COVID-19 in Children with Cancer: A single Low-Middle income center experience

Abstract

Background: Coronavirus disease-2019 (COVID-19) could be associated with morbidity and mortality in immunocompromised children. Objective: To measure the frequency of SARS-COV-2 infection among hospitalized children with cancer and detect the associated clinical manifestations and outcomes. Methodology: A prospective non-interventional study including all hospitalized children with cancer conducted between mid-April and mid-June 2020 in Ain Shams University hospital, Egypt. Clinical, laboratory and radiological data were collected. SARS-CoV2 infection was diagnosed by RT-PCR 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 RT-PCR were not diagnostic; the mean absolute lymphocyte count was 8.7±2.4 x109/L, C-reactive protein was mildly elevated in most of patients. Imaging was performed in 10(66.7%) patients with significant radiological 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. Conclusion: 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. Introduction: Coronavirus disease 2019 (COVID-19) is a viral respiratory illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the first case was detected in December 2019. (1) The COVID-19 pandemic has rapidly escalated into a global crisis. (2) The first case registered in Egypt was in February 2020 and since that date, the numbers have been increasing and by mid-June 2020, 47,856 cases of SARS-CoV-2 and 1766 deaths have been reported by the Ministry of Health (3). Children are usually develops mild disease (4), a Chinese analysis of 2135 confirmed or suspected cases of COVID-19 among children revealed that 55.4% developed mild symptoms or were asymptomatic and only 5.4% had severe illness compared with 18.5% of adult cases. (5) Viral infections in general are associated with increased morbidity and mortality in immunocompromised children. (6) Data on the clinical features and outcomes of immunocompromised children with cancer who are infected with SARS-CoV-2 are scarce. Knowledge from previous influenza A H1N1 pandemics suggests that those vulnerable immunosuppressed children are likely to be infected and to develop manifestation as an increased number of cases are described with time. (7,8) Although isolation as an inpatient is common practice for children who are receiving intensive chemotherapy or stem cell transplant, most children with cancer are treated in the outpatient setting, and hospital visits

Impact of COVID-19 on Pediatric Immunocompromised Patients

“…Clinical outcomes in immunocompetent children with COVID-19 are superior to adults and several mechanisms including lower angiotensin converting enzyme (ACE)-2 expression, enhanced immune tolerance, and fewer co-morbidities have been proposed as reasons for the discrepant outcomes 47 . These protective features may be minimized in some immunocompromised populations as ACE-2 can be overexpressed in some patients with IBD and systemic lupus erythematous (SLE) 48 , 49 .…”

COVID‐19 outcomes in paediatric cancer: A large scale pooled meta‐analysis of 984 cancer patients

“…We screened a total of 2759 records after transferring the databases results without duplicates. We further assessed 61 full texts for eligibility which ended up with a total of 21 articles including 14 studies and additional seven studies following manual search procedures 7 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 (Figure 1 , Table 1 ).…”

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

“…Three of the four cases presented with an MIS-C-like picture (Sherif et al, 2021). On the other hand, studies conducted on cancer children with COVID-19 showed that these can be either asymptomatic (Ebeid et al, 2021) or symptomatic with mainly mild-to-moderate form of the illness (Hammad et al, 2021;Hamdy et al, 2021). The mortality rate was as low as 6.5% after the exclusion of septicemia and cancer progression in one study (Hammad et al, 2021) and almost the half in another one (Hamdy et al, 2021).…”

“…The younger age of the participating HCW with less likely accompanied comorbidities could be the reason behind this observation (El-Raey et al, 2021). Healthcare facility and contact with a confirmed COVID-19 case during work were the most common sources of infection for HCWs (Kassem et al, 2020;Abou-ElWafa et al, 2021;El-Raey et al, 2021;Mostafa et al, 2021). Interestingly, many healthcare workers admitted that they do not know exactly where they were infected (Abou-ElWafa et al, 2021;El-Raey et al, 2021).…”