Background: The role of combination regimens in the treatment of invasive fungal infections (IFI) in patients with hematologic malignancies remains unclear. This study was aimed to demonstrate experience data about combined antifungal therapy (CAT) in pediatric IFI patients with haematological malignancies. Methods: Between January 2014 and December 2017, a total of 33 IFI episodes in 28 patients with hematological malignancies were analyzed retrospectively. Results: Of the patients (19 with acute lymphoblastic leukemia, and 9 with acute myeloblastic leukemia), 21 (75%) had leukemia relapse and 7 (25%) had remission. IFI was classified as possible in 26 (78.8%) episodes, probable in 5 (15.1%) episodes, and proven in 2 (6.1%) episodes. LamB (%50) was the most preferred agent in monotherapy. Mean duration of monotherapy was 12.84 ± 4.28 (5-24) days. LamB plus voriconazole (54.5%) were the most common combination preference in CAT. Mean duration of CAT was 42.36 ± 36.4 days, and unchanged according to combination regimen type (p = 0.571). Total mortality rate and IFI attributable mortality rate were 60.7% vs 76.5%. Mortality rate was significantly higher in patients with relapse (p = 0.006). Complete response was obtained in 81.8% of surviving patients. Duration of neutropenia and CAT, and recovery time were not found statistically different in the episodes with/without death and according to relapse or remission status. Side effects due to CAT use were observed quite low level. Conclusion: CAT has been found to be safe in IFI episodes of pediatric leukemia. The result will contribute to the data about combined antifungal use in daily clinical practice in pediatric haematological patients with IFI.

Since the outbreak of 2019 novel coronavirus infection (COVID-19) 5,698,246 cases were infected with COVID-19, there were 352,461 deaths. Various characteristics of COVID-19 were presented but to our knowledge this is the first pediatric case, an eight year old boy, presenting like Steven Johnson Syndrome. In patients with atypical presentations and pulmonary findings COVID-19 should be kept in mind.

Objectives: The aim of this study is to evaluate the hematologic parameters and peripheral blood cell morphological changes in children with COVID-19 and compare them with those of children suspected but then confirmed to be negative for SARS-CoV-2. Methods: Thirty children were tested to be positive for SARS-CoV-2 and the remaining 40 were negative. Hemoglobin, leukocyte, neutrophil, lymphocyte, monocyte counts according to age-specific intervals, platelet, large unstained cell counts, and delta neutrophil index were recorded. Differential counts were formulated by manual counting and morphology of the blood cells were evaluated. Results: The mean leukocyte counts of the SARS-CoV-2 positive and negative groups were 7.0 ± 3.7x109/L and 10.4 ± 7.1x109/L, respectively (p<0.05). Nine (30%) children with COVID-19 had lymphopenia. Among children with COVID-19, absolute lymphocyte count was lower in those with pneumonia (p<0.05). Reactive lymphocytes were noted in 77.8% and 90% in the SARS-CoV-2 test positive and negative groups, respectively (p>0.05). Mean absolute neutrophil counts of the SARS-CoV-2 test positive and negative groups were 3.7±2.9 x109/L and 5.4±4.2 x109/L (p<0.05). Four patients (13.3%) with SARS-CoV-2 test positive had neutrophilia and seven (23.3%) had mild neutropenia. In the peripheral smear, vacuolated monocytes and dysplastic changes in neutrophils and platelets were noted in both groups. Conclusions: Leukocyte, neutrophil and monocyte counts were significantly lower in children with COVID-19 compared with symptomatic children without COVID-19. Lymphopenia, reactive lymphocytosis and dysplasia, could be noted in children with COVID-19. Further studies on hematological findings linked with the course of the disease in children are warranted.

COVID-19 in a child with severe aplastic anemiaYunus Murat Akçabelen1, Ayça Koca Yozgat1, Aslı Nur Parlakay2, Nese Yarali11 Department of Pediatric Hematology, Ankara City Hospital Children’s Hospital, Turkiye2 Department of Pediatric Infectious Disease, Ankara City Hospital Children’s Hospital, TurkiyeArticle type: Letter to the editörRunning Title: COVID-19 in pediatric aplastic anemiaKey words: COVID-19, children, aplastic anemiaDisclosures: noneWord counts: 625