Background: Invasive fungal disease (IFD) is a common and serious consequence of leukaemia in children and the incidence of these infections increased due to chemotherapy. We present the epidemiology of IFD in a cohort of children with leukaemia from a tertiary reference institution in Oman. Methods: A retrospective study of IFDs in pediatric patients with newly diagnosed or relapsed leukemia was conducted at the Royal Hospital in Muscat, Oman. From 2010 to 2017, IFD episodes in children with leukemia were evaluated retrospectively, taking into account age, gender, type of leukaemia, chemotherapy regimen, IFD detection phase, neutropenia, prophylaxis, diagnostic method, and treatment. Results: Between 2010 and 2017, 198 children with leukemia were admitted and treated at Royal Hospital. In retrospect, the IFI were defined as probable and proven in 53 % (17 patients) and 47% (15 patients) of the attacks. At 1.1:1, the male-to-female ratio was roughly equal. According to chest computed tomography (CT) scans, 65.6% of patients had radiological features of fungal infections. Positive fungal cultures were found in three patients’ bronchoalveolar lavage (BAL), 37.5% of whom had positive blood cultures, and 3% of whom had positive urine cultures. In 3 patients, invasive aspergillosis caused pulmonary IFD, accounting for 9.3% of all infection sites. Candidaemia was found in 28% of IFD patients. The most common organism was Candida tropicalis (15.6%), followed by Candida prapsilosis (6.25%). Conclusion: In children with leukemia, invasive fungal infection is common and serious. Despite aggressive treatment, mortality among these high-risk patients remains high.

In times of health crisis, including the current COVID-19 pandemic, the potential benefit of botanical drugs and supplements emerges as a focus of attention, although controversial efficacy claims are rightly a concern. Phytotherapy has an established role in everyday selfcare and health care, and since botanical preparations contain many chemical constituents rather than single compounds, challenges arise in demonstrating efficacy and safety. However, there is ample traditional, empirical and clinical evidence that botanicals can offer some protection and alleviation of disease symptoms as well as promoting general well-being. Newly emerging viral infections, specifically COVID-19, represent a unique challenge in their novelty and absence of established antiviral treatment or immunization. We discuss here the roles and limitations of phytotherapy in helping to prevent and address viral infections, and specifically regarding their effects on immune response. Botanicals with a documented immunomodulatory, immunostimulatory, and anti-inflammatory effect include adaptogens, Boswellia spp., Curcuma longa, Echinacea spp., Glycyrrhiza spp., medicinal fungi, Pelargonium sidoides, salicylate-yielding herbs, and Sambucus spp. We further provide a clinical perspective on applications and safety of these herbs in prevention, onset, progression, and convalescence from respiratory viral infections.