COVID-19-Associated Pulmonary Fungal Infection among Pediatric Cancer Patients, a Single Center Experience

Madney, Youssef; Shalaby, Lobna; Hammad, Mahmoud; Elanany, Mervat; Hassan, Reem; Youssef, Ayda; Abdo, Ibrahim; Zaki, Abeer; Khedr, Reham

doi:10.3390/jof8080850

Cited by 6 publications

(5 citation statements)

References 31 publications

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“…Of 100 mini-BAL samples from COVID-19 patients, 12% of cases (n: 12) turned positive BAL PCR for Mucor spp. Among the positive cases, there were 83% males (n: 10) and 17% females (n: 2), very much in line with other studies, where mucor presence is more common among males (3,7,8,12,15,17,18). In this study, due to primers specific to A. fumigatus, other Aspergillus species were not which is one of the study's limitations.…”

Section: Discussionsupporting

confidence: 84%

The First Fungal Identification from Mini-BAL of Critical COVID-19 Patients

Fallah,

Lotfali,

Azimi

et al. 2023

Arch Pediatr Infect Dis

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Background: Coronavirus disease 2019 (COVID-19) has become a worldwide issue due to its high prevalence and rapid transmission. Fungal infections have been detected in COVID-19 patients, leading to increased morbidity and mortality. Objectives: This study aimed to isolate Aspergillus fumigatus and Mucor spp. on mini-bronchoalveolar lavage samples obtained from children with COVID-19 hospitalized in an Iranian children's hospital. Methods: A cross-sectional descriptive study was performed on mini-bronchoalveolar lavage samples from children confirmed positive for COVID-19 admitted to ICU with a ventilator from April 2021 to February 2022. Demographic characteristics were recorded, and fungal DNA was extracted from mini-BAL samples taken from children. Nested PCR was made with two primers for Aspergillus fumigatus and Mucor spp. Results: Out of 100 children with COVID-19, all samples were negative for Aspergillus fumigatus; however, 12 cases were positive for BAL PCR for Mucor spp. Among the 12 patients, fever, shortness of breath, cough, and decreased level of consciousness were reported in 8.3% (n: 1), 16.6% (n: 2), 25% (n: 3), and 25% (n: 3), respectively. Most cases (41.7%; n: 5) suffered from heart disease, followed by underlying malignancy (33.4%; n: 4). All positive BAL PCR for Mucor spp. cases had significantly higher chest CT scan scores and spent more time under a ventilator. Conclusions: The identification of COVID-19 with Mucor spp. was observed among 12% (n: 12) of children hospitalized in a COVID-19 ICU. When dealing with pediatric COVID-19 patients, clinicians should consider the differential diagnosis of fungal co-infections and have a low threshold to begin treatment. Moreover, it is highly advisable to take prophylactic measures, such as properly using corticosteroids and shortening the intubation time.

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Section: Discussionsupporting

confidence: 84%

The First Fungal Identification from Mini-BAL of Critical COVID-19 Patients

Fallah,

Lotfali,

Azimi

et al. 2023

Arch Pediatr Infect Dis

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“…Clinical course of COVID-19 in blood cancer children was severe (n = 111, 8.6%) or critical (n = 47, 3.6%), and 41 children (3.2%) eventually died related to COVID-19. Indeed, majority of blood cancer children who died from SARS-CoV-2 infection had relapsed/refractory and advanced blood cancer (7,37,74,77,92,147,150,171,173,176,178) or signi cant medical comorbidities in addition to the uncontrollable cancer (17,19,21,65,99,104,108,110,138,150,153,170,172). Lower COVID-19 severity in blood cancer children infected with SARS-CoV-2 compared to the adults can be explained by the following theories: a) Less expression of angiotensin-converting enzyme 2 distribution that may limit SARS-CoV-2 entry into child's body organs and subsequent in ammation, hypoxia, and tissue injury (184), b) Less risk to hyper in ammatory immune response in children (185), and/or c) Immature receptor system, immune-system-speci c regulatory mechanisms, and possible cross-protection from other common pathogens in children (186).…”

Section: Discussionmentioning

confidence: 99%

“…The median interquartile range (IQR) age of this group was 96 months [48 to 156], with an increased male predominance in leukaemia patients diagnosed with COVID-19 in most of the studies (198/304 = 65.1%) (4, 7, 13-15, 17, 23, 31, 33, 34, 36, 37, 40, 59-63, 70, 72, 73, 76-78, 82, 89-92, 99, 100, 102, 109-112, 115, 118-122, 124-128, 133, 136, 137, 140, 142, 143, (3, 8, 12, 13, 19, 25, 26, 28, 31, 32, 34, 62-64, 67-69, 73, 76, 78-80, 82, 85, 86, 89-91, 94-97, 99, 100, 102, 103, 109, 110, 112, 114, 115, 118-122, 125, 128, 129, 133-137, 141, 147, 150, 151, 153, 156, 161, 167, 176, 177), Arab (160/896 = 17.8%) (23,29,58,59,92,123,126,140,150,171,173,178) and Indian (134/896 = 14.9%) (21,27,30,37,66,117,124,127,139,142,143,157,169,172,174) ethnicity. Many of these leukaemic children infected with SARS-CoV-2 were found to have active concurrent infections (n = 96) [including unspeci ed pathogens (n = 35) (19 bacteria (14,37,108,151,(171)(172)(173), 12 fungi (66, 108, 172, 173), and 4 other unknown pathogens) (113); Rhinovirus (n = 6) (28, 76, 133, 153, 160); Pseudomonas (n = 6) (17,19,21,31,…”

Section: Leukaemiamentioning

confidence: 99%

“…Most of those patients had acute leukaemic conditions (n = 892, 78.2%) (3, 4, 7, 8, 13-15, 17, 19-21, 23-34, 36-40, 58-64, 66-82, 84-86, 89, 90, 92-95, 97-100, 102, 104, 106, 108-129, 131-133, 135-137, 139-143, 146-151, 153-158, 160-163, 167-175, 177, 178) and only few cases had chronic leukaemia (n = 5, 0.4%) (91,92,129). Reported blood cancer status for the leukaemia in children infected with SARS-CoV-2 were active (n = 258/574, 44.9%) (8, 12-15, 17, 19-21, 23, 24, 29, 31, 32, 34, 35, 37, 40, 58-60, 64, 66, 73, 74, 76, 78, 79, 81, 82, 85, 86, 90, 92, 93, 95, 97-100, 102, 103, 108-112, 114, 115, 118, 120-122, 124, 127-129, 134, 136, 140, 142, 143, 146, 148-151, 154, 156, 158-160, 167, 169, 170, 172, 174, 175, 177), remission (n = 256/574, 44.6%) (3, 4, 8, 14, 15, 21, 23-28, 30, 33, 35-37, 40, 59-62, 67-72, 74, 78, 84, 89, 91, 92, 94, 107, 126, 128, 132, 135, 137, 139, 141, 150, 155, 157, 163, 167-177), or relapsed/refractory (n = 60/574, 10.4%) (7,13,14,29,37,63,67,74,77,80,92,106,117,125,131,133,147,150,169,171,173,174,176,178), however, blood cancer status in these leukaemia cases was not reported in a high percentage of patients (n = 567/1141, 49.7%) (18,20,21,38,39,92,96,104,108,113,…”

Section: Leukaemiamentioning

confidence: 99%

“…Paediatric leukaemic cases with concurrent COVID-19 had a documented mortality of 99 (8.7%) (7, 8, 15, 17-21, 35, 37-40, 59-61, 74, 77, 84, 92, 93, 99, 104, 108,110, 113, 116, 147, 150, 153, 161, 171-173, 175, 176, 178), while 1034 (90.6%) of the leukaemic children recovered(3, 4, 8, 12-15, 18-21, 23-40, 58-60, 62-64, 66-82, 84-86, 89-100, 102-104, 106-109, 111- 129, 131-137, 139-143, 146, 148-151, 153-163, 167-177). Mortality was COVID-19-related in a considerable number of paediatric leukaemic cases (41/99, 41.4%)(7,21,35,39,40, 61,74, 84,92,93,99,104,113,150,153, 161,171,173,175, 176), however, COVID-19 was not attributable to death in many of the reported leukaemic children (36/99, 36.4%) (8,15, 17, 19-21, 37, 39, 40, 59, 60, 77, 92, 104, 108, 110, 116, 154, 171, 173, 175) and few studies failed to report if COVID-19 was a leading or an underlying cause of death in those leukaemic children (22/, 22.2%)(18, 38,93,147,172, 178) (see Table2).LymphomaLymphoma was the second most-common blood cancer in children who experienced COVID-19 (n = 133, 10.3%)(12-22, 31, 35, 38-40, 57, 59, 67, 78, 87, 88, 92, 93, 96, 101, 105, 108, 123, 128-130, 144, 145, 150, 152, 164, 165, 169-175, 177, 178) (see Table1). Among them, 59 have non-Hodgkin's lymphoma (44.4% of all lymphomas)(12, 15, 16, 18, 20-22, 32, 38, 39, 57, 59, 67, 78, 87, 101, 105, 129, 130, 144, 150, 165, 169-171, 174, 175, 177), 38 have unspeci ed lymphoma (28.6%)(14,35,92,93, 96, 108,172,173, 178), and 36 have Hodgkin's lymphoma (27.1%)(13, 15, 17, 19-21, 38, 40, 67, 88, 123, 128, 145, 150, 152, 164, 169-171, 174, 177).…”

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confidence: 99%

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Blood cancer in children infected with COVID-19: A comprehensive systematic review

Alhumaid,

Noaim,

Almuslim

et al. 2023

Preprint

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Background: Blood cancer is the most common type of cancer and the leading cause of death by disease past infancy among children. Children with blood cancer are vulnerable population to viral infections such as coronavirus disease 2019 (COVID-19). Objectives: To estimate the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in blood cancer children and analyse the demographic parameters, clinical characteristics and treatment outcomes in blood cancer children with COVID-19 illness. Methods: For this systematic review, we searched ProQuest, Medline, Embase, PubMed, CINAHL, Wiley online library, Scopus and Nature through the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guideline for studies on the development of COVID-19 in children with blood cancer, published from December 1, 2019 to April 30, 2023, with English language restriction. Results: Of the 3077 papers that were identified, 155 articles were included in the systematic review (83 case report, 54 cohort and 18 case-series studies). Studies involving 1289 blood cancer children with confirmed COVID-19 were analysed. Leukaemias (1141 cases) were the most frequent types of blood cancer observed in children who developed COVID-19, followed by non-Hodgkin’s lymphomas (59 cases), Hodgkin’s lymphomas (36 cases), Langerhans cell histiocytosis (7 cases), myelodysplastic syndrome (7 cases) and myeloid neoplasm (1 case). Among all 1289 blood cancer paediatric cases who transmitted SARS-CoV-2, some children were documented to be admitted to the intensive care unit (ICU) (n = 175, 13.6%), intubated and placed on mechanical ventilation (n = 111, 8.6%), suffered acute respiratory distress syndrome (n = 144, 11.2%) or died (n = 111, 8.6%). Overall, COVID-19 in children with different types of blood cancer resulted in no or low severity of disease in more than 78.6% of all included cases (COVID-19 severity: asymptomatic = 239, mild = 603, or moderate = 171). Treatment for COVID-19 was not necessary in a high number of blood cancer children (n = 94, 7.3%). Fatality in blood cancer children with COVID-19 was reported in any of the included blood cancer categories for leukaemias (n = 99, 8.7%), non-Hodgkin’s lymphomas (n = 7, 11.9%), Hodgkin’s lymphomas (n = 2, 5.5%), myelodysplastic syndrome (n = 1, 14.3%) or myeloid neoplasm (n = 1, 100%). Fatality rate in blood cancer children infected with SARS-CoV-2 was the highest in patients with Hispanic ethnicity (n = 44/111, 39.6%) and COVID-19–related fatality was highest in male patients (76.5% of deceased patients). Most studies reported to alter the intensity and regimen of anticancer treatment in blood cancer children during course of SARS-CoV-2 infection, however, many studies have reported to successfully treat COVID-19 without any changes to the anticancer treatment. Conclusion: Globally, leukaemias were the most prevalent and myeloid neoplasms were the least prevalent blood cancer types in children who developed SARS-CoV-2 infection. Children with blood cancer tend to have milder COVID-19 symptoms and are less likely to be hospitalized and have better prognosis when compared to adults. Continuation of anticancer treatment in individual paediatric blood cancer patients with COVID-19 seems to be possible.

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