: 10.1111/trf.16361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/09/2021] [Accepted: 02/14/2021] [Indexed: 01/06/2023]
Affiliation(s)
- Daniela Cuzzubbo
- Pediatric Haematology/Oncology and HSCT Department, Meyer Children's University Hospital, Florence, Italy
| | - Francesco Pegoraro
- Pediatric Haematology/Oncology and HSCT Department, Meyer Children's University Hospital, Florence, Italy.,Department of Health Science, University of Florence, Florence, Italy
| | - Stefano Frenos
- Pediatric Haematology/Oncology and HSCT Department, Meyer Children's University Hospital, Florence, Italy
| | - Tommaso Casini
- Pediatric Haematology/Oncology and HSCT Department, Meyer Children's University Hospital, Florence, Italy
| | - Luisa Galli
- Department of Health Science, University of Florence, Florence, Italy.,Pediatric Infectious Diseases Division, Meyer Children's University Hospital, Florence, Italy
| | - Eleonora Gambineri
- Pediatric Haematology/Oncology and HSCT Department, Meyer Children's University Hospital, Florence, Italy.,Department of Health Science, University of Florence, Florence, Italy
| | - Franco Bambi
- Blood Bank, Meyer Children's University Hospital, Florence, Italy
| | - Veronica Tintori
- Pediatric Haematology/Oncology and HSCT Department, Meyer Children's University Hospital, Florence, Italy
| | - Claudio Favre
- Pediatric Haematology/Oncology and HSCT Department, Meyer Children's University Hospital, Florence, Italy
| |
Collapse
|
14
|
Abstract
Coronaviruses, seven of which are known to infect humans, can cause a spectrum of clinical presentations ranging from asymptomatic infection to severe illness and death. Four human coronaviruses (hCoVs)-229E, HKU1, NL63 and OC43-circulate globally, commonly infect children and typically cause mild upper respiratory tract infections. Three novel coronaviruses of zoonotic origin have emerged during the past two decades: severe acute respiratory syndrome coronavirus (SARS-CoV-1), Middle East respiratory syndrome coronavirus (MERS-CoV) and the recently discovered severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which is the cause of the ongoing coronavirus disease 2019 (COVID-19) pandemic. These novel coronaviruses are known to cause severe illness and death predominantly in older adults and those with underlying comorbidities. Consistent with what has been observed during the outbreaks of SARS and MERS, children with COVID-19 are more likely to be asymptomatic or to have mild-to-moderate illness, with few deaths reported in children globally thus far. Clinical symptoms and laboratory and radiological abnormalities in children have been similar to those reported in adults but are generally less severe. A rare multisystem inflammatory syndrome in children (MIS-C) which has resulted in critical illness and some deaths has recently been described. Clinical trials for therapeutics and vaccine development should include paediatric considerations. Children may play an important role in the transmission of infection and outbreak dynamics and could be a key target population for effective measures to control outbreaks. The unintended consequences of the unprecedented scale and duration of pandemic control measures for children and families around the world should be carefully examined.Abbreviations: 2019-nCoV, 2019 novel coronavirus; ADEM, acute demyelinating encephalomyelitis; AAP, American Academy of Pediatrics; ACE-2, angiotensin-converting enzyme 2; ARDS, acute respiratory distress syndrome; BCG, bacillus Calmette-Guérin; BNP, brain natriuretic peptide; CDC, Centers for Disease Control and Prevention; CRP, C-reactive protein; CSF, cerebrospinal fluid; COVID-19, coronavirus disease 2019; CT, computed tomography; CXR, chest X-ray; DOL, day of life; hCoV, human coronavirus; ICU, intensive care unit; IL, interleukin; IVIG, intravenous immunoglobulin; KD, Kawasaki disease; LDH, lactate dehydrogenase; MERS, Middle East respiratory syndrome; MERS-CoV, Middle East respiratory syndrome coronavirus; MEURI, monitored emergency use of unregistered and experimental interventions; MIS-C, multi-system inflammatory syndrome in children; PCR, polymerase chain reaction; PICU, paediatric intensive care unit; RNA, ribonucleic acid; RCT, randomised-controlled trial; RSV, respiratory syncytial virus; SARS, severe acute respiratory syndrome; SARS-CoV-1, severe acute respiratory syndrome coronavirus 1; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; TNF-alpha, tumour necrosis factor alpha; UK United Kingdom; UNICEF, United Nations Children's Fund; USA, United States of America; WHO, World Health Organization.
Collapse
Affiliation(s)
- Nipunie Rajapakse
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Devika Dixit
- Division of Infectious Diseases, Department of Pediatrics and Internal Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| |
Collapse
|
15
|
Dorantes-Acosta E, Ávila-Montiel D, Klünder-Klünder M, Juárez-Villegas L, Márquez-González H. Survival and Complications in Pediatric Patients With Cancer and COVID-19: A Meta-Analysis. Front Oncol 2021; 10:608282. [PMID: 33552980 PMCID: PMC7861039 DOI: 10.3389/fonc.2020.608282] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/02/2020] [Indexed: 12/24/2022] Open
Abstract
Background The pandemic caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected all age groups, including the pediatric population, in 3–5% of all cases. We performed a meta-analysis to understand the survival and associated complications in pediatric cancer patients as well as their hospitalization, intensive care, and ventilation care (supplemental oxygen/endotracheal intubation) needs. Methods A systematic search was performed using MEDLINE, TRIP Database, International Clinical Trials Registry Platform (WHO), The Cochrane Library, Wiley, LILACS, and Google Scholar. Additionally, a search using the snowball method was performed in Nature, New England Journal of Medicine, Science, JAMA, ELSEVIER editorial, Oxford University Press, The Lancet, and MedRxiv. Searches were conducted until July 18, 2020. A total of 191 cancer patients with coronavirus disease 2019 (COVID-19) were integrated from 15 eligible studies. In a sub-analysis, patients were stratified into two groups: hematological cancer and solid tumors. Outcome measures were overall survival, risk of hospitalized or needing intensive care, and need for ventilatory support in any modality. The random effects statistical analysis was performed with Cochran’s chi square test. The odds ratio (OR) and heterogeneity were calculated using the I2 test. Results The overall survival was 99.4%. There were no statistically significant differences in the risk of hospitalization between hematological malignancies and solid tumors (95% confidence interval [CI] 0.48–18.3; OR = 2.94). The risk of being admitted to the intensive care unit was also not different between hematological malignancies and other tumors (95% CI 0.35–5.81; OR = 1.42). No differences were found for the need of ventilatory support (95% CI 0.14–3.35; OR = 0.68). Although all the studies were cross-sectional, the mortality of these patients was 0.6% at the time of analysis. Conclusions In the analyzed literature, survival in the studied group of patients with COVID-19 was very high. Suffering from hematological neoplasia or other solid tumors and COVID-19 was not a risk factor in children with cancer for the analyzed outcomes.
Collapse
Affiliation(s)
- Elisa Dorantes-Acosta
- Biobanco de Investigación en Células Leucémicas, Hospital Infantil de México Federico Gómez, México City, Mexico
| | - Diana Ávila-Montiel
- Subdirección de Investigación, Hospital Infantil de México Federico Gómez, México City, Mexico
| | - Miguel Klünder-Klünder
- Subdirección de Investigación, Hospital Infantil de México Federico Gómez, México City, Mexico
| | - Luis Juárez-Villegas
- Departamento de Onco-Hematología, Hospital Infantil de México Federico Gómez, México City, Mexico
| | - Horacio Márquez-González
- Investigación Clínica, Hospital Infantil de México Federico Gómez, México City, Mexico.,Cardiopatías Congénitas. Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), México City, Mexico
| |
Collapse
|
16
|
Centeno‐Tablante E, Medina‐Rivera M, Finkelstein JL, Rayco‐Solon P, Garcia‐Casal MN, Rogers L, Ghezzi‐Kopel K, Ridwan P, Peña‐Rosas JP, Mehta S. Transmission of SARS-CoV-2 through breast milk and breastfeeding: a living systematic review. Ann N Y Acad Sci 2021; 1484:32-54. [PMID: 32860259 PMCID: PMC7970667 DOI: 10.1111/nyas.14477] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 01/08/2023]
Abstract
The pandemic of coronavirus disease 2019 (COVID-19) is caused by infection with a novel coronavirus strain, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). At present, there is limited information on potential transmission of the infection from mother to child, particularly through breast milk and breastfeeding. Here, we provide a living systematic review to capture information that might necessitate changes in the guidance on breast milk and breastfeeding given the uncertainty in this area. Our search retrieved 19,414 total records; 605 were considered for full-text eligibility and no ongoing trials were identified. Our review includes 340 records, 37 with breast milk samples and 303 without. The 37 articles with analyzed breast milk samples reported on 77 mothers who were breastfeeding their children; among them, 19 of 77 children were confirmed COVID-19 cases based on RT-PCR assays, including 14 neonates and five older infants. Nine of the 68 analyzed breast milk samples from mothers with COVID-19 were positive for SARS-CoV-2 RNA; of the exposed infants, four were positive and two were negative for COVID-19. Currently, there is no evidence of SARS-CoV-2 transmission through breast milk. Studies are needed with longer follow-up periods that collect data on infant feeding practices and on viral presence in breast milk.
Collapse
Affiliation(s)
| | | | | | - Pura Rayco‐Solon
- Department of Maternal, Newborn,
Child and Adolescent Health and AgeingWorld Health OrganizationGenevaSwitzerland
| | | | - Lisa Rogers
- Department of Nutrition and Food
SafetyWorld Health OrganizationGenevaSwitzerland
| | | | - Pratiwi Ridwan
- Division of Nutritional
SciencesCornell UniversityIthacaNew York
| | | | - Saurabh Mehta
- Division of Nutritional
SciencesCornell UniversityIthacaNew York
| |
Collapse
|
17
|
Perikleous E, Tsalkidis A, Bush A, Paraskakis E. Coronavirus global pandemic: An overview of current findings among pediatric patients. Pediatr Pulmonol 2020; 55:3252-3267. [PMID: 32965785 PMCID: PMC7646267 DOI: 10.1002/ppul.25087] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic has been emerged as a cardinal public health problem. Children have their own specific clinical features; notably, they seem to be escaping the severe respiratory adverse effects. The international scientific community is rapidly carrying out studies, driving to the need to reassess knowledge of the disease and therapeutic strategies. AIM To assess the characteristics of COVID-19 infected children worldwide of all ages, from neonates to children and adolescents, and how they differ from their adult counterparts. SEARCH STRATEGY An electronic search in PubMed was conducted, using combinations of the following keywords: coronavirus, SARS-CoV-2, COVID-19, children. The search included all types of articles written in English between January 1, 2019 until August 15, 2020. RESULTS The search identified 266 relevant articles. Children were mainly within family clusters of cases and have relatively milder clinical presentation compared with adults; children were reported to have better outcomes with a significantly lower mortality rate. Cough and fever were the most common symptoms while pneumonia was the cardinal respiratory manifestation of infected children. Laboratory results and thoracic imaging give varying results. CONCLUSIONS Children were mainly family cluster cases and usually presented with a mild infection, although cases presented with the multisystem inflammatory syndrome are becoming more apparent. Studies determining why the manifestations of SARS-CoV-2 infection are so variable may help to gain a better understanding of the disease and accelerate the development of vaccines and therapies.
Collapse
Affiliation(s)
| | - Aggelos Tsalkidis
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece.,Department of Pediatrics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Andrew Bush
- Departments of Pediatrics and Pediatric Respiratory Medicine, Royal Brompton Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Emmanouil Paraskakis
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece.,Department of Pediatrics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| |
Collapse
|
18
|
Wolfs TF, Attarbaschi A, Balduzzi A, Bernardo ME, Bomken S, Borkhardt A, Bourquin JP, Dufour C, Gennery A, Grainger J, Hasle H, Hrusak O, Izraeli S, Mechinaud F, Trka J, Vormoor J. COVID-19 - Impact on Childhood Haematology Patients. Hemasphere 2020; 4:e465. [PMID: 32984769 PMCID: PMC7489725 DOI: 10.1097/hs9.0000000000000465] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/07/2020] [Indexed: 01/10/2023] Open
Affiliation(s)
- Tom F.W. Wolfs
- Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Adriana Balduzzi
- Clinica Pediatrica, Università degli Studi di Milano Bicocca, Fondazione MBBM / Ospedale San Gerardo, ASST Monza, Italy
| | - Maria Ester Bernardo
- Pediatric Immunohematology Unit and BMT Program, San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan; Vita-Salute San Raffaele University Milan, Italy
| | - Simon Bomken
- Translational and Clinical Research Institute, Newcastle University and The Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Arndt Borkhardt
- Department of Paediatric Oncology, Haematology and Clinical Immunology, Medical Faculty, Heinrich-Heine University Dusseldorf, Dusseldorf, Germany
| | - Jean-Pierre Bourquin
- Divisions of Oncology, Hematology, Immunology and Stem Cell Transplantion, University Children's Hospital Zurich, Switzerland
| | | | - Andrew Gennery
- Newcastle University and Great North Children's Hospital, Newcastle upon Tyne, UK
| | - John Grainger
- Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital, Aarhus University, Denmark
| | - Ondrej Hrusak
- CLIP – Childhood Leukaemia Investigation Prague, Second Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Shai Izraeli
- Rina Zaizov Pediatric Hematology Oncology Division, Schneider Children's Medical Center of Israel, Petach Tiqva, and Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Israel
| | | | - Jan Trka
- CLIP – Childhood Leukaemia Investigation Prague, Second Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Josef Vormoor
- Department of Pediatric Hemato-oncology, Princess Máxima Centrum for Pediatric Oncology, Utrecht, The Netherlands
| |
Collapse
|
19
|
Canarutto D, Del Barba P, Di Frenna M, Del Tedesco F, Pajno R, Guarneri MP, Barera G. Prolonged asymptomatic SARS-CoV-2 infection in a child receiving immunosuppressive therapy. Pediatr Pulmonol 2020; 55:2504-2505. [PMID: 32735761 PMCID: PMC7436661 DOI: 10.1002/ppul.24983] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/06/2020] [Accepted: 07/22/2020] [Indexed: 11/22/2022]
Affiliation(s)
- Daniele Canarutto
- Pediatric Department, IRCCS Ospedale San Raffaele, Milano, Italy.,Faculty of Medicine and Surgery, Università Vita Salute San Raffaele, Milano, Italy.,Pediatric Immunohematology Unit and BMT Program, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Paolo Del Barba
- Pediatric Department, IRCCS Ospedale San Raffaele, Milano, Italy
| | | | - Federica Del Tedesco
- Pediatric Department, IRCCS Ospedale San Raffaele, Milano, Italy.,Faculty of Medicine and Surgery, Università Vita Salute San Raffaele, Milano, Italy
| | - Roberta Pajno
- Pediatric Department, IRCCS Ospedale San Raffaele, Milano, Italy
| | | | - Graziano Barera
- Pediatric Department, IRCCS Ospedale San Raffaele, Milano, Italy.,Faculty of Medicine and Surgery, Università Vita Salute San Raffaele, Milano, Italy
| |
Collapse
|
20
|
Gale RP. COVID-19 in Patients with Hematologic Disorders Undergoing Therapy: Perspective of a Large Referral Hematology Center in Rome. Acta Haematol 2020; 143:574-582. [PMID: 32155631 PMCID: PMC7573911 DOI: 10.1159/000510769] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/07/2020] [Indexed: 12/16/2022]
Abstract
Introduction Patients with cancer may be more susceptible to and have higher morbidity and mortality rates from COVID-19 than the general population, while epidemiologic data specifically addressed to hematologic patients are limited. To investigate whether patients with hematologic diseases undergoing therapy are at increased risk for acquiring SARS CoV-2 infection compared to the general population, a retrospective study was carried out at a referral hematologic center in Rome, Italy, during the period of the greatest epidemic spread (March 8 to May 14, 2020). Methods All adult and pediatric patients with a diagnosis of a neoplastic or a nonneoplastic hematologic disease who underwent treatment (chemotherapy or immunosuppressive or supportive therapy) during the study period or in the previous 6 months were considered. The prevalence of COVID-19 in the overall outpatient and inpatient population undergoing hematologic treatment compared to that of the general population was analyzed. The measures taken to manage patients during the epidemic period are described. Results Overall, 2,513 patients with hematological diseases were considered. Out of 243 (9.7%) patients who were screened for SARS CoV-2, three of 119 (2.5%) outpatients with fever or respiratory symptoms and none of 124 asymptomatic patients were diagnosed with COVID-19. Three further patients were diagnosed with COVID-19 and managed in other hospitals in Rome. As of May 14, 2020, the prevalence of COVID-19 in our hematologic population accounted for 0.24% (95% CI 0.23–0.25; 6 of 2,513 patients: 1 case in every 419 patients) as compared to 0.12% (7,280 of 5,879,082 residents; 1 case in every 807 residents) in the general population (p = 0.14). Three of 6 patients diagnosed with COVID-19 required critical care and 2 died while still positive for SARS CoV-2. Out of 225 healthcare providers on duty at our Institution during the study period, 2 (0.9%) symptomatic cases were diagnosed with COVID-19. Conclusion In our experience, the prevalence of COVID-19 in hematologic patients, mainly affected by malignancies, was not significantly higher compared to that of the general population. Definition of adapted strategies for healthcare services, while continuing to administer the standard hematologic treatments, represents the crucial challenge for the management of hematologic diseases in the COVID-19 era.
Collapse
Affiliation(s)
- Robert Peter Gale
- Centre forHaematology, Department of Immunology and Inflammation, Imperial College London, London, United Kingdom,
| |
Collapse
|
21
|
Akcabelen YM, Koca Yozgat A, Parlakay AN, Yarali N. COVID-19 in a child with severe aplastic anemia. Pediatr Blood Cancer 2020; 67:e28443. [PMID: 32539221 PMCID: PMC7323031 DOI: 10.1002/pbc.28443] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Yunus Murat Akcabelen
- Department of Pediatric HematologyAnkara City Hospital Children's HospitalAnkaraTurkey
| | - Ayca Koca Yozgat
- Department of Pediatric HematologyAnkara City Hospital Children's HospitalAnkaraTurkey
| | - Asli Nur Parlakay
- Department of Pediatric Infectious DiseaseAnkara City Hospital Children's HospitalAnkaraTurkey
| | - Nese Yarali
- Department of Pediatric HematologyAnkara City Hospital Children's HospitalAnkaraTurkey
| |
Collapse
|
22
|
Ferrara F, Zappasodi P, Roncoroni E, Borlenghi E, Rossi G. Impact of Covid-19 on the treatment of acute myeloid leukemia. Leukemia 2020; 34:2254-2256. [PMID: 32561842 PMCID: PMC7304503 DOI: 10.1038/s41375-020-0925-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 05/27/2020] [Accepted: 06/09/2020] [Indexed: 12/26/2022]
Affiliation(s)
| | - Patrizia Zappasodi
- Division of Hematology, Foundation, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elisa Roncoroni
- Division of Hematology, Foundation, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Erika Borlenghi
- Division of Hematology, Spedali Civili Brescia, Brescia, Italy
| | - Giuseppe Rossi
- Division of Hematology, Spedali Civili Brescia, Brescia, Italy
| |
Collapse
|
23
|
Bellmann-Weiler R, Burkert F, Schwaiger T, Schmidt S, Ludescher C, Oexle H, Wolf D, Weiss G. Janus-faced course of COVID-19 infection in patients with hematological malignancies. Eur J Haematol 2020; 105:502-504. [PMID: 32557918 PMCID: PMC7323382 DOI: 10.1111/ejh.13470] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Rosa Bellmann-Weiler
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Francesco Burkert
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Theresa Schwaiger
- Department of Internal Medicine V, Medical University of Innsbruck, Innsbruck, Austria
| | - Stephan Schmidt
- Department of Internal Medicine V, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Horst Oexle
- Department of Internal Medicine, District Hospital Hall, Hall, Austria
| | - Dominik Wolf
- Department of Internal Medicine V, Medical University of Innsbruck, Innsbruck, Austria
| | - Günter Weiss
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
24
|
Gale RP. Treating Plasma Cell Myeloma in Developing Countries: Does Everyone Need the Newest Drugs? Acta Haematol 2020; 143:513-515. [PMID: 32155631 DOI: 10.1159/000505991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 01/15/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Robert Peter Gale
- Centre forHaematology, Department of Immunology and Inflammation, Imperial College London, London, United Kingdom,
| |
Collapse
|