Clinical manifestations of COVID-19 infection and its impact on the outcome in children and adolescents with benign and malignant hematological disease in Egypt: a single-center experience
Authors: Ebeid Fatma Soliman Elsayed , Mostafa Aya , Magdy Sondos M. , Kader Haidy Moahmed Abd El , Lotfy Amal Abdel Azim , Aly Nihal Hussien 
Published: January 2025

Abstract
Background
It is known that viral infections are associated with increased morbidity and mortality in immunocompromised children. Few reports describe the clinical manifestations and outcomes of COVID-19 infection in children and adolescents with benign and malignant hematological disease with a large sample size from our Egyptian population.

Aim
As a preliminary step in developing a national registry for children and adolescents with hemato-oncological disease who were diagnosed with COVID-19 infection, in this study we aimed to determine (a) the frequency of COVID-19 infection in children with hematological disease, (b) the presenting clinical manifestations, and (c) the associated underlying disease outcome and its clinical determinants.

Methods
We collected data from medical records of a retrospective cohort including all children and adolescent patients who were known to have a benign or malignant hematological disease attending the hematology and oncology outpatient clinic or were hospitalized between February 2022 and March 2023 in a university hospital in Cairo, Egypt, for tertiary care. All patients (n = 620) were tested for SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) test by nasopharyngeal swab. For all patients, the collected data included the demographic data, diagnosis, cause of hospital visit, cause and duration of admission if needed, presence of symptoms suggestive of COVID-19 infection, and concurrent medications. Baseline laboratory investigation were collected included complete blood count (CBC), liver and kidney functions, C-reactive protein (CRP), serum ferritin, lactate dehydrogenase, and coagulation test. For COVID-19-positive patients, the additional data collected included the duration of COVID-19 infection, its course, full examination during this illness, its severity, and the outcome of COVID-19 infection and the underlying disease.

Results
Out of the 620 children and adolescents with benign (n = 271) and malignant (n = 349) hematological diseases in in-patients and out-patients’ settings, 86 patients (13.8%) tested positive for SARS-CoV-2. COVID-19 infection was more common in patients with hematological malignancy (n = 56, 65.1%) than those with benign hematological disease (27 patients, 31.4%). Among COVID-19-positive patients, 20 patients (23.3%) required intensive care unit admission compared to 30 (5.6%) COVID-19-negative patients (p-value < 0.000). Death was reported in 5 COVID-19-positive patients (5.8%) compared to 19 in COVID-19-negative patients (3.6%) (p-value = 0.314). The factors associated with mortality in COVID-19-positive patients (3 patients with hematological malignancy and 2 patients with aplastic anemia) was abnormal neurological examination [OR = 17.3; p-value = 0.009].

Conclusion
The current study showed that COVID-19 was higher among patients with hematological malignancies than those with benign hematological disease. COVID-19 was tolerable among the studied patients with underlying hematological disease where 94.1% of the COVID-19-positive patients survived. Mortality was associated with abnormal neurological examination in COVID-19-positive patients with underlying hematological disease.