Severe SARS-CoV-2 infections in pediatrics are rare and usually presented as multisystem inflammatory syndrome in children. There are few descriptions about pediatric oncology patients. We describe a case of 5-year-old male with acute myeloid leukemia. He presented febrile neutropenia with skin lesions and progressive clinical worsening. He had positive RT-PCR test for SARS-CoV-2 and criteria for MIS-C. He received methylprednisolone, immunoglobulin and granulocyte-colony-stimulating factor. Anti-interleukin 6 was administrated due to severe lung disease and refractory to treatment, presenting response and slow clinical recovery. Chemotherapy was restarted, he didn't present relapse during treatment and has no sequelae of COVID-19.

Background: Invasive fungal diseases (IFD) are important causes of mortality in children with cancer. We aimed to determine the extent of survival in patients treated for IFD in the last nine years at our center. Procedure: a retrospective cohort of patients treated from January 1, 2011 to December 31, 2019. Weibull distribution was used to parameterize hazard ratios and accelerated failure time models, for the outcome “death attributed to IFD”. Results: We analyzed 152 patients with IFD (133 proven and 19 probable), with median age of 97 months. The most frequent diagnoses were leukemia (39, 25.7%) and central nervous system tumors (36, 23.7%). Thirty-seven patients received prophylaxis with fluconazole (24.3%). There were 133 fungi isolates, and most frequent were Candida species in blood (84, 55.2%). Forty-three deaths were attributed to IFD (28.3%). Survival probabilities were lower for pulmonary IFD (46.9%, p = 0.0017), leukemia (62.5%, p = 0.004), and neutropenia <500 cells/mm3 (55.4%, p < 0.0001). For Candida fungemia, survival probabilities were 76.6% (p = 0.043). In Weibull models, diagnosis of leukemia shortened survival times by a factor of 0.006, relapse of disease by 0.05, lymphoma by 0.04, pulmonary IFD by 0.04, and neutropenia by 0.015. Hematopoietic stem cell transplantation did not affect the survival times, as well as prophylaxis with fluconazole. Conclusions: Host factors, like neutropenia, relapse of disease and hematologic malignancies, are determinant in the survival times of children with IFD, as well as pulmonary involvement. Fluconazole prophylaxis and HSCT do not affect the hazards of death.

Background: Febrile neutropenia (FN) is a frequent complication of chemotherapy treatment in children with oncological diseases. It can cause serious complications due to infections (SIC), such as severe sepsis and septic shock. In order to identify the predictors of severity for diminished survival in these patients, it is important to have a better treatment strategy, so as to reduce the rate of mortality. Procedure: Retrospective, descriptive and analytical study conducted through a review of medical records of cancer patients from 0 to 18 years old with FN episodes admitted to the Pediatric Intensive Care Unit in Brazil, from June/2013 to January/2018. Epidemiological, clinical and laboratory variables were analyzed for survival outcome. The rates of severe sepsis, septic shock, and mortality were also investigated. Results: Data from 140 FN episodes were analyzed. Most of the children had hematological diseases (80.8%), the average age was 8.5 years old, and the main microorganisms identified in cultures were Gram negative bacteria. The predictors of severity for diminished survival utilizing multivariate analyses were hematological neoplasms in relapse, abnormal capillary filling, and a serum calcium value <7 mg/dL. The rate of severe sepsis was 38.57%, the rate of septic shock was 37.85%, and the rate of mortality was 25.71%. Conclusion: Predictors of severity for diminished survival were hematological neoplasms in relapse, abnormal capillary filling time, and a serum calcium value lower than 7 mg/dL. The rate of severe sepsis was 38.57%, the rate of septic shock was 37.85%, and the rate of mortality was 25.71%.