Repeat‐positive SARS‐CoV‐2 in a child with cancer

Abstract

We report a case of repeat positivity with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a child with cancer. The SARS-CoV-2 virus is responsible for the ongoing coronavirus disease 2019 (COVID19) pandemic. A 4-year-old male was treated for pre-B cell acute lymphoblastic leukemia (ALL) at our hospital. The patient was receiving treatment with the Indian Childhood Collaborative Leukaemia Group (ICiCLe) protocol under the high-risk arm. 1 On June 27, 2020, the patient and his caregiver tested positive for SARS-CoV-2 on the reverse transcriptase-polymerase chain reaction (RT-PCR) test of their nasopharyngeal and oropharyngeal swabs.They were asymptomatic but were tested as they were high-risk contacts of a COVID19 patient. The patient had started the interim maintenance phase of the protocol and was 5 days post the first 24-h high-dose methotrexate (HDMTX) infusion (3 gm/m 2) along with 6mercaptopurine (6MP) when he tested positive for SARS-CoV-2. His white blood cell (WBC) count, absolute neutrophil count (ANC), and absolute lymphocyte count (ALC) were 2500, 650, and 1225/mm 3 , respectively, on the day of the positive RT-PCR test. 6MP was stopped 2 of 2 LETTER TO THE EDITOR SARS-CoV-2 infection. Since we did not do genetic sequencing of the virus or test the patient and the caregiver for antibodies, we cannot be sure if it was reinfection or a prolonged carrier state. Our report should alert physicians to continue testing pediatric cancer patients who previously tested positive for SARS-CoV-2 and recovered. Consent was obtained from the caregiver for publishing this case report.

Clinical presentations and outcomes of children with cancer and COVID‐19: A systematic review

“…In 29 studies ( n = 177 patients), 8,11–14,16–39 there was a mention of the type of test used to detect SARS‐CoV‐2. Among the 177 patients in these studies, PCR‐based tests were used to establish the diagnosis in 142 (one was also positive on CBNAAT) and antibody‐based tests in 23 (the type of test used was not mentioned for 12 patients in the study by Montoya et al 18 …”

“…In 196 patients (31 studies), 5,10–39 there was a mention about the type of malignancy, and 120 (53%) had hematological malignancies, and 76 (47%) had solid tumors. In studies that reported remission status (18 studies), 23 patients out of 47 were in remission from the underlying malignancy 10,11,14,20–26,29–37 (Table 1).…”

“…Among 24 studies including 102 patients 5,10,13–17,20–25,27–35,37 for whom information was available on the phase of chemotherapy/hematopoietic stem cell transplant (HSCT) status, 34 were on the intensive phase of chemotherapy, 13 were on low‐dose chemotherapy, six had completed treatment, and 17 post HSCT (Table 1).…”

“…Gastrointestinal symptoms were present in 17, and skin involvement was mentioned for three patients. In 30 studies ( n = 209 patients), 5,8,10–18,20–38 the severity of the symptoms was reported. Sixty‐three patients had no symptoms, 38 had mild symptoms, nine had moderate symptoms, and 20 (9.6%) had severe symptoms.…”

Asymptomatic reactivation of SARS-CoV-2 in a child with neuroblastoma characterised by whole genome sequencing

“…To et al and others [ [3] , [4] , [5] , [6] ] have recently reported reinfections with SARS-CoV-2 confirmed by genome sequencing. A few recent cases of potential reactivation with SARS-CoV-2 have been reported in cancer patients on chemotherapy [ [7] , [8] , [9] ], however were not confirmed by genetic characterization of the virus. Here we report results of genome sequencing in child with neuroblastoma reported previously by us as re-infected with SARS-CoV-2 after recovering fully and developing IgG antibodies [ 8 ].…”