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Background:
Coronavirus disease 2019 (COVID-19) affects people of any age with high mortality and morbidity in adults older than 65 years. Reports on pediatric cases highlighted those children generally develop milder symptoms than adults or are asymptomatic. We aimed to assess the epidemiological and clinical data of children and adolescents with...
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Context 1
... significant correlation was demonstrated between a more severe COVID-19 and previous pathologies, particularly with obesity/overweight, immune deficit, and heart disease. Patients underwent laboratory and radiological tests ( Table 5 and Table 6). Lymphopenia (p= 0.01), eosinopenia (p= 0.01), elevated RCP (p= 0.006 and p= 0.03), elevated procalcitonin (p= 0.02) were significantly related to the risk of severe/critical disease. ...Citations
... However, some immunocompromised patients still may present the severe course of COVID-19. Studies have consistently shown low rates of mortality in this group, emphasizing the different clinical spectrum of COVID-19 in children compared to adults [14]. ...
Background: Patients treated with hemato-oncological malignancies (HO) or undergoing cellular therapies such as hematopoietic stem cell transplantation (HSCT) or chimeric antigen receptor T cells (CAR-T) were significantly affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite the success of SARS-CoV-2 vaccination, immunocompromised patients remain at increased risk for severe coronavirus disease (COVID-19), rendering this group of population a high priority for additional prevention and treatment options. Tixagevimab and Cilgavimab (TIXA/CILGA, AZD7442, Evusheld®) is a combination of two fully human, long-acting monoclonal antibodies. TIXA/CILGA have been approved as pre-exposure prophylaxis and treatment in patients at risk of severe disease with impaired vaccine response. Our objective was to describe the efficacy and safety among immunocompromised pediatric patients. Methods: This was an observational multicenter cohort study of immunocompromised pediatric patients receiving TIXA/CILGA conducted at nine Polish centers of Pediatric Oncology, Hematology and Bone Marrow Transplantation. We analyzed patients in two groups; those treated with HO and those undergoing cellular therapies: HSCT or CAR-T cells. In addition, two other cohorts were identified: patients given TIXA/CILGA as pre-exposure prophylactic and therapeutic intervention. Results: A total of 78 patients were evaluated during the study period: 69 (88.5%) received TIXA/CILGA as pre-exposure prophylaxis and 9 (11.5%) as a treatment strategy. A total of 52 (66.6%) patients were treated with standard chemotherapy at HO departments; 21 (27%) underwent HSCT, and 5 (6.4%) received CAR-T cell therapy. All children with COVID-19 receiving TIXA/CILGA presented a mild degree of severity. The most common clinical manifestations were fever, cough and coryza. At least one adverse event (AE) was reported in two (3.8%) patients excluding standard injection site reactions. Reported AEs were mild or moderate in intensity. One child reported mild myalgia and one reported moderate bone pain and weakness. Conclusions: In our observational multicenter cohort study, we explored the use of TIXA/CILGA as pre-exposure prophylaxis and treatment for COVID-19 among immunocompromised pediatric patients. While our findings suggest a potential benefit in preventing and managing COVID-19 in this vulnerable population, it is important to note the study’s non-comparative design. Our results highlight the need for well-designed clinical trials to confirm these observations and further assess the efficacy and safety of TIXA/CILGA in immunocompromised children.
... Long-term organ damage, particularly to the lungs and heart, has been observed. There is concern for a significant number of patients recovering from the acute phase of the disease but still experiencing a range of symptoms including severe fatigue, memory loss, cognitive issues, mild fever, muscle weakness, shortness of breath, and other symptoms for several months post-recovery [1,3,5,8] . The standard diagnostic method involves a throat or nasal swab for PCR testing and can be achieved by integrating symptoms and risk factors with computed tomography (CT) imaging that reveals lung manifestations. ...
... The infection usually spreads from person to person through respiratory droplets produced by coughing or sneezing. The incubation period, from exposure to the virus to symptom onset, ranges from 2 to 14 days, with a median of five days [3,[11][12][13] . Given that a vaccine for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is not anticipated to be accessible prior to 2021 at the earliest, the management of the COVID-19 pandemic depends on implementing various measures to decrease the peak of the pandemic. ...
... Adults showed higher levels of inflammation markers in laboratory tests and a higher incidence of pneumonia on chest X-rays compared to children. They concluded that while COVID-19 affects children similarly to adults, their presentation is less severe, with children exhibiting milder clinical symptoms [3] . A recent cohort study found significant sex-based disparities in COVID-19 outcomes, with male patients showing higher rates of hypoxemia, smoking, obesity, and other health issues. ...
... Although hospitalized children may not have comorbidities, the coexistence of other medical conditions increases the risk of severe illness, hospitalization, and death [8]. Pediatric patients with obesity, diabetes, cardiac and circulatory congenital anomalies, chronic lung diseases, severe/uncontrolled asthma, seizures, and immunodeficiencies experienced a higher prevalence of more severe disease courses than healthy children [6,[9][10][11]. Moreover, newborns and premature infants also had a higher risk of more severe COVID-19 [5 && ,12]. ...
... Several studies have proposed peripheral eosinophils cells as a possible prognostic biomarker in patients with severe or critical COVID-19 [29]. In a retrospective Italian pediatric study of 71 children hospitalized for COVID-19, De Filippo et al. found that low levels of peripheral eosinophils significantly characterize severe/critical cases compared to asymptomatic cases [11]. The pathogenesis of peripheral eosinopenia in COVID-19 remains unclear. ...
Purpose of review:
This review summarizes current evidence on the potential link between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and autoimmunity.
Recent findings:
Several viral infections are potential triggers of reactive and autoimmune diseases by inducing type II and type IV hypersensitivity reactions. Recent evidence demonstrated that SARS-CoV-2 infection is not an exception, triggering the production of tissue-specific autoantibodies during the acute phase of coronavirus disease 2019 (COVID-19) and leading to autoimmune diseases development as long-term complication. The significant immune dysregulation with cytokine storm and organ damage observed in patients with severe to critical COVID-19 is considered the main mechanism explaining the high levels of autoantibodies, which are also implicated in disease severity and the need for an intensive care assessment. Multisystem inflammatory syndrome in children (MIS-C) is an immune-mediated disease where the recent viral infection leads to systemic inflammation, as already observed in other reactive and autoimmune diseases.
Summary:
Autoimmunity may be a complication of SAR-CoV-2 infection. Understanding the pathogenesis of autoimmune manifestations in COVID-19 might help prevent the incidence or exacerbation of autoimmune disorders and design better and more efficient treatment strategies in children and adult populations.
... Regarding the assessment of the cause of admission, most studies do not usually differentiate between them and describe the entire cohort of patients admitted with COVID-19 [2,18]. Some studies distinguish between the acute COVID-19 and MIS-C groups, which they then compare [4,11]. ...
... Disease severity in the COVID group included all categories from mild to critical. Most studies assessed severity according to the same or slightly modified classification [10,11,18,21]. The proportion of severities varied considerably. ...
... Patients in the COVID group generally had lower signs of inflammation (CRP 12.2 mg/L), which is consistent with the majority of published data [7,19,22] which also applies to the incidence of pneumonia and pleural effusions in the COVID group [4,15,18,22]. ...
Background: The proportion of intensive care unit (ICU) admissions in children that have and have not been directly caused by SARS-CoV-2 remains unclear. The aim of the study is to analyse a cohort of children admitted to the ICU with SARS-CoV-2 and determine whether the infection was the primary cause of their hospitalisation, a significant contributor, a suspected accomplice, or an incidental finding. Methods: This was a retrospective observational study of all the children admitted to the ICU with SARS-CoV-2 from March 2020 to February 2022 from the South Moravia region. The aim of the study was to assess whether the hospitalisation was likely to be directly caused by the virus (i.e., patients with acute COVID-19; the COVID group), whether the virus was a significant contributor to the hospitalisation (i.e., patients with multisystem inflammatory syndrome in children due to COVID-19; the MIS-C group), whether it may have contributed to the worsening of their underlying disease (the WORSENING group), or whether it was an incidental finding very likely unrelated to hospitalisation where SARS-CoV-2 positivity merely placed patients in the COVID-19 unit (the ISOLATION group). The groups were compared using a series of secondary outcomes. Results: The study population represented 150 paediatric ICU cases (age 8.6; IQR 3.5–13.3 years), with 66.7% being male. The COVID group represented 32.7% of cases (49/150); MIS-C, 30% (45/150); WORSENING, 14.7% (22/150); and ISOLATION, 22.7% (34/150). The median length of hospitalisation was found for the MIS-C group (11 days; 9 days in the ICU), the COVID group (6 days; five days in the ICU), WORSENING group (4.5 days; 4.5 days in the ICU) and the ISOLATION group (5.5 days; 3.5 days in the ICU), where the difference was significant (p < 0.001). Asymptomatic and mild cases were most common in the WORSENING (36.4% and 63.6%) and ISOLATION (52.9% and 44.1%) groups. Severe and critical cases were only present in the COVID (6.1% and 12.2%) and MIS-C (4.4% and 11.1%) groups; the severity difference was significant (p < 0.001). The groups did not differ significantly in the proportion of complete recovery and short- and long-term sequelae (p = 0.09). Conclusions: Patients with acute COVID-19 accounted for one-third of all ICU admissions, patients with MIS-C accounted for approximately another third, patients with worsening underlying disease accounted for 15%, and patients with incidental findings of SARS-CoV-2 positivity accounted for one-fifth of ICU admissions. A more significant disease was seen with acute COVID-19 and MIS-C.
... The most frequent symptoms were fever, cough, and rhinitis, especially in infants and toddlers. These symptoms were also described by other authors [25,32,[39][40][41][42][43]. In infants, cough and dyspnea were more common symptoms of upper respiratory tract infection, and the most common symptom was laryngitis (Table 5). ...
Since the beginning of the pandemic, many reports have pointed to age as the most important risk factor for severe COVID-19 in adults, but this relationship is less clear in children. Between March 2020 and April 2022, 1405 pediatric COVID-19 patients were included in our prospective study, which aimed to analyze the disease’s characteristics in three age groups: infants, toddlers (1–5 years), and children (5–18 years). We observed male prevalence of the disease in infants and toddlers compared to female prevalence in children. Comorbidities appeared most often in children. In the first pandemic wave, the vast majority of pediatric patients were children, but later, the percentage of infant and toddler patients increased significantly. A total of 74% of hospitalized children were younger than five years. Upper respiratory tract symptoms were most common in infants and toddlers, and lower respiratory tract symptoms and gastroenterocolitis were more common in children. Neurological symptoms appeared similarly in all age groups. The activities of ALT, CK, and LDH were the most elevated in infants, along with D-dimers. The median length of hospitalization fluctuated between three and four days and was highest in infants. Severe courses were more common in adolescents.
