Abstract Background The impact of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection among pediatric solid organ transplant (SOT) recipients remains unclear. We sought to characterize the clinical epidemiology and outcomes following SARS-CoV-2 infection among pediatric SOT recipients in Dallas, TX. Methods Retrospective review of all SOT recipients with laboratory confirmed COVID-19 infection from March 1, 2020 –March 31, 2021. Demographic, clinical, and outcome data were stratified by transplant type and disease severity. Fischer’s exact test and Kruskall-Wallis test were used to evaluate risk factors for more severe disease among hospitalized children. Results Twenty-six SOT recipients with a median age of 14 years were included in the study. Fifteen (58%) were female, eighteen (69%) were Hispanic and thirteen (50%) were overweight/obese. Median time post-transplant was 3.6 years (1311 days, interquartile range (IQR) 394-2881). Fourteen patients were liver recipients, seven kidney, three heart, and two multiorgan. The majority of patients (65%) had a known community exposure and presented with fever (50%), cough (38%) and GI symptoms (19%). Half of all cases were hospitalized (n=13), with 2 requiring intensive care unit (ICU) admission, but no patients required positive pressure ventilation. Median hospital stay was 3 days. Five of the thirteen hospitalized patients were categorized as having moderate disease. No patients developed severe disease and there were no deaths. Older children, as well as children with multiple co-morbidities were noted on univariate analysis to be at higher risk for moderate, as compared to mild, disease. Conclusion SARS-CoV-2 infection among pediatric SOT recipients are at increased risk for hospital admission but demonstrate an overall mild /moderate disease course. Larger studies are required to elucidate the risk of morbidity between pediatric SOT recipients and immunocompetent children with SARS-CoV-2. Disclosures Amal Aqul, MD, Albireo pharma Inc. (Consultant)
Abstract Background Nontuberculous mycobacteria (NTM) infection is associated with high rates of morbidity and mortality among immunocompromised adults. However, sparse data exists regarding clinical outcomes among immunocompromised (IC) children with NTM infection. We sought to characterize clinical features and outcomes among IC children at our institution with microbiologically confirmed NTM disease. Methods Retrospective review of cases of microbiologically confirmed NTM infection among IC children between January 2017 and December 2020. Children (≤21y.o) with microbiologically confirmed NTM disease and known primary or secondary immunodeficiency diagnosed between January 1, 2017 and December 20, 2020 were included in the study. All subjects with a positive NTM microbiologic stain or culture but no subsequent treatment for NTM infection were excluded. Demographic and clinical characteristics were assessed and risk factors for mortality were evaluated. Results Of 147 mycobacterial cultures sent during the study period, 72 subjects had a positive microbiologically confirmed NTM species, with 10 subjects meeting all inclusion and no exclusion criteria. Median age was 16 years old, with 40 percent being female and 50 percent of Hispanic ethnicity. NTM disease was distributed among patients with primary immunodeficiency (30%), solid organ transplantation (20%), hematopoietic stem cell transplant (20%), rheumatologic disease on immunosuppressive therapy (10%), and hematologic malignancy (10%). Bacteremia was common, with blood cultures positive in 70% of cases, and M. abscessus (50%) and M. avium complex (30%) the most frequently implicated pathogens. Hospital acquired infection was common (60%). 2 year mortality following invasive NTM infection was high at 40%. Conclusion While rare, NTM infections are associated with significant morbidity and mortality among immunocompromised children. Additional investigations are needed to assess for risk factors associated with NTM and severe NTM disease. Disclosures Laura Filkins, PhD, Avsana Labs (Board Member, Scientific advisory board member)Biofire Diagnostics (Grant/Research Support)
