First reported case of an immunocompromised child with #COVID-19 infection suggests risk for severe disease. (1/12)@PIDSociety @IDSAInfo #TxID #IDtwitter
Most descriptions of children with #COVID-19 have been reassuring, few have had severe disease and most recover rapidly. However, there is some concern that immunocompromised children will fare much worse. (2/12)
This case in the Chinese Journal of Hematology is reportedly the first case of documented COVID-19 infection in an immunocompromised child. It’s in Chinese and I had a lab colleague read it to me – apologies for any errors. (3/12)
The patient developed severe disease despite multiple therapies. Here are a few important features: (4/12)
1. This is an 8 year old boy with T-cell acute lymphoblastic leukemia 1 year into therapy and in remission – so, presumably cured of leukemia and at low risk of relapse. (5/12)
2. The suspected incubation period was 14 days (1/13/20 - 1/27/20). This is relatively long compared with other reports. (6/12)
3. The child had a slow deterioration, starting with fever and cough, then progression (over 22 days) to respiratory failure. The eventual outcome of the patient is not included in the report. (7/12)
4. CT chest was abnormal throughout and worsened over time. It showed bilateral ground glass opacities with some areas of dense consolidation and small pleural effusions. (8/12)
5. The deterioration did not seem to be related to the hyperinflammatory syndrome described in adults; CRP (max. 8.4mg/L) and IL6 (max 36.5 ng/L) were only mildly elevated despite high fever and severe lung disease. (9/12)
6. In contrast to CRP and IL6, ferritin was very elevated (first measured on Day 9 at 15,000 ng/mL) but dropped as the illness worsened (6400 ng/mL on Day 24 at transfer to ICU). (10/12)
7. Deterioration coincided with increase in ANC and decrease in ALC. (11/12)
8. Attempted treatments at various doses and routes included: Empiric antibiotics and antifungal, oseltamivir, IVIG, methylprednisolone, ribavirin, Interferon alfa-1b, arbidol. (12/12)
Link to original article: rs.yiigle.com/yufabiao/11843…
