Differential diagnosis of pneumonia in pediatric patients with oncohematological disease in condition of new coronavirus infection COVID-19

Pneumoniasinpatientswithhempblastoses, arisingduringtreatmentinsettingofmyelotoxicagranulocytosis, arelife-threateningcomplications, which press complex approach for diagnosis and treatment. In condition of new coronavirus infection COVID-19 pandemia, differential diagnosis of pneumonia with “ground glass” lung changes is a hot issue. In the current paper we present world data on clinical, laboratory and X-ray diagnosis of SARS-CoV-2 (severe acute respiratory syndrome-related coronavirus 2) pneumonia in children. Special attention is paid to X-ray features depending of child age. It is provided two clinical examples, demonstrating a necessity of complex microbiological, immunological, molecular and X-ray diagnosis for detection of lung change genesis in oncohematologic patients.

1. Zvereva N.N., Sayfullin M.A., Rtishchev A.Yu., Shamsheva O.V., Pshenichnaya N.Yu. Coronavirus infection in children. Pediatriya. Zhurnal im. G.N. Speranskogo = Pediatria. Journal named after G.N. Speransky 2020;99(2):270–8. (In Russ.).

2. Peiris J.S.M., Chu C.M., Cheng V.C.C., Chan K.S., Hung I.F.N., Poon L.L.M., Law K.I., Tang B.S.F., Hon T.Y.W., Chan C.S., Chan K.H., Ng J.S.C., Zheng B.J., Ng W.L., Lai R.W.M., Guan Y., Yuen K.Y.; HKU/UCH SARS Study Group. Clinical progresssion and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet 2003;361:1767–72. doi: 10.1016/s0140-6736(03)13412-5.

3. Assiri A., Al-Tawfiq J.A., Al-Rabeeah A.A., Al-Rabiah F.A., Al-Hajjar S., Al-Barrak A., Flemban H., Al-Nassir W.N., Balkhy H.H., Al-Hakeem R.F., Makhdoom H.Q., Zumla A.I., Memish Z.A. Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study. Lancet Infect Dis 2013;13:752–61. doi: 10.1016/S1473-3099(13)70204-4.

4. Saad M., Omrani A.S., Baig K., Bahloul A., Elzein F., Matin A.M., Selim M.A., Mutairi M.A., Nakhli D.A., Aidaroos A.Y., Sherbeeni N.A., Al-Khashan H.I., Memish Z.A., Albarraka A.M. Clinical aspects and outcomes of 70 patients with Middle East respiratory syndrome coronavirus infection: a single-center experience in Saudi Arabia. Int J Infect Dis 2014;29:301–6. doi: 10.1016/j.ijid.2014.09.003.

5. Hu Y., Sun J., Dai Z., Deng H., Li X., Huang Q., Wu Y., Sun L., Xu Y. Prevalence and severity of corona virus disease 2019 (COVID-19): A systematic review and meta-analysis. J Clin Virol 2020;127:104371. doi: 10.1016/j.jcv.2020.104371.

6. Hrusak O., Kalina T., Wolf J., Balduzzi A., Provenzi M., Rizzari C., Rives S., Del Pozo Carlavilla M., Alonso M.E.V., Domínguez-Pinilla N., Bourquin J.P., Schmiegelow K., Attarbaschi A., Grillner P., Mellgren K., van der Werff Ten Bosch J., Pieters R., Brozou T., Borkhardt A., Escherich G., Lauten M., Stanulla M., Smith O., Yeoh A.E.J., Elitzur S., Vora A., Li C.K., Ariffin H., Kolenova A., Dallapozza L., Farah R., Lazic J., Manabe A., Styczynski J., Kovacs G., Ottoffy G., Felice M.S., Buldini B., Conter V., Stary J., Schrappe M. Flash survey on severe acute respiratory syndrome coronavirus-2 infections in paediatric patients on anticancer treatment. Eur J Cancer 2020;132:11–6. doi: 10.1016/j.ejca.2020.03.021.

7. Liang W., Guan W., Chen R., Wang W., Li J., Xu K., Li C., Ai Q., Lu W., Liang H., Li S., He J. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol 2020;21(3):335–7. doi: 10.1016/S1470-2045(20)30096-6.

8. Stroud C.R., Hegde A., Cherry C., Naqash A.R., Sharma N., Addepalli S., Cherukuri S., Parent T., Hardin J., Walker P. Tocilizumab for the management of immune mediated adverse events secondary to PD-1 blockade. J Oncol Pharm Pract 2019;25(3):551–7. doi: 10.1177/1078155217745144.

9. Agarwal S., Jun C.H. Harnessing CAR T-cell insights to develop treatments for hyperinflammatory responses in COVID-19 patients. Cancer Discov 2020;10(6):775–8. doi: 10.1158/2159-8290.CD-20-0473.

10. Lu X., Zhang L., Du H., Zhang J., Li Y.Y., Qu J., Zhang W., Wang Y., Bao S., Li Y., Wu C., Liu H., Liu D., Shao J., Peng X., Yang Y., Liu Z., Xiang Y., Zhang F., Silva R.M., Pinkerton K.E., Shen K., Xiao H., Xu S., Wong G.W.K.; Chinese Pediatric Novel Coronavirus Study Team. SARS-CoV-2 infection in children. N Engl J Med 2020;382(17):1663–5. doi: 10.1056/NEJMc2005073.

11. Minotti C., Tirelli F., Barbieri E., Giaquinto C., Donà D. How is immunosuppressive status affecting children and adults in SARS-CoV-2 infection? A systematic review. J Infect 2020;81(1):e61–6. doi: 10.1016/j.jinf.2020.04.026.

12. Elzembely M.M., Abdelrahman Y.S., Fadel S., Hafez H. Providing care for pediatric cancer patients in the COVID-19 era: Rapid response recommendations from a developing country. Pediatr Blood Cancer 2020;67(8):e28467. doi: 10.1002/pbc.28467.

13. Balduzzi A., Brivio E., Rovelli A., Rizzari C., Gasperini S., Melzi M.L., Conter V., Biondi A. Lessons after the early management of the COVID-19 outbreak in a pediatric transplant and hemato-oncology center embedded within a COVID-19 dedicated hospital in Lombardia, Italy. Estote parati. Bone Marrow Transplant 2020;1–6. doi: 10.1038/s41409-020-0895-4.

14. Liang W., Guan W., Chen R., Wang W., Li J., Xu K., Li C., Ai Q., Lu W., Liang H., Li S., He J. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol 2020;21(3):335–7. doi: 10.1016/S1470-2045(20)30096-6.

15. Bouffet E., Challinor J., Sullivan M., Biondi A., Rodriguez-Galindo C., Pritchard-Jones K. Early advice on managing children with cancer during the COVID-19 pandemic and a call for sharing experiences. Pediatr Blood Cancer 2020;67(7):e28327. doi: 10.1002/pbc.28327.

16. Cheng Y., Luo R., Wang K., Zhang M., Wang Zh., Dong L., Li J., Yao Y., Ge Sh., Xu G. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int 2020;97(5):829–38. doi: 10.1016/j.kint.2020.03.005.

17. Song S.-H., Chen T.-L., Deng L.-P., Zhang Y.-X., Mo P.-Z., Gao S.-C., Hu W.-J., Xiong Y., Ma Z.-Y. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020. doi: 10.1016/S0140-6736(20)30183-53.

18. Nemirovchenko V.S., Shervashidze M.A., Valiev T.T., Kondratchik K.L. Treatment results of pediatric acute myeloid leukemia with epigenetic drugs addition. Onkogematologiya = Oncohematology 2020;15(2):19–28. (In Russ.). doi: 10.17650/1818-8346-2020-15-2-19-28 [

19. Rao U., Piccin A., Malone A., O’Hanlon K., Breatnach F., O’Meara A., McDermott M., Butler K., O’Sullivan N., Russell J., O’Marcaigh A., Smith O.P. Utility of bronchoalveolar lavage in the diagnosis of pulmonary infection in children with haematological malignancies. Ir J Med Sci 2013;182(2):177–83. doi: 10.1007/s11845-012-0852-3.

20. Marchesi F., Cattaneo Ch., Criscuolo M., Delia M., Dargenio M., Del Principe M.I., Spadea A., Fracchiolla N.S., Melillo L., Perruccio K., Alati C., Russo D., Garzia M., Brociner M., Cefalo M., Armiento D., Cesaro S., Decembrino N., Mengarelli A., Tumbarello M., Busca A., Pagano L.; Sorveglianza Epidemiologica Infezioni nelle Emopatie (SEIFEM) Group. A bronchoalveolar lavage-driven antimicrobial treatment improves survival in hematologic malignancy patients with detected lung infiltrates: A prospective multicenter study of the SEIFEM group. Am J Hematol 2019;94(10):1104–12. doi: 10.1002/ajh.25585.

21. Quinn M., Fannin J.T., Sciasci J., Bragg A., Сampbell P.K., Carias D., Crews K.R., Gregornik D., Jeha S., Maron G., Pauley J.L., Swanson H.D., Wolf J., Greene W. Pentamidine for Prophylaxis against Pneumocystis jirovecii Pneumonia in Pediatric Oncology Patients Receiving Immunosuppressive Chemotherapy. Antimicrob Agents Chemother 2018;62(8):e00173–18. doi: 10.1128/AAC.00173-18.

22. Lange S., Walsh D. Radiation diagnosis of diseases of the chest organs. Leadership. Edited by acad. RAMS S.K. Ternovy and A.I. Schechter. M.: GEOTAR-Media, 2010. Pp. 340–341. (In Russ.).

23. Trofimova T.N., Lukina O.V., Speranskaya A.A., Ilyina N.A., Gavrilov P.V., Panuntseva K.K. Lecture: Coronavirus infection COVID-19. Part 5. Radiation methods of research with COVID-19 and viral pneumonia. I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia. (In Russ.).

24. Tyurin I.E. Symptom of “ground glass” in interstitial lung diseases. Materials of the VII International Congress and School for Physicians “Cardiothoracic Radiology”. Moscow, 2020. (In Russ.).

25. Sokolina I.A. Coronavirus Covid-19: a view of a radiologist. Materials of the VII International Congress and School for Physicians “Cardiothoracic Radiology”. Moscow, 2020. (In Russ.).