Screening of COVID-19 in outpatient children with cancer or solid organ transplantation: preliminary report

Cleto-Yamane, Thaís Lira; Santos, Gustavo Rodrigues dos; Magalhães-Barbosa, Maria Clara de; Moura, Paulo; Vasconcelos, Rafael Dias; Gouveia, Jaqueline Leal Santos; Oliveira, Anne Louise de; Ferreira, Fernanda Couto; Shalders, Ana Letícia; Oliveira, Mariana Barros Genuíno de; Lima‐Setta, Fernanda; Cunha, Antônio José Lêdo Alves da; Prata‐Barbosa, Arnaldo

doi:10.1007/s00431-021-04044-9

Cited by 18 publications

(12 citation statements)

References 13 publications

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“…Furthermore, the death rate is low in the youngest age group, but age below 1 month, male sex, pre-existing medical conditions, and presence of lower respiratory tract infection signs or symptoms at presentation are associated with higher complication rates [ 5 – 7 ]. For immunocompromised children, as many as 77% show an asymptomatic course of SARS-CoV-2 infection [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

COVID-19 in pediatric cancer patients is associated with treatment interruptions but not with short-term mortality: a Polish national study

Węcławek-Tompol

Zakrzewska

Gryniewicz–Kwiatkowska

et al. 2021

J Hematol Oncol

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Background Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) currently constitutes the leading and overwhelming health issue worldwide. In comparison with adults, children present milder symptoms, with most having an asymptomatic course. We hypothesized that COVID-19 infection has a negative impact on the continuation of chemotherapy and increases nonrelapse mortality. Material and methods This study was performed to assess the course of SARS-CoV-2 among children with hematological or oncological malignancies and its impact on cancer therapy. Records of SARS-CoV-2 infection in 155 children with malignancies from 14 Polish centers for pediatric hematology and oncology were collected and analyzed. Results SARS-CoV-2 replication was observed in 155 patients. Forty-nine patients were symptomatic, with the following being the most common manifestations: fever (31 patients), gastrointestinal symptoms (10), coryza (13), cough (13) and headache (8). In children who were retested, the median time of a positive PCR result was 16 days (range 1–70 days), but 12.7% of patients were positive beyond day + 20. The length of viral PCR positivity correlated with the absolute neutrophil count at diagnosis. Seventy-six patients did not undergo further SARS-CoV-2 testing and were considered convalescents after completion of isolation. Antibiotic therapy was administered in 15 children, remdesivir in 6, convalescent plasma in 4, oxygen therapy in 3 (1—mechanical ventilation), steroids in 2, intravenous immunoglobulins in 2, and heparin in 4. Eighty patients were treated with chemotherapy within 30 days after SARS-CoV-2 infection diagnosis or were diagnosed with SARS-CoV-2 infection during 30 days of chemotherapy administration. Respiratory symptoms associated with COVID-19 and associated with oxygen therapy were present in 4 patients in the study population, and four deaths were recorded (2 due to COVID-19 and 2 due to progressive malignancy). The probability of 100-day overall survival was 97.3% (95% CI 92.9–99%). Delay in the next chemotherapy cycle occurred in 91 of 156 cases, with a median of 14 days (range 2–105 days). Conclusions For the majority of pediatric cancer patients, SARS-CoV-2 infection does not result in a severe, life-threatening course. Our data show that interruptions in therapy are common and can result in suboptimal therapy.

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Section: Introductionmentioning

confidence: 99%

COVID-19 in pediatric cancer patients is associated with treatment interruptions but not with short-term mortality: a Polish national study

Węcławek-Tompol

Zakrzewska

Gryniewicz–Kwiatkowska

et al. 2021

J Hematol Oncol

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“…2 While these infections, including SARS-CoV-2, have the potential to be more severe in immunocompromised adults, 3,4 emerging data suggests that SARS-CoV-2 does not necessarily present with an increased risk of severe disease in immunocompromised children (ICC). [5][6][7][8] However, the persistence of SARS-CoV-2 infection in pediatric immunosuppressed patients is still unknown, with case series suggesting that infection can be more prolonged in this population. 9 An understanding of viral persistence in immunocompromised hosts has important public health implications.…”

Section: Introductionmentioning

confidence: 99%

SARS‐CoV‐2 persistence in immunocompromised children

Dolan

Levy

Moss

et al. 2021

Pediatric Blood & Cancer

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Objectives: We evaluated the length of time immunocompromised children (ICC) remain positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), identified factors associated with viral persistence, and determined cycle threshold (C T ) values of children with viral persistence as a surrogate of viral load. Methods: We conducted a retrospective cohort study of ICC at a pediatric hospital from March 2020 to March 2021. Immunocompromised status was defined as primary, secondary, or acquired due to medical comorbidities/immunosuppressive treatment. The primary outcome was time to first of two consecutive negative SARS-CoV-2 polymerase chain reaction (PCR) tests at least 24 hours apart. Testing of sequential clinical specimens from the same subject was conducted using the Centers for Disease Control (CDC) 2019-nCoV real-time reverse transcriptase (RT)-PCR Diagnostic Panel assay. Descriptive statistics, Kaplan-Meier curve median event times and log-rank tests were used to compare outcomes between groups.Results: Ninety-one children met inclusion criteria. Median age was 15.5 years (interquartile range [IQR] 8-18), 64% were male, 58% were White, and 43% were Hispanic/Latinx. Most (67%) were tested in outpatient settings and 58% were asymptomatic. The median time to two negative tests was 42 days (IQR 25.0-55.0), with no differences in median time by illness presentation or level of immunosuppression.Seven children had more than one sample available for repeat testing, and five of seven (71%) children had initial C T values of <30 (moderate to high viral load); four children had C T values of <30, 3-4 weeks later, suggesting persistent moderate to high viral loads. Conclusions: Most ICC with SARS-CoV-2 infection had mild disease, with prolonged viral persistence >6 weeks and moderate to high viral load.

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“…So, 50% dose reduction or complete cessation of antimetabolite drugs is appropriate to limit the viral replication. On the other hand, Cleto-Yamane et al, [ 7 ] hypothesized that immunosuppression may act as a protection for severe forms of COVID-19. Complete withdrawal of immunosuppression may result in episodes of allograft rejection and renal failure.…”

Section: Discussionmentioning

confidence: 99%

“…Marlais et al [ 6 ] in their multinational survey of pediatric KTRs with COVID-19 described a mild course without greater severity or complications in their group of patients. There is a possibility that immunosuppression may protect them from severe form of disease [ 7 ]. But the question remains whether immunosuppressive therapy could be considered a risk factor for COVID-19 in children as a small group of them were reported to have adverse outcomes including death.…”

Section: Introductionmentioning

confidence: 99%

Severe Acute Respiratory Syndrome Corona Virus-2 Infection in a Pediatric Kidney Transplant Recipient: A Case Report from India

Tatapudi

Kopparti

Poosapati

et al. 2021

Case Rep Nephrol Dial

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COVID-19 pandemic affected millions of people across India. COVID-19 cases are fewer in children with less severity and better outcomes than in adults. However, a small proportion develop severe illness and succumb to the disease. Clinical manifestations and optimal management of COVID-19 in immunocompromised children are not clearly known. Remdesivir was shown to be efficient in reducing the recovery time in COVID-19 patients requiring supplemental oxygen. Remdesivir is approved for use in children with severe COVID-19, but there are no guidelines in patients with risk factors like recent solid organ transplantation. We report a case of a 10-year-old kidney transplant recipient (KTR) infected with severe acute respiratory syndrome corona virus-2, 2.5 months after the transplantation. Unlike most children, he presented with high fever, cough, and vomiting. His inflammatory markers were elevated. In this case report, we discussed management and clinical outcomes of this patient. In view of recent kidney transplantation and the severity of infection with emergent oxygen requirement, we gave him remdesivir. We continued prednisolone and tacrolimus and stopped mycophenolate. He recovered completely in 7 days. We feel that severely immunosuppressed KTR children with COVID-19 will benefit with remdesivir administration. Monitoring tacrolimus trough levels is essential for maintaining adequate immunosuppression.

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Screening of COVID-19 in outpatient children with cancer or solid organ transplantation: preliminary report

Cited by 18 publications

References 13 publications

COVID-19 in pediatric cancer patients is associated with treatment interruptions but not with short-term mortality: a Polish national study

COVID-19 in pediatric cancer patients is associated with treatment interruptions but not with short-term mortality: a Polish national study

SARS‐CoV‐2 persistence in immunocompromised children

Severe Acute Respiratory Syndrome Corona Virus-2 Infection in a Pediatric Kidney Transplant Recipient: A Case Report from India

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