Clinical Profile and Outcome of COVID-19 Among Immunocompromised Children

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children manifests as mild to moderate disease with low fatality [1]. There is limited information about susceptibility to SARS-CoV-2 infection, clinical profile and outcome among immunocompromised children in India. Published literature has revealed milder disease and favorable outcome without discontinuation of immunosuppressive medication in these children [2][3][4][5][6]. We, herein describe the clinical features and outcome of immunocompromised children diagnosed with SARS-CoV-2 infection at our center.This was a retrospective analysis of data from 1 June to 31 October, 2020 at a tertiary care center of a teaching hospital. The analysis was approved by institutional ethics committee. All children admitted during the study period were screened for SARS-CoV-2 infection and those who were diagnosed with coronavirus disease 19 (COVID-19) were classified into immunocompromised and immunocompetent. All immunocompromised children in the present study were either on anticancer drugs or immunosuppressive therapy for kidney diseases, and fulfilling criteria for immunocompromised state [6]. The variables extracted from the hospital records were age, gender, presenting symptoms, complications, severity of illness, diagnosis, laboratory investigations, imaging findings, treatment and outcome. The diagnosis of COVID-19 was made by positive reverse transcription polymerase chain reaction (RT-PCR) test for SARS-CoV-2. The severity of illness was classified as per guidelines given by Ministry of Health and Family Welfare, Government of India [7], and children were treated as per unit protocol without alteration in immunosuppressive treatment regime. Proportions were compared using Fisher exact test.

Progress in the Diagnosis and Treatment of COVID-19 in Children: A Review

“… 75 The frequency of dyspnea and mortality in immunocompromised adults hospitalized may be due to their incidence of complications (such as hypertension, cardiovascular disease and diabetes). 32 Children have relatively fewer neurological complications after infection with SARS-CoV-2 compared with adults. 76 Neurological symptoms are mainly non-specific symptoms such as headaches, and the incidence of severe symptoms and specific complications is only about 1%.…”

“… 31 Immunocompromised children have a 2.89-fold increased risk of contracting SARS-CoV-2. 32 On the other hand, as children age, the risk posed by a history of malnutrition to children with severe COVID-19 decreases only slightly and is highest in younger children (under 5 years of age). 29 At the same time, the length of hospital stay was significantly prolonged in children with other viral (such as adenovirus, rhinovirus, enterovirus, etc.)…”

“… 72 Compared with adults, vomiting and diarrhea are more common in pediatric patients, while the incidence of fever and pulmonary symptoms is lower, 22 and anosmia and taste are less common. 73 Children with cancer, children undergoing hematopoietic cell transplantation, children undergoing solid organ transplantation and other children taking immunosuppressive agents mostly present with asymptomatic or mild gastrointestinal symptoms due to low immune function and weak immune response after infection with COVID-19, 32 , 74 with a low risk of death. 75 The frequency of dyspnea and mortality in immunocompromised adults hospitalized may be due to their incidence of complications (such as hypertension, cardiovascular disease and diabetes).…”

clinical presentation and clinical severity of COVID-19 in pediatric age group in Iraq

“…After infection with COVID-19, children with cancer, children undergoing hematopoietic cell transplantation, children undergoing solid organ transplantation, and other children taking immunosuppressive agents typically present with asymptomatic or mild gastrointestinal symptoms, with a low risk of death (12). The high incidence of dyspnea and death in immunocompromised persons admitted to hospitals could be attributable to complications (such as hypertension, cardiovascular disease and diabetes) (22). When compared to adults, children suffer fewer neurological problems as a result of SARS-CoV-2 infection.…”

“…Children with chronic medical conditions have been shown to be three times more liable for severe disease than children who are free of such disorders (16). Children with immune suppression have been shown to be about 2.89 times more liable to develop severe disease when compared to immune competent children (17). Moreover, children with concomitant viral infection are more prone for prolonged hospital stay (18).…”