Poor Respiratory Health Following Relapsing SARS-CoV-2 Infection in Children with Cystic Fibrosis

Children with cystic fbrosis (CF) constitute a high-risk group for COVID-19 with underlying chronic lung disease. COVID19 severity varying from mild infection to need of intensive care has been described in children with CF. Two children with signifcant underlying pulmonary morbidity are described here, who developed severe disease following SARS-CoV-2 infection. Case 1 (a 9-y-old boy) had pneumonia with respiratory failure requiring noninvasive ventilation support. He had delayed clearance of SARS-CoV-2, with recurrence of symptomatic disease with short asymptomatic period in between. He was also diagnosed with CF-related diabetes and allergic bronchopulmonary aspergillosis during the second episode. Case 2 (an 18-mo-old boy) had two episodes of SARS-CoV-2–related severe lower respiratory infection within a period of 2 mo, requiring high-fow nasal oxygen support. Both children had 3rd pulmonary exacerbation but SARS-CoV-2 was not detected in respiratory secretions. To conclude, children with CF with underlying pulmonary morbidity, can develop severe COVID-19 and prolonged SARS-CoV-2 shedding.

Study Designs: Diagnostic Studies

Diagnostic tests are evolving with betterment of technology, quest for patient safety with less invasive medicine, and evolution of new diseases. It is important to assess diagnostic accuracy of a new test, and clinical impact of introduction of new test on outcomes and cost. A diagnostic study is planned for the index test based on place of new test in diagnostic pathway (screening, triage, diagnostic or add-on test) and established information of the test. A reference standard is used to classify population into diseased and healthy, and the discriminating ability of index test is measured. A sample size is calculated for expected sensitivity/specificity, margin of error and prevalence of disease in population. For dichotomous outcomes, sensitivity, specificity, predictive values and likelihood ratio are used to describe diagnostic accuracy. Efforts should be made to avoid common forms of bias including spectrum bias and partial verification bias, and blinding of observers should preferably be done.

Predictors of Malnutrition in Children with Cystic Fibrosis

Objective: To determine occurrence of malnutrition in childrenwith cystic fibrosis and identify predictors of malnutrition at time ofenrolment and after 2 years of follow up.Design: Retrospective chart review.Setting: Pediatric chest clinic at a tertiary-care center in northernIndia.Patients: Cystic fibrosis patients enrolled between 2009-2015with at least 3 years follow-up.Procedure: Weight and height were noted at enrolment, and after1 year and 2 years of follow-up. Clinical details, medications, andpulmonary exacerbations during second year were recorded.Main outcome measure: Occurrence of malnutrition i.e. weightfor age Z-score < -2.Results: 61 medical records were reviewed. Occurrence ofmalnutrition at baseline, and 1- and 2-year follow-up was 65.5%,54.1% and 57.3%, respectively. Weight for age Z-score atenrolment significantly correlated with time to diagnosis fromonset r=0.015, P=0.029). Weight for age Z-score at 2-year follow-up was significantly associated with steatorrhea (P=0.03),increased frequency of stools (P<0.01) and pulmonaryexacerbation (P=0.03) during second year. Linear regressionshowed significant association between weight for age Z-score at2 years with steatorrhea and pulmonary exacerbations [r=-0.795(-1.527, -0.062)] and [r=-0.261 (-0.493, -0.028)]. Pulmonaryexacerbations during second and third year had significantcorrelation with weight for age Z-score at the beginning ofrespective years (r = -0.219, P=0.015).Conclusion: Occurrence of malnutrition is high in children withcystic fibrosis in this region, with uncontrolled fat malabsorptionand recurrent respiratory infections being significant risk factors.