Background CT chest severity score (CTSS) is a semi-quantitative measure done to correlate the severity of the pulmonary involvement on the CT with the severity of the disease. The objectives of this study are to describe chest CT criteria and CTSS of the COVID-19 infection in pediatric oncology patients, to find a cut-off value of CTSS that can differentiate mild COVID-19 cases that can be managed at home and moderate to severe cases that need hospital care. A retrospective cohort study was conducted on 64 pediatric oncology patients with confirmed COVID-19 infection between 1 April and 30 November 2020. They were classified clinically into mild, moderate, and severe groups. CT findings were evaluated for lung involvement and CTSS was calculated and range from 0 (clear lung) to 20 (all lung lobes were affected). Results Overall, 89% of patients had hematological malignancies and 92% were under active oncology treatment. The main CT findings were ground-glass opacity (70%) and consolidation patches (62.5%). In total, 85% of patients had bilateral lung involvement, ROC curve showed that the area under the curve of CTSS for diagnosing severe type was 0.842 (95% CI 0.737–0.948). The CTSS cut-off of 6.5 had 90.9% sensitivity and 69% specificity, with 41.7% positive predictive value (PPV) and 96.9% negative predictive value (NPV). According to the Kaplan–Meier analysis, mortality risk was higher in patients with CT score > 7 than in those with CTSS < 7. Conclusion Pediatric oncology patients, especially those with hematological malignancies, are more vulnerable to COVID-19 infection. Chest CT severity score > 6.5 (about 35% lung involvement) can be used as a predictor of the need for hospitalization.
Background: Patients with hematologic malignancies are at higher risk for Invasive Fungal Infections (IFI) mainly patients with acute myeloid leukemia. Antifungal prophylaxis can help to decrease the incidence of these infections and their related complications. Patients and methods: Prospective study compared to historical control data included 136 newly diagnosed Acute Myeloid Leukemia patients treated at the National Cancer Institute, Cairo University from 2011 to 2014. The prospective group received primary Voriconazole compared to retrospective control regarding the infectious complications and incidence of fungal infection. Results: One hundred thirty-six (136) newly diagnosed pediatric AML patients were included in the study, 61 patients didn't receive antifungal prophylaxis (Non-prophylactic arm) while 75 patients received Voriconazole prophylaxis (prophylactic arm). The median age among both groups was 5.5 years old. Thirty-one (50%) of the 61 patients in (non-prophylactic arm) and five (6.6%) of the 75 patients enrolled in group B (prophylactic arm) developed an invasive fungal infection. The most commonly affected sites were pulmonary (34/36) while fungal sinus infection was reported in 2 patients. Most patients develop an invasive fungal infection during the induction treatment phase. Primary prophylaxis with Voriconazole had a highly statistically significant impact on the reduction of incidence of invasive fungal infection between 2 groups (p-value=0.001). Fungal attributable mortality was reported in 8 patients (13%) in the historical group (no antifungal prophylaxis) in comparison to 2 patients (2.6%) in group patients received Voriconazole antifungal prophylaxis. Three Overall and Event-free survival were comparable between both groups. Conclusion: Prophylactic Voriconazole significantly decreased the incidence of fungal infections but it had no impact on diseases or overall survival outcome. Bacterial sepsis and disease-related mortality was the main cause of deaths among our group patients.
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