SARS-CoV-2 in children with cancer in Brazil: Results of a multicenter national registry.

BACKGROUND: Strategies to mitigate the impact of COVID-19 in special populations are complex and challenging. Few studies have addressed the impact of COVID-19 on pediatric patients with cancer in low- and middle-income countries. METHODS: Multicenter observational cohort study with prospective records and retrospective analyses starting in April 2020 in 21 pediatric oncology centers distributed throughout Brazil. PARTICIPANTS: Patients under 18 years of age who are infected by the SARS-CoV-2 virus (confirmed diagnosis through reverse transcriptase-polymerase chain reaction [RT-PCR]) while under treatment at pediatric oncology centers. The variables of interest included clinical symptoms, diagnostic and therapeutic measures. The repercussions of SARS-CoV-2 infection on cancer treatment and general prognosis were monitored. RESULTS: One hundred seventy-nine patients were included (median age 6 [4-13] years, 58% male). Of these, 55.9% had acute leukemia and 34.1% had solid tumors. The presence of SARS-CoV-2 was diagnosed by RT-PCR. Various laboratory markers were analyzed, but showed no correlation with outcome. Children with low or high BMI for age had lower overall survival (71.4% and 82.6%, respectively) than those with age-appropriate BMI (92.7%) (p = .007). The severity of presentation at diagnosis was significantly associated with outcome (p < .001). Overall mortality in the presence of infection was 12.3% (n = 22). CONCLUSION: In children with cancer and COVID-19, lower BMI was associated with worse prognosis. The mortality in this group of patients (12.3%) was significantly higher than that described in the pediatric population overall (∼1%).

[Salmonella septicemia associated with interleukin 12 receptor beta1 (IL-12Rbeta1) deficiency]. / Sepse por Salmonella associada à deficiência do receptor da interleucina-12 (IL-12Rbeta1).

OBJECTIVE: To present a case report of a child who developed sepsis by Salmonella enteritidis associated with the diagnosis of primary immunodeficiency. DESCRIPTION: A twenty-one month old boy presenting fever and skin lesions, bilateral pneumonia with pleural effusion and septic shock. Salmonella enteritidis was isolated in blood cultures and pleural fluid. The identification of the bacteria suggested the presence of the MIM syndrome. The diagnosis of IL-12Rbeta1 was confirmed after IL-12 and IFN-gamma levels were measured using patient cells in a culture medium. The results showed absence of IL-12 and the IFN-gamma post stimulation using BCG. COMMENTS: A severe infection by Salmonella enteritidis is strongly suggestive of an immune system dysfunction. Laboratory tests for humoral, cellular and innate immunity were performed. Interleukin 12 receptor beta1 (IL-12 Rbeta1) deficiency was confirmed after specific laboratory evaluation. The use of INF-gamma is recommended in severe cases.

Sepse por Salmonella associada à deficiência do receptor da interleucina12 (IL-12Rß1) / Samonella septicemia associated with interleukin 12 receptor ß1 (Il-12Rß1) deficiency

Objetivo: descrever caso clínico de uma criança que desenvolveu septicemia por Salmonella enteritidis, sendo diagnosticada imunodeficiência primária. Descrição: paciente masculino, de um ano e nove meses, com febre e lesões de pele há 50 dias, internado com lesão perilabialulcerada com secreção purulenta, lesão ulcerada friável em língua, lesões ulcerocrostosas em membros, pneumonia bilateral com derrame pleural e choque séptico, sendo diagnosticado Salmonella enteritidis como agente etiológico. A identificação desta bactéria direcionou a investigação para a síndrome MIM. O diagnóstico de defici-ência do receptor da interleucina-12 (IL-12Rß1) foi confirmado através da dosagem de IL-12 e do interferon (IFN)-y produzido pelas células do paciente em meio de cultura. O resultado demonstrou ausência de produção de IL-12 e do IFN-y, mesmo após estímulo adequado.Comentários: a identificação da Salmonella enteritidis como agente etiológico de septicemia sugere uma disfunção do sistema imunológico. Foi realizada avaliação laboratorial das imunidades humoral, celular e inata. Após avaliação laboratorial direcionada para síndrome MIM, foi confirmada a deficiência do receptor da interleucina-12 (IL-12Rß1). O uso do IFN-y é recomendado nos casos graves, assim como o tratamento de suporte e o aconselhamento genético