Clinical and epidemiological characteristics of pediatric COVID-19 patients in a community-based study

Összefoglaló. Bevezetés: A COVID-19-pandémia kapcsán számos tanulmány vizsgálta a tünetek gyakoriságát és a járványterjedés jellemzőit gyermekkorban, kevés azonban az alapellátás adatait összefoglaló publikáció. Közleményünkben 12 házi gyermekorvosi praxis 545 SARS-CoV-2-fertőzött betegének adatait elemeztük a 2. (n = 293) és a 3. (n = 252) járványhullámban. Célkitűzés: A gyermekkori fertőzések tünettanának és epidemiológiai jellemzőinek összehasonlítása korcsoportok és járványhullámok között. Módszer: Valamennyi alapellátó praxis egységes retrospektív adatgyűjtést végzett ugyanazon paraméterek regisztrálásával. Eredmények: A 10 év alatti betegekben a láz, a nátha és a köhögés dominált (30-50%), míg a 10 év felettiekben magas arányban regisztráltunk általános tüneteket is (30-40% fejfájás, gyengeség, szaglászavar). A 2. hullámban a 11-18 évesek (68%), a 3. hullámban a 0-10 évesek (53%) voltak többségben. A 3. hullámban szignifikánsan emelkedett a légúti tünetek előfordulása, az általános tünetek gyakorisága jelentősen csökkent, és szignifikánsan nőtt a családon belüli expozíció aránya (36% vs. 58%) a 2. hullámmal összehasonlítva. A gyermekről családtagra történő továbbterjedés 24% és 16% volt a két járványhullámban, és mértékét az életkor befolyásolta. Megbeszélés: A klinikai kép az életkorral és a feltételezett vírusvariánssal mutatott összefüggést: 10 év alatt a légúti tünetek domináltak, 10 év felett szignifikánsan több általános tünetet regisztráltunk a 0-10 évesekhez képest. A 3. járványhullámban az alfa-variáns terjedésével gyakoribbá váltak a légúti tünetek, az iskolabezárások következtében megváltozott az életkori megoszlás, és megemelkedett a családi expozíció okozta fertőzések aránya. A fertőzés továbbadása háztartáson belül mindkét hullámban alacsony maradt. Következtetés: A COVID-19 klinikai megjelenését és terjedési jellemzőit jelentősen befolyásolta az érintett gyermekpopuláció életkori összetétele, a cirkuláló vírusvariáns és az aktuális korlátozó intézkedések. Orv Hetil. 2021; 162(44): 1751-1760.

SUMMARY

INTRODUCTION

During the COVID-19 pandemic, a large number of publications examined the frequency of symptoms and the mode of transmission in childhood but only a few community-based studies have been published. In our paper, 545 pediatric COVID-19 patients' data were collected by 12 primary care pediatricians in the second (n = 293) and third (n = 252) waves of the pandemic.

OBJECTIVE

To compare the frequency of symptoms and household transmission in different age groups and between the two waves.

METHOD

Patients' data and disease characteristics were recorded retrospectively in the same manner by all participating pediatricians.

RESULTS

In patients of <10 years of age, fever, rhinorrhea and cough were registered the most frequently (30-50%), in contrast to patients of >10 years, where high frequency of general symptoms was found (30-40% headache, weakness, anosmia). In the third wave, the ratio of the age group 11-18 years declined from 68% to 47%, the frequency of respiratory symptoms increased significantly, while the ratio of general symptoms decreased. Household exposition was more frequent in the third wave (36% vs. 58%), while the transmission rate from children to family members was 24% and 16%, respectively, and it varied with age.

DISCUSSION

Clinical manifestation showed relation to age and virus variant: the older age associated with higher frequency of general symptoms and the spread of the alpha variant led to the predominance of respiratory symptoms over general complaints. Prolonged school closures affected the age distribution and increased the frequency of household exposition. Secondary household transmission remained low.

CONCLUSION

Clinical and epidemiological characteristics of pediatric COVID-19 disease were highly influenced by age, dominant virus variant and mitigation measures. Orv Hetil. 2021; 162(44): 1751-1760.

Treatment of pediatric non-Hodgkin lymphoma in Hungary: 15 years experience with NHL-BFM 90 and 95 protocols

Retrospective analysis was performed to assess the survival-rates of children with non-Hodgkin lymphoma (NHL), treated according to the NHL-BFM (Berlin-Frankfurt-Münster)-90 and -95 protocols between 1990 and 2004 in Hungary, and to compare our data with the international results. Ninety-one patients had non-B-NHL, 108 B-NHL, and 31 ALCL. Complete remission rate was 89%, while 12% relapsed later. The 5-year-overall-survival was 78% and the event-free survival was 75%. These results are lower than those reported by the BFM study group, but comparable from other European centers. In the last 5 years, the results showed 10% improvement and death during induction was reduced from 10 to 3%.

[Hungarian experience with non-Hodgkin's lymphoma in childhood]

Between 1990 and 2004, 230 children with non-Hodgkin's lymphoma (NHL) were treated according to the Berlin-Frankfurt-Münster (BFM) protocols (NHL-BFM-90 and -95) in Hungary. The aim of the present study was to summarize our experience with these protocols, to assess the survival rates and to compare the Hungarian data with the international results. The male-to-female ratio was 2.59:1, the mean age at the time of diagnosis was 10 years and 1 month. Ninety-one children had lymphoblastic/T-NHL (LB/T-NHL), 108 B-NHL and 31 anaplastic large cell lymphoma (ALCL). Twenty-eight patients had relapse after a mean time of 13 months from the time of the initial diagnosis. In the above mentioned period, 16 children underwent autologous stem-cell transplantation. Nine patients with B-NHL got anti-CD20 immunotherapy. The five-year overall survival (OS) of our patients is 77.8%+/-3%, the event-free survival (EFS) is 75.1%+/-3%. The 5-year OS and EFS rates were not statistically different in the three histology groups (OS: 71.6%+/-5%, 82.7%+/-4% and 80.3%+/-7%; EFS: 68.7%+/-5%, 81.1%+/-4% and 73.9%+/-8% in LB/T-NHL, B-NHL and ALCL, respectively). We can conclude that non-Hodgkin's lymphoma has a quite good prognosis among the malignant pediatric diseases. The cure rate is over 75%. The Hungarian results are comparable with other international data. In the last five years the mortality during induction was reduced from 10% to 2% and the OS is about 10% better than it was before. In case of relapse or residual disease, therapeutic results can be improved with stem-cell transplantation with or without immunotherapy.

[Subacute cardiotoxicity caused by anthracycline therapy in children: can dexrazoxane prevent this effect?]

OBJECTIVES

The use of anthracyclines are limited by their cardiotoxic side effects (first of all congestive cardiomyopathy). In this study we analyzed the anthracycline-induced cardiotoxicity and the possible preventive role of dexrazoxane in children.

PATIENTS

158 anthracycline-treated long-term survivors could be analyzed. Sixty-one children received dexrazoxane (group D) and 97 patients received anthracyclines only (group C).

METHODS

Cardiac ultrasound examinations (ECHO) and electrocardiograms (ECG) were performed regularly from the beginning of chemotherapy and yearly thereafter. Shortening fraction (FS) was used as indicator of the ventricular function.

RESULTS

The incidence of reduced left ventricular function (FS) was 13.4% in C, and 8.2% in D (p=ns). Two years after completion of the chemotherapy FS was reduced in 13.7% in C and 0% in D, respectively (p=0.056), and 5 years after therapy in 11.0% in C and 2.4% in D, respectively (P=0.034). Left chamber wall diameter was abnormal in systole in 6% in C and 2% in D, in diastole in 11% in C and 7% in D (p=ns) after 3 years of follow-up.

CONCLUSION

Anthracycline-induced subacute cardiotoxicity can be significantly diminished by the concomitant use of dexrazoxane. For the final conclusions longer follow-up is necessary.