COVID-19 infection in children with underlying malignancies in Iran

Manifestations of COVID-19 infection in children with malignancy: A single-center experience in Jordan

BACKGROUND

The coronavirus disease 2019 (COVID-19) has been the cause of a global health crisis since the end of 2019. All countries are following the guidelines and re-commendations released by the World Health Organization to decrease the spread of the disease. Children account for only 3%-5% of COVID-19 cases. Few data are available regarding the clinical course, disease severity, and mode of treatment in children with malignancy and COVID-19.

AIM

To evaluate the treatment plan and outcome of children with malignancy who contracted COVID-19.

METHODS

A retrospective study of the medical files of patients with malignancy who contracted COVID-19 between July 2020 and June 2021 was performed. The following data were reviewed for all patients: primary disease, laboratory data, admission ward, clinical status upon admission, disease course, treatment plan, and outcome. Eligible patients were those with malignancy who tested positive for COVID-19 by reverse transcription polymerase chain reaction.

RESULTS

A total of 40 patients who had malignancy contracted COVID-19 from July 1, 2020 to June 1, 2021. Their primary diseases were as follows: 34 patients (85%) had hematological malignancies (30 had acute lymphoblastic leukemia, 2 had acute myeloblastic leukemia, and 2 had Hodgkin lymphoma), whereas 6 patients (15%) had solid tumors (2 had neuroblastoma, 2 had rhabdomyosarcoma, and 2 had central nervous system tumors). Twelve patients (30%) did not need hospitalization and underwent home isolation only, whereas twenty-eight patients (70%) required hospitalization (26 patients were admitted in the COVID-19 ward and 2 were admitted in the pediatric intensive care unit).

CONCLUSION

COVID-19 with malignancy in the pediatric age group has a benign course and does not increase the risk of having severe infection compared to other children.

Prognosis of COVID-19 in the middle eastern population, knowns and unknowns

Since its emergence in China in 2019, the SARS-CoV-2 virus has affected all countries worldwide. The virus is easily transmitted from one person to another via infected aerosols or contaminated surfaces. Unlike its counterparts, the prognosis of COVID-19 ranges from asymptomatic to critical disease or death. Several factors play a role in determining the severity of the disease in infected patients. Among others, is the pre-existence of an underlying medical condition such as diabetes, cancer, and others. Furthermore, although children are less prone to the severe form of the COVID-19 disease, they require attention due to the report of many atypical presentations of the infection, post-asymptomatic exposure. In the Middle East, little is known about the prognosis of the SARS-CoV-2 infection in high-risk categories, notably patients with diabetes, cancer, and pregnant women. The aim of this review is to summarize the current knowledge about this group of population in the middle eastern region as well as to highlight the gap in the literature. We have found that the majority of the papers were from the Gulf countries. Although, few studies were conducted; high-risk patients appear to have an increased risk of morbidity and mortality from COVID-19 compared to their counterparts. Higher levels of inflammatory markers, C-reactive protein, erythrocyte sedimentation rate, D-dimer, and ferritin levels were also observed. Children are often asymptomatic or present with atypical presentations. More studies should be conducted to determine the clinical biomarkers of COVID-19 in high-risk categories to help in patient risk stratification and management in the middle eastern population.

COVID-19 in Children with Cancer

PURPOSE OF REVIEW

This study aims to describe what is currently known about how children with cancer have been affected by the COVID-19 pandemic, including morbidity and mortality, interruptions in cancer care and delays in diagnosis, and psychosocial effects. Here we summarize the literature on how this patient population has fared during the pandemic, reviewing multiple smaller reports along with two large registries.

RECENT FINDINGS

Although children with cancer generally have better outcomes with COVID-19 infection than adults with cancer, their risks of hospitalization, ICU admission, and death are greatly increased compared to the general pediatric population. There are socioeconomic and ethnic disparities present in these effects. Children with cancer experience significant risks from the COVID-19 pandemic. It has yet to be seen how delays and interruptions of cancer treatment and direct organ toxicities caused by the virus itself may affect long-term outcomes in these patients.

COVID-19 Pandemic Experiences in Pediatric Intensive Care Unit: An Iranian Referral Hospital-Based Study

INTRODUCTION

In late February 2020, after we had informed about the presence of some cases of COVID-19 in Iran and its rapid spread throughout the country, we decided to make the necessary arrangements for patients with critical conditions in Pediatric Intensive Care Unit (PICU) at Children's Medical Center. There are a little data on critically ill children with COVID-19 infection with ICU requirements. The aim of this study was to describe clinical characteristics, laboratory parameters, treatment, and outcomes of the pediatrics population infected by SARS-CoV-2 admitted to PICU.

MATERIALS AND METHODS

This study was performed between February 2020 and May 2020 in the COVID PICU of the Children's Medical Center Hospital in Tehran, Iran. Patients were evaluated in terms of demographic categories, primary symptoms and signs at presentation, underlying disease, SARS-CoV-2 RT-PCR test result, laboratory findings at PICU admission, chest X-ray (CXR) and lung CT findings, and treatment. Moreover, the need to noninvasive ventilation (NIV) or mechanical ventilation, the length of hospital stay in the PICU, and outcomes were assessed.

RESULTS

In total, 99 patients were admitted to COVID PICU, 42.4% (42 patients) were males, and 66 patients had positive SARS-CoV-2 real-time reverse transcriptase-polymerase chain reaction (RT-PCR). There was no statistically significant difference in the frequency of clinical signs and symptoms (except for fever) among patients with positive SARS-CoV-2 RT-PCR and negative ones. Among all admitted patients, the presence of underlying diseases was noticed in 81 (82%) patients. Of 99 patients, 34 patients were treated with NIV during their admission. Furthermore, 35 patients were intubated and treated with mechanical ventilation. Unfortunately, 11 out of 35 mechanically ventilated patients (31%) passed away.

CONCLUSION

No laboratory and radiological findings in children infected with COVID-19 were diagnostic in cases with COVID-19 admitted to PICU. There are higher risks of severe COVID-19, PICU admission, and mortality in children with comorbidities.