1
|
Lap CR, Brackel CLH, Winkel AMAM, Hashimoto S, Haverkort M, Noij LCE, Alsem MW, von Asmuth EGJ, Bannier MAGE, Buddingh EP, van Goudoever JB, Haverman L, van der Zee AHM, Mooij MG, Oostrom K, Pijnenburg MW, Kloosterman S, Teela L, Luijten M, Tulling AJ, Lugthart G, Bogaert D, Biesbroek G, van Houten MA, Terheggen-Lagro SWJ. Post-COVID-19 condition in children: epidemiological evidence stratified by acute disease severity. Pediatr Res 2024:10.1038/s41390-024-03597-3. [PMID: 39333387 DOI: 10.1038/s41390-024-03597-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 07/18/2024] [Accepted: 09/05/2024] [Indexed: 09/29/2024]
Abstract
BACKGROUND To determine the prevalence of pediatric Post-COVID-19 condition (PPCC), identify risk factors, and assess the quality of life in children with differing severities of acute COVID-19. METHODS During a prospective longitudinal study with a 1-year follow-up, we compared non-hospitalized (mild) and hospitalized (severe) COVID-19 cases to a negatively tested control group. RESULTS 579 children were included in this study. Of these, 260 had mild acute disease (median age:8, IQR:6-10), 60 had severe acute disease (median age:1, IQR:0.1-4.0), and 259 tested negative for SARS-CoV-2 (NT) (median age:8, IQR:5-10). At three months, 14.6% of the SARS-CoV-2 positive mild group (RR:6.31 (CI 95%: 2.71-14.67)) and 29.2% of the severe group (RR:12.95 (CI 95%: 5.37-31.23)) reported sequelae, versus 2.3% of the NT group. PPCC prevalence in the mild group decreased from 16.1% at one month to 4.4% at one year. Children with PPCC exhibited lower physical health-related quality of life scores and higher fatigue scores than the NT children. CONCLUSIONS Severe acute COVID-19 in children leads to a higher PPCC prevalence than in mild cases. PPCC prevalence decreases over time. Risk factors at three months include prior medical history, hospital admission, and persistent fatigue one month after a positive test. IMPACT We demonstrate children with severe COVID-19 are more likely to develop Post-COVID-19 condition than those with mild or no infections, and highlights the risk factors. Here we have stratified by acute disease severity, prospectively included a negative control group, and have demonstrated the heterogeneity in prevalence when utilizing various recent definitions of post-COVID. Identifying risk factors for pediatric post-COVID and highlighting the heterogeneity in prevalence based on various current definitions for post-COVID should aid in correctly identifying potential pediatric post-COVID cases, aiding in early intervention.
Collapse
Affiliation(s)
- Coen R Lap
- Department of Pediatrics - Van Houten research group, Spaarne Gasthuis, Hoofddorp and Haarlem, Haarlem, The Netherlands.
- Department of Pediatric Pulmonology and Allergy, Emma Children's Hospital, Amsterdam University Medical Centre (Amsterdam UMC), University of Amsterdam (UvA), Amsterdam, The Netherlands.
- Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital and University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Caroline L H Brackel
- Department of Pediatric Pulmonology and Allergy, Emma Children's Hospital, Amsterdam University Medical Centre (Amsterdam UMC), University of Amsterdam (UvA), Amsterdam, The Netherlands
- Department of Pediatrics, Tergooi Medical Centrum, Hilversum, The Netherlands
| | - Angelique M A M Winkel
- Department of Pediatrics - Van Houten research group, Spaarne Gasthuis, Hoofddorp and Haarlem, Haarlem, The Netherlands
- Department of Pediatric Pulmonology and Allergy, Emma Children's Hospital, Amsterdam University Medical Centre (Amsterdam UMC), University of Amsterdam (UvA), Amsterdam, The Netherlands
| | - Simone Hashimoto
- Department of Pediatric Pulmonology and Allergy, Emma Children's Hospital, Amsterdam University Medical Centre (Amsterdam UMC), University of Amsterdam (UvA), Amsterdam, The Netherlands
- Department of Pulmonary Medicine, Amsterdam UMC University of Amsterdam, Amsterdam, The Netherlands
| | - Milly Haverkort
- Department of Infection Prevention and Control, Public Health Service (GGD) Kennemerland, Haarlem, The Netherlands
| | - Lieke C E Noij
- Department of Pediatric Pulmonology and Allergy, Emma Children's Hospital, Amsterdam University Medical Centre (Amsterdam UMC), University of Amsterdam (UvA), Amsterdam, The Netherlands
| | - Mattijs W Alsem
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam University Medical Centre (Amsterdam UMC), University of Amsterdam (UvA), Amsterdam, The Netherlands
| | - Erik G J von Asmuth
- Willem Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
| | - Michiel A G E Bannier
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, MosaKids Children's Hospital, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Emmeline P Buddingh
- Willem Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
| | - Johannes B van Goudoever
- Department of Pediatrics, Emma Children's Hospital, Amsterdam University Medical Centre (Amsterdam UMC), University of Amsterdam (UvA), Amsterdam, The Netherlands
| | - Lotte Haverman
- Child and Adolescent Psychiatry & Psychosocial Care, Emma Children's Hospital, Amsterdam University Medical Centre (Amsterdam UMC), University of Amsterdam (UvA), Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health and Digital Health, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Child Development, Amsterdam, The Netherlands
| | - Anke H Maitland- van der Zee
- Department of Pediatric Pulmonology and Allergy, Emma Children's Hospital, Amsterdam University Medical Centre (Amsterdam UMC), University of Amsterdam (UvA), Amsterdam, The Netherlands
- Department of Pulmonary Medicine, Amsterdam UMC University of Amsterdam, Amsterdam, The Netherlands
| | - Miriam G Mooij
- Department of Pediatric Nephrology, Sophia Children's Hospital, Erasmus MC, Rotterdam, The Netherlands
| | - Kim Oostrom
- Child and Adolescent Psychiatry & Psychosocial Care, Emma Children's Hospital, Amsterdam University Medical Centre (Amsterdam UMC), University of Amsterdam (UvA), Amsterdam, The Netherlands
| | - Mariëlle W Pijnenburg
- Division of Pediatric Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC -Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Sanne Kloosterman
- Division of Pediatric Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC -Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Lorynn Teela
- Child and Adolescent Psychiatry & Psychosocial Care, Emma Children's Hospital, Amsterdam University Medical Centre (Amsterdam UMC), University of Amsterdam (UvA), Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health and Digital Health, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Child Development, Amsterdam, The Netherlands
| | - Michiel Luijten
- Child and Adolescent Psychiatry & Psychosocial Care, Emma Children's Hospital, Amsterdam University Medical Centre (Amsterdam UMC), University of Amsterdam (UvA), Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health and Digital Health, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Child Development, Amsterdam, The Netherlands
| | - Adam J Tulling
- Willem Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
| | - Gertjan Lugthart
- Willem Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
| | - Debby Bogaert
- Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital and University Medical Centre Utrecht, Utrecht, The Netherlands
- Centre for Inflammation Research, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, UK
| | - Giske Biesbroek
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Amsterdam University Medical Centre (Amsterdam UMC), University of Amsterdam (UvA), Amsterdam, The Netherlands
| | - Marlies A van Houten
- Department of Pediatrics - Van Houten research group, Spaarne Gasthuis, Hoofddorp and Haarlem, Haarlem, The Netherlands
| | - Suzanne W J Terheggen-Lagro
- Department of Pediatric Pulmonology and Allergy, Emma Children's Hospital, Amsterdam University Medical Centre (Amsterdam UMC), University of Amsterdam (UvA), Amsterdam, The Netherlands
| |
Collapse
|
2
|
Areti S, Parrillo M, Baker L, Meszaros A, Dram A, Remy KE. Multisystem inflammatory syndrome in children: an evolving understanding of a syndrome amid the inflammatory continuum. Minerva Pediatr (Torino) 2024; 76:545-555. [PMID: 37335186 DOI: 10.23736/s2724-5276.23.07279-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a rare hyperinflammatory and immunosuppressed condition affecting children exposed to COVID-19. MIS-C has been associated with an over-exaggerated innate and adaptive immune response characterized by a 'selective' cytokine production and T cell suppression. As COVID-19 information has evolved, the knowledge and field surrounding MIS-C is ever evolving. Thus, a comprehensive clinical review that concisely presents current literature findings regarding common clinical presentations and comparisons with similar conditions, associations with the COVID-19 vaccine effects and relevant epigenetic markers and evaluates treatment and long-term outcomes to help guide future studies is needed and provided.
Collapse
Affiliation(s)
- Sathya Areti
- Department of Medicine, Case Western University School of Medicine, University Hospitals of Cleveland, Cleveland, OH, USA
- Department of Pediatrics, Case Western University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Marissa Parrillo
- Department of Pediatrics, Case Western University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Lena Baker
- Department of Pediatrics, Case Western University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Alexandra Meszaros
- Division of Basic Research, Washington University in St. Louis, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Alexandra Dram
- Division of Basic Research, Washington University in St. Louis, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Kenneth E Remy
- Department of Medicine, Case Western University School of Medicine, University Hospitals of Cleveland, Cleveland, OH, USA -
- Department of Pediatrics, Case Western University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| |
Collapse
|
3
|
Supino MC, Buonsenso D, Agostiniani R, Gori L, Tipo V, Morello R, Del Monaco G, Falsaperla R, Biagi C, Cazzato S, Villani A, Musolino AM. The lung ultrasound in children with SARS-COV-2 infection: a national multicenter prospective study. Eur J Pediatr 2024; 183:3397-3405. [PMID: 38767693 DOI: 10.1007/s00431-024-05609-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/07/2024] [Accepted: 05/11/2024] [Indexed: 05/22/2024]
Abstract
Coronavirus disease-19 (COVID-19) caused hospitalizations, severe disease, and deaths in any age, including in the youngest children. The aim of this multicenter national study is to characterize the clinical and the prognostic role of lung ultrasound (LU) in children with COVID-19. We enrolled children between 1 month and 18 years of age with severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection who underwent a LU within 6 h from the first medical evaluation. A total of 213 children were enrolled, 51.6% were male, median age was 2 years and 5 months (interquartile range (IQR) 4 months -11 years and 4 months). One hundred and forty-eight (69.4%) children were admitted in hospital, 9 (6.1%) in pediatric intensive care unit. We found an inverse correlation between the lung ultrasound score (LUS) and the oxygen saturation at the first clinical evaluation (r = -0.16; p = 0.019). Moreover, LUS was significantly higher in patients requiring oxygen supplementation (8 (IQR 3-19) vs 2 (IQR 0-4); p = 0.001). Among LU pathological findings, irregular pleural lines, subpleural consolidations, and pleural effusions were significantly more frequent in patients needing oxygen supplementation (p = 0.007, p = 0.006, and p = 0.001, respectively). Conclusion: This multicenter study showed that LU in children with COVID-19 can highlight pleural line irregularities, vertical artifacts, and subpleural consolidation. Notably, children with higher LUS have a higher risk of hospitalization and need for oxygen supplementation, supporting LU as a valid and safe point-of-care first level tool for the clinical evaluation of children with COVID-19. What is Known: • Few children infected with SARS-CoV-2 develop a severe disease and need oxygen therapy. • Lung ultrasound can easily detect low respiratory tract infection during SARS-CoV-2. What is New: • Children with higher lung ultrasound score have a higher risk of need for oxygen supplementation. • Irregular pleural line, sub-pleural consolidations and pleural effusions were significantly more frequent in patients needing oxygen supplementation.
Collapse
Affiliation(s)
- Maria Chiara Supino
- Pediatric Emergency Unit, Pediatric Emergency Department and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Centro di Salute Globale, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Laura Gori
- Department of Maternal and Child Health, Division of Pediatric Unit, S. Chiara Hospital, Pisa, Italy
| | - Vincenzo Tipo
- Pediatric Emergency and Short Stay Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Raffaele Falsaperla
- Neonatal Intensive Care Unit [NICU], AOU "Rodolico-San Marco", PO "San Marco", University of Catania, Catania, Italy
| | - Carlotta Biagi
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Salvatore Cazzato
- Pediatric Unit, Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | - Alberto Villani
- Pediatric Emergency Unit, Pediatric Emergency Department and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Anna Maria Musolino
- Pediatric Emergency Unit, Pediatric Emergency Department and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| |
Collapse
|
4
|
Baldi F, De Rose C, Mariani F, Morello R, Raffaelli F, Valentini P, Buonsenso D. Cardiopulmonary Exercise Testing in Children With Long COVID: A Case-controlled Study. Pediatr Infect Dis J 2024; 43:795-802. [PMID: 38713816 PMCID: PMC11250093 DOI: 10.1097/inf.0000000000004371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND Cardiopulmonary exercise testing (CPET) is a noninvasive and nonexpensive diagnostic tool, that provides a comprehensive evaluation of the pulmonary, cardiovascular, and skeletal muscle systems' integrated reactions to exercise. CPET has been extensively used in adults with Long COVID (LC), while the evidence about its role in children with this condition is scarce. METHODS Prospective, case-controlled observational study. Children with LC and a control group of healthy children underwent CPET. CPET findings were compared within the 2 groups, and within the LC groups according to main clusters of persisting symptoms. RESULTS Sixty-one children with LC and 29 healthy controls were included. Overall, 90.2% of LC patients (55 of 61) had a pathologic test vs 10.3% (3/29) of the healthy control. Children with LC presented a statistically significant higher probability of having abnormal values of peak VO2 ( P = 0.001), AT% pred ( P <0.001), VO2/HR % ( P = 0.03), VO2 work slope ( P = 0.002), VE/VCO2 slope ( P = 0.01). The mean VO2 peak was 30.17 (±6.85) in LC and 34.37 (±6.55) in healthy patients ( P = 0.007). CONCLUSIONS Compared with healthy controls, children with LC have objective impaired functional capacity (expressed by a low VO2 peak), signs of deconditioning and cardiogenic inefficiency when assessed with CPET. As such, CPET should be routinely used in clinical practice to objectify and phenotype the functional limitations of children with LC, and to follow-up them.
Collapse
Affiliation(s)
- Fabiana Baldi
- From the Pulmonary Medicine Unit, Department of Medical and Surgical Sciences
| | | | | | - Rosa Morello
- Department of Woman and Child Health and Public Health
| | - Francesca Raffaelli
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS
| | | | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health
- Centro di Salute Globale, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
5
|
Angelhoff C, Duchen K, Ertzgaard P, Rytterström P. Navigating an unfamiliar world - Parents' experiences of having a child with post COVID-19. J Pediatr Nurs 2024; 77:e565-e572. [PMID: 38796360 DOI: 10.1016/j.pedn.2024.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/18/2024] [Accepted: 05/18/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Post COVID-19 diagnosis in children has been difficult as there has been a lack of knowledge within the healthcare system, leading to uncertainty concerning how these children should be assessed and treated. To understand the aspects of how parents experience seeking care for their child with an array of symptoms and how the child's symptoms affect their everyday life and family situation, we need to listen to the parents' stories about having a child living with post COVID-19. PURPOSE To describe parents' experiences of seeking professional care for their child with post COVID-19 symptoms and what kinds of impacts there are on their children's daily life. DESIGN AND METHODS A qualitative study with an inductive and exploratory approach including seventeen parents of children with post COVID-19. Face-to-face interviews were conducted between October 2022 and March 2023 and analyzed with thematic analysis. RESULTS The findings describe how the parents' constant struggle for their child and how the child's symptoms affect their daily life and their family situation in three themes: Navigating the unknown, Navigating life with post COVID-19, and Navigating between fear and hope for an uncertain future. CONCLUSIONS This study corroborates the parents' struggle for acceptance of the children's problems in the health system. PRACTICE IMPLICATIONS It is important that health care focuses on the everyday world and the problems that the child and parents express to understand the family's perspective and the problems that arise in everyday life.
Collapse
Affiliation(s)
- Charlotte Angelhoff
- Allergy Center in Linköping and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Karel Duchen
- Allergy Center in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Per Ertzgaard
- Department of Rehabilitation Medicine in Linköping and Department of Health, Medicine and Caring Sciences, Linkoping University, Linköping, Sweden
| | - Patrik Rytterström
- Department of Health, Medicine and Caring Sciences, Division of Nursing Science, Linköping University, Norrköping, Sweden
| |
Collapse
|
6
|
Takahashi Y, Yatomi T, Yamaguchi N, Yoshimura K, Hori S, Uchida H. Comparable Psychotropic Prescription Rates After Hospital Discharge Between Patients with COVID-19 and Those With Non-COVID-19-Related Respiratory Infection. PHARMACOPSYCHIATRY 2024; 57:186-190. [PMID: 38531375 DOI: 10.1055/a-2286-1427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
INTRODUCTION Whether psychiatric symptoms after recovery from coronavirus disease 2019 (COVID-19) are specific to this illness remains unclear. METHODS In this retrospective study, the Diagnosis Procedure Combination data and outpatient clinic data were used for patients who received inpatient treatment in Saiseikai-affiliated hospitals for COVID-19 or other respiratory tract infections (non-COVID) from 2020 to 2022. The primary outcome was new prescriptions of psychotropic drugs after discharge (i. e., prescriptions of psychotropics to patients who had not received them before or during their hospitalization). Values of interest were compared between groups using the chi-square test or Fisher's exact test. A COX proportional-hazards model was used to examine factors associated with psychotropic prescriptions after discharge in age- and sex-matched COVID-19 and non-COVID patients. RESULTS Of 31,993 chart records, 19,613 were excluded due to a positive history with psychiatric disorders (n=2,445), prescriptions of psychotropics (n=744), and no follow-ups (n=16,424). Thus, 3,648 COVID-19 and 8,732 non-COVID patients were included (mean [range] duration of follow-up, days: 146.9 [1-727] and 239.2 [1-729], respectively). Two hundred and four (5.6%) of the 3,648 patients with COVID-19 received psychotropic prescriptions after discharge. No statistically significant differences were observed in the prescription rates of any psychotropic category between the COVID-19 and non-COVID groups. An increase in severity during hospitalization was significantly associated with more frequent psychotropic prescriptions (hazard ratio 1.83, p<0.001). DISCUSSION The development of psychiatric symptoms should be closely observed, especially in patients who experienced increased severity during hospitalization, regardless of whether they suffered from COVID-19.
Collapse
Affiliation(s)
- Yuna Takahashi
- Division of Drug Informatics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Taisuke Yatomi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Naohito Yamaguchi
- Saiseikai Research Institute of Health Care and Welfare, Tokyo, Japan
| | - Kimio Yoshimura
- Department of Health Policy and Management, Keio University School of Medicine, Tokyo, Japan
| | - Satoko Hori
- Division of Drug Informatics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
7
|
Brackel CLH, Noij LCE, Vijverberg SJH, Legghe CL, Maitland-van der Zee AH, van Goudoever JB, Buonsenso D, Munblit D, Sigfrid L, McFarland S, Anmyr L, Ashkenazi-Hoffnung L, Bellinat APN, Dias NLS, Edwards A, Fashina T, Juraški RG, Gonçalves ALN, Hansted E, Herczeg V, Hertting O, Jankauskaite LN, Kaswandani N, Kevalas R, Krivácsy P, Lorenz M, Malone LA, McVoy M, Miller DW, Morrow AK, Nugawela MD, Oliveira CR, Oliveira PRS, Osmanov IM, Overmars IM, Paintsil E, Pinto Pereira SM, Prawira Y, Putri ND, Ramos RCF, Rasche M, Ryd-Rinder M, De Rose C, Samitova E, Jovanović TS, Say D, Scott JT, Shachar-Lavie I, Shafran R, Shmueli E, Snipaitiene A, Stephenson T, Ténai N, Tosif S, Turkalj M, Valentini P, Vasconcelos LRS, Villard L, Vilser D, Hashimoto S, Terheggen-Lagro SWJ. International Care programs for Pediatric Post-COVID Condition (Long COVID) and the way forward. Pediatr Res 2024; 96:319-324. [PMID: 38287106 DOI: 10.1038/s41390-023-03015-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/16/2023] [Accepted: 12/15/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Pediatric Post-COVID-Condition (PPCC) clinics treat children despite limited scientific substantiation. By exploring real-life management of children diagnosed with PPCC, the International Post-COVID-Condition in Children Collaboration (IP4C) aimed to provide guidance for future PPCC care. METHODS We performed a cross-sectional international, multicenter study on used PPCC definitions; the organization of PPCC care programs and patients characteristics. We compared aggregated data from PPCC cohorts and identified priorities to improve PPCC care. RESULTS Ten PPCC care programs and six COVID-19 follow-up research cohorts participated. Aggregated data from 584 PPCC patients was analyzed. The most common symptoms included fatigue (71%), headache (55%), concentration difficulties (53%), and brain fog (48%). Severe limitations in daily life were reported in 31% of patients. Most PPCC care programs organized in-person visits with multidisciplinary teams. Diagnostic testing for respiratory and cardiac morbidity was most frequently performed and seldom abnormal. Treatment was often limited to physical therapy and psychological support. CONCLUSIONS We found substantial heterogeneity in both the diagnostics and management of PPCC, possibly explained by scarce scientific evidence and lack of standardized care. We present a list of components which future guidelines should address, and outline priorities concerning PPCC care pathways, research and international collaboration. IMPACT Pediatric Post-COVID Condition (PPCC) Care programs have been initiated in many countries. Children with PPCC in different countries are affected by similar symptoms, limiting many to participate in daily life. There is substantial heterogeneity in diagnostic testing. Access to specific diagnostic tests is required to identify some long-term COVID-19 sequelae. Treatments provided were limited to physical therapy and psychological support. This study emphasizes the need for evidence-based diagnostics and treatment of PPCC. The International Post-COVID Collaboration for Children (IP4C) provides guidance for guideline development and introduces a framework of priorities for PPCC care and research, to improve PPCC outcomes.
Collapse
Affiliation(s)
- Caroline L H Brackel
- Department of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands.
- Department of Pediatrics, Tergooi MC, Hilversum, the Netherlands.
| | - Lieke C E Noij
- Department of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Susanne J H Vijverberg
- Department of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
- Department of Pulmonary Medicine, Amsterdam Institute for Infection and Immunology, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Camille L Legghe
- Department of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
- Faculty of Pharmacy, University of Lille, Lille, France
| | - Anke H Maitland-van der Zee
- Department of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
- Department of Pulmonary Medicine, Amsterdam Institute for Infection and Immunology, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Johannes B van Goudoever
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Daniel Munblit
- Care for Long Term Conditions Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - Louise Sigfrid
- ISARIC Global Support Centre, Pandemic Science Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sammie McFarland
- Long COVID Kids and Friends, Fletcher & Partners, Crown Chambers, Bridge Street, Salisbury, SP1 2LZ, UK
| | - Lena Anmyr
- Medical Unit Social Work, Function Allied Health Professionals, Karolinska University Hospital, Stockholm, Sweden
| | - Liat Ashkenazi-Hoffnung
- Department of Day Hospitalization, Schneider Children's Medical Center, Petach Tikva, Tel Aviv, Israel
| | - Ana P N Bellinat
- Pediatric Intensive Care Unit, Hospital Martagão Gesteira - Children's Hospital, Salvador, Brazil
| | - Nathália L S Dias
- Pediatric Intensive Care Unit, Hospital Martagão Gesteira - Children's Hospital, Salvador, Brazil
| | - Amy Edwards
- Department of Infectious Disease, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Tomini Fashina
- Department of Global Health, Yale University School of Public Health, New Haven, CT, USA
| | - Romana Gjergja Juraški
- Department of Pediatric Neurology, Srebrnjak Children's Hospital, Srebrnjak, Zagreb, Croatia
- Medical School of Osijek, University of Osijek, Osijek, Zagreb, Croatia
| | | | - Edita Hansted
- Department of Pediatrics, Lithuanian University of Health Sciences Hospital KaunoKlinikos, Kaunas, Lithuania
| | - Vivien Herczeg
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Bókay Unit, Budapest, Hungary
| | - Olof Hertting
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Lina N Jankauskaite
- Department of Pediatrics, Lithuanian University of Health Sciences Hospital KaunoKlinikos, Kaunas, Lithuania
| | - Nastiti Kaswandani
- Department of Child Health, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Rimantas Kevalas
- Department of Pediatrics, Lithuanian University of Health Sciences Hospital KaunoKlinikos, Kaunas, Lithuania
| | - Péter Krivácsy
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Bókay Unit, Budapest, Hungary
| | - Michael Lorenz
- Pediatric Pulmonology, Department of Paediatrics, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany
| | - Laura A Malone
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Kennedy Krieger Institute, Baltimore, MD, USA
| | - Molly McVoy
- Department of Pediatric Psychiatry, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - David W Miller
- Department of Pediatric Integrative Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Amanda K Morrow
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Carlos R Oliveira
- Department of Pediatrics, Division of Infectious Diseases & Global Health, Yale University School of Medicine, New Haven, CT, USA
| | | | - Ismael M Osmanov
- ZA Bashlyaeva Children's Municipal Clinical Hospital, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Isabella M Overmars
- Department of Infection and Immunity, Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - Elijah Paintsil
- Department of Pediatrics, Division of Infectious Diseases & Global Health, Yale University School of Medicine, New Haven, CT, USA
| | | | - Yogi Prawira
- Department of Child Health, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Nina Dwi Putri
- Department of Child Health, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | | | - Marius Rasche
- Pediatric Pulmonology, Department of Paediatrics, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany
| | - Malin Ryd-Rinder
- Pediatric Emergency Care, Astrid Lindgren Children Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Christina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elmira Samitova
- ZA Bashlyaeva Children's Municipal Clinical Hospital, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | | | - Daniela Say
- Department of Infection and Immunity, Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - Janet T Scott
- Department of Infectious Disease, MRC-University of Glasgow Centre for Virus Research, Glasgow, United Kingdom
| | - Iris Shachar-Lavie
- Department of Psychological Medicine, Schneider Children's Medical Center, Petach Tikva, Israel
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Einat Shmueli
- Pulmonary Institute, Schneider Children's Medical Center, Petach Tikva, Tel Aviv, Israel
| | - Ausra Snipaitiene
- Department of Pediatrics, Lithuanian University of Health Sciences Hospital KaunoKlinikos, Kaunas, Lithuania
| | - Terence Stephenson
- UCL Great Ormond Street Institute of Child Health, University College Hospital & Great Ormond Street Hospital, London, UK
| | - Nikolett Ténai
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Bókay Unit, Budapest, Hungary
| | - Shidan Tosif
- Department of General Medicine, Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Melbourne, Australia
| | - Mirjana Turkalj
- Department of Pulmonology, Allergy and Immunology, Srebrnjak Children's Hospital, Zagreb, Croatia
- Medical School, Catholic University of Croatia, Zagreb, Croatia
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luydson R S Vasconcelos
- Hospital Universitário Oswaldo Cruz, Recife, Pernambuco, Brazil
- Aggeu Magalhães Institute, Oswaldo Cruz Foundation, FIOCRUZ-PE, Recife, Brazil
| | - Li Villard
- Medical Unit Occupational Therapy and Physiotherapy, Function Allied Health Professionals, Karolinska University Hospital, Stockholm, Sweden
| | - Daniel Vilser
- Clinic for Pediatric and Adolescent Medicine Neuberg/Ingolstadt AMEOS Hospital Association, Neuberg, Germany
| | - Simone Hashimoto
- Department of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
- Department of Pulmonary Medicine, Amsterdam Institute for Infection and Immunology, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Suzanne W J Terheggen-Lagro
- Department of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
8
|
Bush A, Buonsenso D, Peroni D, Piazza M, Piacentini G, Boner AL. Early-life respiratory infection: How do we react to this red flag? Pediatr Pulmonol 2024; 59:1817-1819. [PMID: 38477636 DOI: 10.1002/ppul.26963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 03/14/2024]
Affiliation(s)
- Andrew Bush
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital and National Heart and Lung Institute, School of Medicine, Imperial College London, London, UK
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS. And Centro di Salute Globale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Diego Peroni
- Pediatric Clinic, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Michele Piazza
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Attilio L Boner
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| |
Collapse
|
9
|
Delogu AB, Aliberti C, Birritella L, De Rosa G, De Rose C, Morello R, Cambise N, Marino AG, Belmusto A, Tinti L, Di Renzo A, Lanza GA, Buonsenso D. Autonomic cardiac function in children and adolescents with long COVID: a case-controlled study. Eur J Pediatr 2024; 183:2375-2382. [PMID: 38446228 PMCID: PMC11035407 DOI: 10.1007/s00431-024-05503-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/07/2024]
Abstract
Although the mechanisms underlying the pathophysiology of long COVID condition are still debated, there is growing evidence that autonomic dysfunction may play a role in the long-term complications or persisting symptoms observed in a significant proportion of patients after SARS-CoV-2 infection. However, studies focused on autonomic dysfunction have primarily been conducted in adults, while autonomic function has not yet been investigated in pediatric subjects. In this study, for the first time, we assessed whether pediatric patients with long COVID present abnormalities in autonomic cardiac function. Fifty-six long COVID pediatric patients (mean age 10.3 ± 3.8 y) and 27 age-, sex-, and body surface area-matched healthy controls (mean age 10.4 ± 4.5y) underwent a standard 12-lead electrocardiography (ECG) and 24-h ECG Holter monitoring. Autonomic cardiac function was assessed by time-domain and frequency-domain heart rate variability parameters. A comprehensive echocardiographic study was also obtained by two-dimensional echocardiography and tissue Doppler imaging. Data analysis showed that pediatric patients with long COVID had significant changes in HRV variables compared to healthy controls: significantly lower r-MSSD (root mean square of successive RR interval differences, 47.4 ± 16.9 versus 60.4 ± 29.1, p = 0.02), significant higher values VLF (very low frequency, 2077.8 ± 1023.3 versus 494.3 ± 1015.5 ms, p = 0.000), LF (low frequency, 1340.3 ± 635.6 versus 354.6 ± 816.8 ms, p = 0.000), and HF (high frequency, 895.7 ± 575.8 versus 278.9 ± 616.7 ms, p = 0.000). No significant differences were observed between the two groups both in systolic and diastolic parameters by echocardiography. Conclusion: These findings suggest that pediatric patients with long COVID have an imbalance of cardiac autonomic function toward a relative predominance of parasympathetic tone, as already reported in adult patients with long COVID. Further studies are needed to clarify the clinical significance of this autonomic dysfunction and demonstrate its role as a pathophysiological mechanism of long COVID, paving the way for effective therapeutic and preventive strategies. What is Known: • Long Covid in children has been described globally, but studies have mostly focused on collecting the temporal evolution of persisting symptoms. What is New: • Cardiac autonomic imbalance toward a relative predominance of parasympathetic tone is a mechanism underlying Long Covid in children, as also described in adults.
Collapse
Affiliation(s)
- A B Delogu
- Institute of Pediatrics, Pediatric Cardiology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Aliberti
- Institute of Pediatrics, Pediatric Cardiology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - L Birritella
- Institute of Pediatrics, Pediatric Cardiology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - G De Rosa
- Institute of Pediatrics, Pediatric Cardiology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - C De Rose
- Università Cattolica del Sacro Cuore, Rome, Italy
- Institute of Pediatrics, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - R Morello
- Università Cattolica del Sacro Cuore, Rome, Italy
- Institute of Pediatrics, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - N Cambise
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A G Marino
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A Belmusto
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - L Tinti
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A Di Renzo
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - G A Lanza
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - D Buonsenso
- Università Cattolica del Sacro Cuore, Rome, Italy.
- Institute of Pediatrics, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, Rome, 00168, Italy.
| |
Collapse
|
10
|
Toepfner N, Brinkmann F, Augustin S, Stojanov S, Behrends U. Long COVID in pediatrics-epidemiology, diagnosis, and management. Eur J Pediatr 2024; 183:1543-1553. [PMID: 38279014 PMCID: PMC11001657 DOI: 10.1007/s00431-023-05360-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/24/2023] [Accepted: 11/29/2023] [Indexed: 01/28/2024]
Abstract
This review summarizes current knowledge on post-acute sequelae of COVID-19 (PASC) and post-COVID-19 condition (PCC) in children and adolescents. A literature review was performed to synthesize information from clinical studies, expert opinions, and guidelines. PASC also termed Long COVID - at any age comprise a plethora of unspecific symptoms present later than 4 weeks after confirmed or probable infection with severe respiratory syndrome corona virus type 2 (SARS-CoV-2), without another medical explanation. PCC in children and adolescents was defined by the WHO as PASC occurring within 3 months of acute coronavirus disease 2019 (COVID-19), lasting at least 2 months, and limiting daily activities. Pediatric PASC mostly manifest after mild courses of COVID-19 and in the majority of cases remit after few months. However, symptoms can last for more than 1 year and may result in significant disability. Frequent symptoms include fatigue, exertion intolerance, and anxiety. Some patients present with postural tachycardia syndrome (PoTS), and a small number of cases fulfill the clinical criteria of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). To date, no diagnostic marker has been established, and differential diagnostics remains challenging. Therapeutic approaches include appropriate self-management as well as the palliation of symptoms by non-pharmaceutical and pharmaceutical strategies. Conclusion: PASC in pediatrics present with heterogenous severity and duration. A stepped, interdisciplinary, and individualized approach is essential for appropriate clinical management. Current health care structures have to be adapted, and research was extended to meet the medical and psychosocial needs of young people with PASC or similar conditions. What is Known: • Post-acute sequelae of coronavirus 2019 (COVID-19) (PASC) - also termed Long COVID - in children and adolescents can lead to activity limitation and reduced quality of life. • PASC belongs to a large group of similar post-acute infection syndromes (PAIS). Specific biomarkers and causal treatment options are not yet available. What is New: • In February 2023, a case definition for post COVID-19 condition (PCC) in children and adolescents was provided by the World Health Organization (WHO), indicating PASC with duration of at least 2 months and limitation of daily activities. PCC can present as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). • Interdisciplinary collaborations are necessary and have been established worldwide to offer harmonized, multimodal approaches to diagnosis and management of PASC/PCC in children and adolescents.
Collapse
Affiliation(s)
- Nicole Toepfner
- Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
| | - Folke Brinkmann
- Division of Pediatric Pulmonology and Allergology, University Children's Hospital, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Luebeck, Germany
| | - Silvia Augustin
- MRI Chronic Fatigue Center for Young People, Pediatrics, Children's Hospital, Technical University Munich and Munich Municipal Hospital, Munich, Germany
| | - Silvia Stojanov
- MRI Chronic Fatigue Center for Young People, Child and Adolescent Psychosomatics, Children's Hospital, Technical University Munich and Munich Municipal Hospital, Munich, Germany
| | - Uta Behrends
- MRI Chronic Fatigue Center for Young People, Pediatrics, Children's Hospital, Technical University Munich and Munich Municipal Hospital, Munich, Germany
| |
Collapse
|
11
|
Minotti C, McKenzie C, Dewandel I, Bekker C, Sturniolo G, Doni D, Giaquinto C, Van Der Zalm MM, Donà D. How does post COVID differ from other post-viral conditions in childhood and adolescence (0-20 years old)? A systematic review. EClinicalMedicine 2024; 68:102436. [PMID: 38333536 PMCID: PMC10850405 DOI: 10.1016/j.eclinm.2024.102436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/03/2024] [Accepted: 01/10/2024] [Indexed: 02/10/2024] Open
Abstract
Background Post Coronavirus disease (COVID) and other post-viral infection syndromes present an overlap of pathogenesis, onset, progression, and symptom profile. We aimed to systematically describe studies on post-viral conditions and determine the entity of post COVID compared to other post-viral conditions in children. Methods We conducted a systematic search of the Embase, MEDLINE, Cochrane Library, and GoogleScholar databases (January 1946-3 November 2023), according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The main outcomes were differences in condition duration, symptom type, and development of chronic symptoms. This systematic review was registered on PROSPERO (CRD42023401789). Findings 35/5051 studies were included, with 42,934 children, adolescents and young adults (0-20 years old) overall. Twenty-eight studies focused on post COVID symptoms, followed by five papers on Respiratory Syncytial Virus (RSV) and Rhinovirus, one study on Epstein-Barr Virus (EBV), and one on gastrointestinal viruses. Studies on post COVID mainly reported data on older children/adolescents, describing long-lasting symptoms, including fatigue, neurologic, cardiorespiratory, musculoskeletal, mental health, and gastrointestinal symptoms. The maximum described symptoms duration was eighteen months, with an average follow-up of seven months. The development of chronic symptoms was reported by 30 studies (93.8%) for 10,473/28,474 patients (36.8%). Recovery was achieved in 18,001/28,474 cases (63.2%). The study on EBV reported persistent fatigue in adolescents for a similar duration (6 months, 46% chronic). Studies on RSV and Rhinovirus were mainly done in children under three years, with development of recurrent wheezing (up to 3 years). Interpretation Post-viral fatigue was a shared feature between post COVID and post EBV conditions. A better understanding of post COVID as a unique condition, sharing features with other post-viral syndromes, is needed. The healthcare burden and socio-economic consequences for children and their families warrant further investigation and development of appropriate healthcare management plans. The foremost requirement is the establishment of consistent and shareable definitions, as well as a consensus on outcomes, to effectively evaluate follow-up and quantify the burden of different viral infections. Funding EU Horizon, EDCTP, NIH.
Collapse
Affiliation(s)
- Chiara Minotti
- Department of Women's and Children's Health, University of Padua, Italy
- PhD Program in Clinical Research, University Children's Hospital Basel, University of Basel, Switzerland
| | - Carla McKenzie
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Isabelle Dewandel
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Carien Bekker
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Giulia Sturniolo
- Department of Women's and Children's Health, University of Padua, Italy
| | - Denis Doni
- Department of Women's and Children's Health, University of Padua, Italy
| | - Carlo Giaquinto
- Department of Women's and Children's Health, University of Padua, Italy
| | - Marieke M. Van Der Zalm
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Daniele Donà
- Department of Women's and Children's Health, University of Padua, Italy
| |
Collapse
|
12
|
Mariani F, Rainaldi S, Dall’Ara G, De Rose C, Morello R, Buonsenso D. Persisting Gastrointestinal Symptoms in Children with SARS-CoV-2: Temporal Evolution over 18 Months and Possible Role of Lactoferrin. CHILDREN (BASEL, SWITZERLAND) 2024; 11:105. [PMID: 38255418 PMCID: PMC10814461 DOI: 10.3390/children11010105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/06/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND AND AIM Persisting gastrointestinal symptoms are reported to be relatively common in children with long COVID; however, their detailed characterization and long-term outcomes have not yet been described. METHODS We performed a retrospective study aiming to investigate the temporal evolution of gastrointestinal symptoms in children with SARS-CoV-2, from acute infection to 18-months follow-up. To further investigate possible therapeutic strategies, we evaluated the role of lactoferrin in improving gastrointestinal symptoms in these children, compared with those not treated. RESULTS A total of 1224 patients (47.7% females) were included. Of these participants, 246 (19.8%) were vaccinated and 143 (11.5%) presented with comorbidities. A total of 175 patients (14.1%) presented gastrointestinal symptoms during acute infection, 54 (4.4%) at three months, 23 (1.9%) at six months, 6 (3.3%) at twelve months, and 2 (2.3%) at eighteen months follow-up. At six months follow-up, children who were treated with 3 months oral lactoferrin had less persisting symptoms compared to those who did not receive lactoferrin, although this difference was not statistically significant (three patients (25%) in the lactoferrin group vs. fourteen patients (33.3%) not treated, p = 0.73), probably due to the low number of patients with persisting GI symptoms. CONCLUSIONS GI symptoms are relatively common during acute SARS-CoV-2 infection in children, and a non-negligible proportion of these children reported persisting symptoms for up to 12-18 months after the acute infection. In addition, we found a trend even if statistically nonsignificant toward faster improvement of persisting gastrointestinal symptoms in children with long COVID treated with lactoferrin. Despite the limitations relating to the present study's design, given the significant burden of gastrointestinal symptoms in children with long COVID, our findings provide the basis to perform a prospective, placebo-controlled study.
Collapse
Affiliation(s)
- Francesco Mariani
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.M.); (C.D.R.); (R.M.)
| | - Saveena Rainaldi
- Medicine and Surgery International Faculty, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (S.R.); (G.D.)
| | - Giulia Dall’Ara
- Medicine and Surgery International Faculty, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (S.R.); (G.D.)
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.M.); (C.D.R.); (R.M.)
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.M.); (C.D.R.); (R.M.)
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.M.); (C.D.R.); (R.M.)
- Centro di Salute Globale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| |
Collapse
|
13
|
El-Baky NA, Amara AA, Uversky VN, Redwan EM. Intrinsic factors behind long COVID: III. Persistence of SARS-CoV-2 and its components. J Cell Biochem 2024; 125:22-44. [PMID: 38098317 DOI: 10.1002/jcb.30514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/27/2023] [Accepted: 12/07/2023] [Indexed: 01/16/2024]
Abstract
Considerable research has been done in investigating SARS-CoV-2 infection, its characteristics, and host immune response. However, debate is still ongoing over the emergence of post-acute sequelae of SARS-CoV-2 infection (PASC). A multitude of long-lasting symptoms have been reported several weeks after the primary acute SARS-CoV-2 infection that resemble several other viral infections. Thousands of research articles have described various post-COVID-19 conditions. Yet, the evidence around these ongoing health problems, the reasons behind them, and their molecular underpinnings are scarce. These persistent symptoms are also known as long COVID-19. The persistence of SARS-CoV-2 and/or its components in host tissues can lead to long COVID. For example, the presence of viral nucleocapsid protein and RNA was detected in the skin, appendix, and breast tissues of some long COVID patients. The persistence of viral RNA was reported in multiple anatomic sites, including non-respiratory tissues such as the adrenal gland, ocular tissue, small intestine, lymph nodes, myocardium, and sciatic nerve. Distinctive viral spike sequence variants were also found in non-respiratory tissues. Interestingly, prolonged detection of viral subgenomic RNA was observed across all tissues, sometimes in multiple tissues of the same patient, which likely reflects recent but defective viral replication. Moreover, the persistence of SARS-CoV-2 RNA was noticed throughout the brain at autopsy, as late as 230 days following symptom onset among unvaccinated patients who died of severe infection. Here, we review the persistence of SARS-CoV-2 and its components as an intrinsic factor behind long COVID. We also highlight the immunological consequences of this viral persistence.
Collapse
Affiliation(s)
- Nawal Abd El-Baky
- Protein Research Department, Genetic Engineering and Biotechnology Research Institute (GEBRI), City of Scientific Research and Technological Applications (SRTA-City), New Borg El-Arab City, Egypt
| | - Amro A Amara
- Protein Research Department, Genetic Engineering and Biotechnology Research Institute (GEBRI), City of Scientific Research and Technological Applications (SRTA-City), New Borg El-Arab City, Egypt
| | - Vladimir N Uversky
- Department of Molecular Medicine, USF Health Byrd Alzheimer's Research Institute, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Elrashdy M Redwan
- Biological Sciences Department, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
14
|
Chuang HJ, Lin CW, Hsiao MY, Wang TG, Liang HW. Long COVID and rehabilitation. J Formos Med Assoc 2024; 123 Suppl 1:S61-S69. [PMID: 37061399 PMCID: PMC10101546 DOI: 10.1016/j.jfma.2023.03.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/17/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has caused tremendous morbidity and mortality worldwide. The large number of post-COVID survivors has drawn attention to the management of post-COVID condition, known as long COVID. This review examines current knowledge of long COVID, regarding its epidemiology, mechanism, and clinical presentations in both adults and children. We also review the rehabilitation principles, modules, and effects, and share Taiwan's efforts to provide a top-down, nationwide care framework for long COVID patients. Dyspnea, chronic cough, and fatigue are the most commonly reported symptoms in the first 6 months after infection, but cognitive impairment and psychological symptoms may persist beyond this time. Several possible mechanisms behind these symptoms were proposed, but remained unconfirmed. These symptoms negatively impact individuals' function, activities, participation and quality of life. Rehabilitation is a key element of management to achieve functional improvement. Early management should start with comprehensive evaluation and identification of red flags. Exercise-based therapy, an essential part of management of long COVID, can be conducted with different modules, including telerehabilitation. Post-exertional symptom exacerbation and orthostatic hypotension should be carefully monitored during exercise. Randomized control trials with a large sample size are needed to determine the optimal timing, dosage, and modules.
Collapse
Affiliation(s)
- Hung-Jui Chuang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and College Medicine, Taipei, Taiwan, ROC
| | - Chia-Wei Lin
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and College Medicine, Taipei, Taiwan, ROC
| | - Ming-Yen Hsiao
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and College Medicine, Taipei, Taiwan, ROC
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and College Medicine, Taipei, Taiwan, ROC
| | - Huey-Wen Liang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and College Medicine, Taipei, Taiwan, ROC; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan, ROC.
| |
Collapse
|
15
|
Liu Y, Gu X, Li H, Zhang H, Xu J. Mechanisms of long COVID: An updated review. CHINESE MEDICAL JOURNAL PULMONARY AND CRITICAL CARE MEDICINE 2023; 1:231-240. [PMID: 39171285 PMCID: PMC11332859 DOI: 10.1016/j.pccm.2023.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Indexed: 08/23/2024]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has been ongoing for more than 3 years, with an enormous impact on global health and economies. In some patients, symptoms and signs may remain after recovery from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which cannot be explained by an alternate diagnosis; this condition has been defined as long COVID. Long COVID may exist in patients with both mild and severe disease and is prevalent after infection with different SARS-CoV-2 variants. The most common symptoms include fatigue, dyspnea, and other symptoms involving multiple organs. Vaccination results in lower rates of long COVID. To date, the mechanisms of long COVID remain unclear. In this narrative review, we summarized the clinical presentations and current evidence regarding the pathogenesis of long COVID.
Collapse
Affiliation(s)
- Yan Liu
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China–Japan Friendship Hospital, Beijing 100029, China
- Department of Infectious Disease, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, China
| | - Xiaoying Gu
- Department of Clinical Research and Data Management, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - Haibo Li
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China–Japan Friendship Hospital, Beijing 100029, China
| | - Hui Zhang
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China–Japan Friendship Hospital, Beijing 100029, China
- Department of Pulmonary and Critical Care Medicine, China–Japan Friendship Hospital, Capital Medical University, Beijing 100029, China
| | - Jiuyang Xu
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China–Japan Friendship Hospital, Beijing 100029, China
| |
Collapse
|
16
|
Cotugno N, Amodio D, Buonsenso D, Palma P. Susceptibility of SARS-CoV2 infection in children. Eur J Pediatr 2023; 182:4851-4857. [PMID: 37702769 PMCID: PMC10640404 DOI: 10.1007/s00431-023-05184-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/14/2023]
Abstract
Coronavirus disease 2019 in children presents with distinct phenotype in comparison to adults. Overall, the pediatric infection with a generally milder clinical course of the acute infection compared to adults still faces several unknown aspects. Specifically, the presence of a wide range of inflammatory manifestations, including multisystem inflammatory syndrome in children (MIS-C), myocarditis, and long COVID in the period after infection suggests a particular susceptibility of some children upon severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Albeit peculiar complications such as long covid are less frequent in children compared to adults, research on the relationship between inflammatory syndromes and SARS-CoV-2 is rapidly evolving. Conclusions: new studies and findings continue to emerge, providing further insights into the underlying mechanisms and potential therapeutic strategies. In the present work, we revised current knowledge of the main factors accounting for such variability upon SARS-CoV-2 infection over the pediatric age group. What is Known: • COVID19 in children overall showed a milder course compared to adults during the acute phase of the infection. • Children showed to be susceptible to a wide range of post infectious complications including multisystem inflammatory syndrome in children (MIS-C), myocarditis, neuroinflammation, and long COVID. What is New: • Mechanisms underlying susceptibility to a severe course of the infection were recently shown to pertain to the host. • A specific combination of HLA was recently shown to be associated to higher susceptibility to MIS-C in children.
Collapse
Affiliation(s)
- Nicola Cotugno
- Clinical Immunology and Vaccinology Unit, Bambino Gesù Children's Hospital, IRCCS, 00165, Rome, Italy
- Chair of Pediatrics, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Donato Amodio
- Clinical Immunology and Vaccinology Unit, Bambino Gesù Children's Hospital, IRCCS, 00165, Rome, Italy
- Chair of Pediatrics, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
- Centro di Salute Globale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo Palma
- Clinical Immunology and Vaccinology Unit, Bambino Gesù Children's Hospital, IRCCS, 00165, Rome, Italy.
- Chair of Pediatrics, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
| |
Collapse
|
17
|
Ha EK, Kim JH, Han MY. Long COVID in children and adolescents: prevalence, clinical manifestations, and management strategies. Clin Exp Pediatr 2023; 66:465-474. [PMID: 37350170 PMCID: PMC10626026 DOI: 10.3345/cep.2023.00472] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/09/2023] [Accepted: 06/18/2023] [Indexed: 06/24/2023] Open
Abstract
Long coronavirus disease (COVID), also known as postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection, has been defined as signs and symptoms which persist for 4 weeks or even lasting for 6 months after the initial infection. Although the prevalence of long COVID in children is currently unknown, epidemiological investigations have reported cases in pediatric populations. Clinical manifestations of long COVID in children include respiratory symptoms, such as cough and dyspnea, as well as neuropsychiatric and general conditions, including fatigue, headache, and muscle weakness. The pathophysiology of long COVID in children is still being investigated, but potential mechanisms include viral persistence, autoimmunity, and neuroinflammation. Risk factors for long COVID in children are not yet well understood, but studies have suggested that children with a history of severe acute COVID-19 infection or comorbidities may be at increased risk. Evaluation for respiratory symptoms of long COVID in children is essential, including spirometry and imaging studies to assess lung function and any potential damage. Furthermore, long COVID in children has been associated with a higher prevalence of mental health problems than in adults, emphasizing the importance of monitoring and addressing these aspects in pediatric patients. Although our understanding of long COVID in children and adolescents is still evolving, it is clear that the condition can have significant impacts on their health and well-being. The aim of this review is to synthesize the current knowledge on the prevalence, risk factors, and pathophysiology of long COVID in children and adolescents, and to discuss potential management strategies based on existing evidence.
Collapse
Affiliation(s)
- Eun Kyo Ha
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Ju Hee Kim
- Department of Pediatrics, Kyung Hee University Medical Center, Seoul, Korea
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| |
Collapse
|
18
|
Ogonowska-Slodownik A, Labecka MK, Maciejewska-Skrendo A, McNamara RJ, Kaczmarczyk K, Starczewski M, Gajewski J, Morgulec-Adamowicz N. Effect of Water-Based vs. Land-Based Exercise Intervention (postCOVIDkids) on Exercise Capacity, Fatigue, and Quality of Life in Children with Post COVID-19 Condition: A Randomized Controlled Trial. J Clin Med 2023; 12:6244. [PMID: 37834888 PMCID: PMC10573606 DOI: 10.3390/jcm12196244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/17/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
Evidence suggests that COVID-19 can cause lasting health consequences called post-COVID-19 condition. We conducted a three-group, randomized controlled trial for children aged 10-12 years with post COVID-19 condition. Participants were randomized to AQUA, LAND, or CONTROL groups. The AQUA and LAND training sessions were conducted twice a week for eight weeks. The primary outcomes were exercise capacity, measured using the modified Balke treadmill protocol, and fatigue, measured using the Cumulative Fatigue Symptoms Questionnaire (CFSQ). The secondary outcome was health-related quality of life (HRQoL), measured with the Pediatric Quality of Life Inventory (PedsQL) for children and parents. A total of 74 of the 86 children completed the intervention and attended the post-intervention assessment. The absolute maximal oxygen uptake (VO2max) values increased after both AQUA (p = 0.001) and LAND (p = 0.004) interventions. No significant differences were found in the degree of total fatigue and individual fatigue symptoms. A significant improvement was found in the PedsQL reported by the parents in the LAND group. In conclusion, the applied eight-week water-based and land-based exercise training programs improved exercise capacity in children aged 10-12 years old with post COVID-19 condition. The parents of the children in the training groups also noted an improvement in HRQoL.
Collapse
Affiliation(s)
- Anna Ogonowska-Slodownik
- Faculty of Rehabilitation, Jozef Pilsudski University of Physical Education in Warsaw, Marymoncka 34, 00-968 Warsaw, Poland; (M.K.L.); (K.K.); (M.S.); (J.G.); (N.M.-A.)
| | - Marta Kinga Labecka
- Faculty of Rehabilitation, Jozef Pilsudski University of Physical Education in Warsaw, Marymoncka 34, 00-968 Warsaw, Poland; (M.K.L.); (K.K.); (M.S.); (J.G.); (N.M.-A.)
| | - Agnieszka Maciejewska-Skrendo
- Faculty of Physical Culture, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland;
- Institute of Physical Culture Sciences, University of Szczecin, 70-453 Szczecin, Poland
| | - Renae J. McNamara
- Physiotherapy, Prince of Wales Hospital, Sydney, NSW 2031, Australia;
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW 2006, Australia
- Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia
| | - Katarzyna Kaczmarczyk
- Faculty of Rehabilitation, Jozef Pilsudski University of Physical Education in Warsaw, Marymoncka 34, 00-968 Warsaw, Poland; (M.K.L.); (K.K.); (M.S.); (J.G.); (N.M.-A.)
| | - Michał Starczewski
- Faculty of Rehabilitation, Jozef Pilsudski University of Physical Education in Warsaw, Marymoncka 34, 00-968 Warsaw, Poland; (M.K.L.); (K.K.); (M.S.); (J.G.); (N.M.-A.)
| | - Jan Gajewski
- Faculty of Rehabilitation, Jozef Pilsudski University of Physical Education in Warsaw, Marymoncka 34, 00-968 Warsaw, Poland; (M.K.L.); (K.K.); (M.S.); (J.G.); (N.M.-A.)
| | - Natalia Morgulec-Adamowicz
- Faculty of Rehabilitation, Jozef Pilsudski University of Physical Education in Warsaw, Marymoncka 34, 00-968 Warsaw, Poland; (M.K.L.); (K.K.); (M.S.); (J.G.); (N.M.-A.)
| |
Collapse
|
19
|
Buonsenso D, Camporesi A, Morello R, De Rose C, Fracasso M, Chieffo DPR, Valentini P. Social Stigma in Children with Long COVID. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1518. [PMID: 37761479 PMCID: PMC10529184 DOI: 10.3390/children10091518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/03/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023]
Abstract
There is growing evidence that adults with Long COVID suffer from different sets of stigmata related to their condition. In children with Long COVID, this aspect has never been investigated. This study aims to investigate if children with Long COVID also experience stigma. METHODS Children with a previous SARS-CoV-2 infection evaluated at 3 month follow-ups in a pediatric post COVID unit were asked to fill in an online Long COVID Stigma Scale survey before they were assessed by a pediatrician. Doctors were unaware of children's responses when they performed a diagnosis of Long COVID or full recovery from previous infection, according to the World Health Organization definition of pediatric Long COVID. Responses to the Stigma scale were then compared in the two cohorts of children. RESULTS 224 patients responded to the questionnaire; 40 patients were diagnosed with Long COVID. Children with Long COVID significantly more frequently felt embarrassed about having Long COVID (p 0.035), felt embarrassed about having physical limitations (p < 0.001), felt they were valued less due to Long COVID (p 0.003), felt they were different from other peers due to Long COVID (p 0.033), felt significantly more frequently that people behaved differently towards them because they might be lying since the diagnosis of Long COVID (p 0.006), that they were less respected by others due to Long COVID (p 0.017), that other people thought that Long COVID is not a real disease (p 0.007), that other people thought that developing Long COVID is a sign of weakness (p 0.008), and that other people might judge them negatively due to their diagnosis of Long COVID (p < 0.001). CONCLUSIONS Children with Long COVID, similar to adults, are suffering from stigmata due to their condition,. These data may have implication and should be used by the public, policy makers, and healthcare professionals regarding pediatric Long COVID.
Collapse
Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (R.M.); (C.D.R.); (P.V.)
- Center for Global Health Research Studies, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Anna Camporesi
- Pediatric Anesthesia and Intensive Care Unit, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy;
| | - Rosa Morello
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (R.M.); (C.D.R.); (P.V.)
| | - Cristina De Rose
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (R.M.); (C.D.R.); (P.V.)
| | - Matteo Fracasso
- Medicine and Surgery, Universityà Cattolica del Sacro Cuore, 00168 Roma, Italy;
| | - Daniela Pia Rosaria Chieffo
- Clinical Psychology Unit, Fondazione Policlinico Universitario A Gemelli IRCCS, 00168 Rome, Italy;
- Department of Woman, Children and Public Health, Catholic University of Sacred Heart, 00168 Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (R.M.); (C.D.R.); (P.V.)
| |
Collapse
|
20
|
Mustafa MI, Mohammed A. Revolutionizing antiviral therapy with nanobodies: Generation and prospects. BIOTECHNOLOGY REPORTS (AMSTERDAM, NETHERLANDS) 2023; 39:e00803. [PMID: 37332617 PMCID: PMC10276140 DOI: 10.1016/j.btre.2023.e00803] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/21/2023] [Accepted: 06/06/2023] [Indexed: 06/20/2023]
Abstract
As the world continues to grapple with infectious diseases, scientists are constantly searching for effective ways to combat these deadly pathogens. One promising avenue of research is the use of nanobodies as neutralization agents. These small proteins, derived from camelid antibodies, have several unique advantages over traditional antibodies, including their small size. Nanobodies are much smaller than conventional antibodies, typically weighing in at around 15 kDa compared to the 150 kDa of a typical human antibody. This small size allows them to penetrate into tight spaces that larger molecules cannot reach, such as the crevices on the surface of viruses or bacteria. This makes them highly effective at neutralizing viruses by binding to and blocking their key functional sites. In this mini-review we discuss the construction approaches of nanobodies, and some methods to increase the half-life of nanobodies. Moreover, we discuss Nanobodies and their therapeutic potential for infectious agents.
Collapse
Affiliation(s)
- Mujahed I. Mustafa
- Department of Biotechnology, College of Applied and Industrial Sciences, University of Bahri, Khartoum, Sudan
| | - Ahmed Mohammed
- Department of biotechnology, school of life sciences and technology, Omdurman Islamic university, Omdurman, Sudan
| |
Collapse
|
21
|
Buonsenso D. Further evidence from a large US electronic health record-based study that some children and adolescents can develop postacute sequelae of SARS-CoV-2 infection. Evid Based Nurs 2023; 26:97. [PMID: 36599668 DOI: 10.1136/ebnurs-2022-103632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| |
Collapse
|
22
|
Martino L, Morello R, De Rose C, Buonsenso D. Persistent respiratory symptoms associated with post-Covid condition (Long Covid) in children: a systematic review and analysis of current gaps and future perspectives. Expert Rev Respir Med 2023; 17:837-852. [PMID: 37844017 DOI: 10.1080/17476348.2023.2271836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 10/13/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION There is increasing evidence that also children can develop Long Covid. However, there are no specific reviews providing a clear description of reported respiratory symptoms and potential diagnostics. AREAS COVERED We performed on PubMed a systematic search of studies conducted on children aged less than 18 years with previous SARS-CoV-2 infection complaining about persistent respiratory symptoms; the aim of our review is to characterize the incidence, pattern and duration of respiratory symptoms after the acute infection in pediatric population. EXPERT OPINION Children can develop persisting respiratory symptoms, as documented by several follow-up studies both including or not control groups of non-infected children. However, the methodological variabilities of the analyzed studies does not allow to provide firm conclusions about the rate, type and best diagnostics for children with persistent respiratory symptoms. Future studies should investigate on larger pediatric cohorts the role of noninvasive diagnostics and new biomarkers as well as investigating therapeutic options both during acute infection or when Long Covid has been diagnosed.
Collapse
Affiliation(s)
- Laura Martino
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Centro di Salute Globale, Università Cattolica del Sacro Cuore, Roma, Italia
| |
Collapse
|
23
|
Sansone F, Pellegrino GM, Caronni A, Bonazza F, Vegni E, Lué A, Bocci T, Pipolo C, Giusti G, Di Filippo P, Di Pillo S, Chiarelli F, Sferrazza Papa GF, Attanasi M. Long COVID in Children: A Multidisciplinary Review. Diagnostics (Basel) 2023; 13:1990. [PMID: 37370884 DOI: 10.3390/diagnostics13121990] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
Long COVID syndrome has emerged as a long-lasting consequence of acute SARS-CoV-2 infection in adults. In addition, children may be affected by Long COVID, with potential clinical issues in different fields, including problems in school performance and daily activities. Yet, the pathophysiologic bases of Long COVID in children are largely unknown, and it is difficult to predict who will develop the syndrome. In this multidisciplinary clinical review, we summarise the latest scientific data regarding Long COVID and its impact on children. Special attention is given to diagnostic tests, in order to help the physicians to find potential disease markers and quantify impairment. Specifically, we assess the respiratory, upper airways, cardiac, neurologic and motor and psychological aspects. Finally, we also propose a multidisciplinary clinical approach.
Collapse
Affiliation(s)
| | | | - Antonio Caronni
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, 20122 Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, Italy
| | - Federica Bonazza
- Department of Health Sciences, Clinical Psychology, University of Milan, Via di Rudinì 8, 20142 Milan, Italy
| | - Elena Vegni
- Department of Health Sciences, Clinical Psychology, University of Milan, Via di Rudinì 8, 20142 Milan, Italy
- Unit of Clinical Psychology, San Paolo Hospital, ASST Santi Paolo e Carlo, Via di Rudinì 8, 20142 Milan, Italy
| | - Alberto Lué
- Service of Digestive Diseases, University Clinic Hospital Lozano Blesa, IIS Aragón, 50009 Zaragoza, Spain
| | - Tommaso Bocci
- Department of Health Sciences, University of Milan, 20146 Milan, Italy
- Clinical Neurology Unit, Department of Health Sciences, "Azienda Socio-Sanitaria Territoriale Santi Paolo e Carlo", University of Milan, 20146 Milan, Italy
| | - Carlotta Pipolo
- Department of Health Sciences, Otorhinolaryngology Department, ASST Santi Paolo e Carlo, University of Milan, 20142 Milan, Italy
| | - Giuliano Giusti
- Paediatric Cardiology Unit, Niguarda Hospital, 20162 Milan, Italy
| | - Paola Di Filippo
- Paediatric Allergy and Pulmonology Unit, Department of Paediatrics, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Sabrina Di Pillo
- Paediatric Allergy and Pulmonology Unit, Department of Paediatrics, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Francesco Chiarelli
- Paediatric Allergy and Pulmonology Unit, Department of Paediatrics, University of Chieti-Pescara, 66100 Chieti, Italy
| | | | - Marina Attanasi
- Paediatric Allergy and Pulmonology Unit, Department of Paediatrics, University of Chieti-Pescara, 66100 Chieti, Italy
| |
Collapse
|
24
|
Becerra-García JA, Sánchez-Gutiérrez T. [Long-COVID psychological symptoms in child and adolescent population: a standardized proposal for its exploration]. Enferm Infecc Microbiol Clin 2023; 41:384-385. [PMID: 36742339 PMCID: PMC9890386 DOI: 10.1016/j.eimc.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
25
|
Cocciolillo F, Chieffo DPR, Giordano A, Arcangeli V, Lazzareschi I, Morello R, Zampino G, Valentini P, Buonsenso D. Case report: Post-COVID new-onset neurocognitive decline with bilateral mesial-temporal hypometabolism in two previously healthy sisters. Front Pediatr 2023; 11:1165072. [PMID: 37303754 PMCID: PMC10251436 DOI: 10.3389/fped.2023.1165072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/17/2023] [Indexed: 06/13/2023] Open
Abstract
Background Long coronavirus disease (COVID) is increasingly recognized in adults and children; however, it is still poorly characterized from a clinical and diagnostic perspective, particularly in the younger populations. Case presentation We described the story of two sisters-with high social and academic performance before their severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection-who reported severe neurocognitive problems, initially classified as psychologic pandemic distress and eventually found to have significant brain hypometabolism. Conclusions We provided a detailed clinical presentation of neurocognitive symptoms in two sisters with long COVID associated with brain hypometabolism documented in both sisters. We believe that the evidence of objective findings in these children further supports the hypothesis that organic events cause persisting symptoms in a cohort of children after SARS-CoV-2 infection. Such findings highlight the importance of discovering diagnostics and therapeutics.
Collapse
Affiliation(s)
- Fabrizio Cocciolillo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Medicina Nucleare, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Daniela Pia Rosaria Chieffo
- Clinical Psychology Unit, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
- Department of Woman, Children and Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - Alessandro Giordano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Medicina Nucleare, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Sezione di Medicina Nucleare, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valentina Arcangeli
- Clinical Psychology Unit, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Ilaria Lazzareschi
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe Zampino
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piero Valentini
- Sezione di Medicina Nucleare, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Centro di Salute Globale, Università Cattolica del Sacro Cuore, Roma, Italy
| |
Collapse
|
26
|
Buonsenso D, Morello R, Mariani F, De Rose C, Cortese R, Vetrugno L, Valentini P. Role of Lung Ultrasound in the Follow-Up of Children with Previous SARS-CoV-2 Infection: A Case-Control Assessment of Children with Long COVID or Fully Recovered. J Clin Med 2023; 12:jcm12093342. [PMID: 37176782 PMCID: PMC10179159 DOI: 10.3390/jcm12093342] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
Lung ultrasound (LUS) can detect lower respiratory tract involvement in children with acute SARS-CoV-2 infection. However, its role in follow-up assessments is still unclear. To describe LUS findings in children after SARS-CoV-2 infection, we conducted a prospective study in a population of pediatric patients referred to the post-COVID unit in a tertiary center during the study period from February 2021 to May 2022. Children were classified as recovered from acute infection or with persisting symptoms. LUS was performed in all children and a LUS score (ranging from 0 to 36 points) was calculated according to the Italian Academy of Thoracic Ultrasound. Six hundred forty-seven children (304 females, 47%) were enrolled. The median follow-up evaluation was two months. The median age was 7.9 (IQR: 6) years. At the follow-up evaluation, 251 patients (38.8%) had persistent symptoms, of whom 104 (16.1%) had at least one respiratory symptom. The median LUS level was 2 (IQR: 4). LUS findings and LUS scores did not differ in children with Long COVID compared to the group of children fully recovered from the initial infection. In conclusion, after SARS-CoV-2 infection, LUS was mostly normal or showed minimal artifacts in all groups of children.
Collapse
Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Global Health Center, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Francesco Mariani
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Rossella Cortese
- School of Medicine, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| |
Collapse
|
27
|
Morello R, Mariani F, Mastrantoni L, De Rose C, Zampino G, Munblit D, Sigfrid L, Valentini P, Buonsenso D. Risk factors for post-COVID-19 condition (Long Covid) in children: a prospective cohort study. EClinicalMedicine 2023; 59:101961. [PMID: 37073325 PMCID: PMC10101848 DOI: 10.1016/j.eclinm.2023.101961] [Citation(s) in RCA: 48] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 04/20/2023] Open
Abstract
Background Adults and children can develop post-Covid-19 condition (PCC) (also referred to as Long Covid). However, existing evidence is scarce, partly due to a lack of a standardised case definition, short follow up duration, and heterogenous study designs, resulting in wide variation of reported outcomes. The primary aim of this study was to characterise risk factors for PCC and longitudinal rates of recovery in a cohort of children and young people using a standardised protocol. Methods We performed a prospective "disease-based" cohort study between 01/02/2020 to 31/10/2022 including children aged 0-18 years old, with a previous diagnosis of Covid-19. Children with microbiologically confirmed SARS-CoV-2 infection, were invited for an in-clinic follow-up assessment at a paediatric post-covid clinic in Rome, Italy, at serial intervals (3-, 6-, 12- and 18-months post-onset). PCC was defined as persistence of otherwise unexplained symptoms for at least three months after initial infection. The statistical association between categorical variables was obtained by Chi-squared tests or Fisher's exact tests. Multivariable logistic regressions are presented using odds ratios (OR) and 95% confidence interval (CI). Survival analysis was conducted using the Kaplan-Meier method. Findings 1243 children were included, median age: 7.5 (4-10.3) years old; 575 (46.3%) were females. Of these, 23% (294/1243) were diagnosed with PCC at three months post-onset. Among the study population, 143 patients remained symptomatic at six months, 38 at 12 months, and 15 at 18 months follow up evaluation. The following risk factors were associated with PCC: >10 years of age (OR 1.23; 95% CI 1.18-1.28), comorbidities (OR 1.68; 95% CI 1.14-2.50), and hospitalisation during the acute phase (OR 4.80; 95%CI 1.91-12.1). Using multivariable logistic regression, compared to the Omicron variant, all other variants were significantly associated with PCC at 3 and 6 months. At least one dose of vaccine was associated with a reduced, but not statistically significant risk of developing PCC. Interpretation In our study, acute-phase hospitalisation, pre-existing comorbidity, being infected with pre-Omicron variants and older age were associated with a higher risk of developing PCC. Most children recovered over time, but one-in-twenty of those with PCC at three months reported persistent symptoms 18 months post-Sars-CoV-2 infection. Omicron infection was associated with shorter recovery times. We did not find a strong protective effect of vaccination on PCC development. Although our cohort cannot be translated to all Italian children with PCC as more nationwide studies are needed, our findings highlight the need of new strategies to prevent and treat pediatric PCC are needed. Funding This study has been funded by Pfizer non-competitive grant, granted to DB (# 65925795).
Collapse
Affiliation(s)
- Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Mariani
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Mastrantoni
- Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe Zampino
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, I.M. Sechenov First Moscow State Medical University, Sechenov University, Moscow, Russia
- Care for Long Term Conditions Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Louise Sigfrid
- ISARIC Global Support Centre, GloPID-R Research and Policy Team, Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Centro di Salute Globale, Università Cattolica del Sacro Cuore, Roma, Italy
| |
Collapse
|
28
|
Pizzuto DA, Buonsenso D, Morello R, De Rose C, Valentini P, Fragano A, Baldi F, Di Giuda D. Lung perfusion assessment in children with long-COVID: A pilot study. Pediatr Pulmonol 2023. [PMID: 37097045 DOI: 10.1002/ppul.26432] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/09/2023] [Accepted: 04/16/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND There is increasing evidence that chronic endotheliopathy can play a role in patients with Post-Covid Condition (PCC, or Long Covid) by affecting peripheral vascularization. This pilot study aimed at assessing lung perfusion in children with Long-COVID with 99m Tc-MAA SPECT/CT. MATERIALS AND METHODS lung 99m Tc-MAA SPECT/CT was performed in children with Long-COVID and a pathological cardiopulmonary exercise testing (CPET). Intravenous injections were performed on patients in the supine position immediately before the planar scan according to the EANM guidelines for lung scintigraphy in children, followed by lung SPECT/CT acquisition. Reconstructed studies were visually analyzed. RESULTS Clinical and biochemical data were collected during acute infection and follow-up in 14 children (6 females, mean age: 12.6 years) fulfilling Long-COVID diagnostic criteria and complaining of chronic fatigue and postexertional malaise after mild efforts, documented by CPET. Imaging results were compared with clinical scenarios during acute infection and follow-up. Six out of 14 (42.8%) children showed perfusion defects on 99m Tc-MAA SPECT/CT scan, without morphological alterations on coregistered CT. CONCLUSIONS This pilot investigation confirmed previous data suggesting that a small subgroup of children can develop lung perfusion defects after severe acute respiratory syndrome coronavirus 2 infection. Larger cohort studies are needed to confirm these preliminary results, providing also a better understanding of which children may deserve this test and how to manage those with lung perfusion defects.
Collapse
Affiliation(s)
- Daniele Antonio Pizzuto
- Department of Radiology, Radiotherapy and Hematology, Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
- GlobalHealth Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - A Fragano
- Department of Radiology, Radiotherapy and Hematology, Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Fabiana Baldi
- Division of Respiratory Medicine, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Daniela Di Giuda
- Department of Radiology, Radiotherapy and Hematology, Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- University Department of Radiological Sciences and Hematology, Section of Nuclear Medicine, Uniiversità Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
29
|
Becerra-García JA, Sánchez-Gutiérrez T. Long-COVID psychological symptoms in child and adolescent population: A standardized proposal for its exploration. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023:S2529-993X(23)00109-0. [PMID: 37100668 PMCID: PMC10123519 DOI: 10.1016/j.eimce.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/22/2022] [Accepted: 12/22/2022] [Indexed: 04/28/2023]
|
30
|
Buonsenso D. It is OK to tell patients with long COVID that we don't know much about the condition yet. Acta Paediatr 2023; 112:585-586. [PMID: 36607266 DOI: 10.1111/apa.16658] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/29/2022] [Accepted: 01/05/2023] [Indexed: 01/07/2023]
Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Univeritario A. Gemelli IRCCS, Rome, Italy.,Centro di Salute Globale, Università Cattolica del Sacro Cuore, Roma, Italy
| |
Collapse
|
31
|
Iodice F, Orlando B, Selleri R, Zito G, Rossini PM. Bilateral anterior ischemic optic neuropathy after COVID-vaccination. Neurol Sci 2023; 44:1155-1157. [PMID: 36622477 PMCID: PMC9838257 DOI: 10.1007/s10072-022-06556-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 12/07/2022] [Indexed: 01/10/2023]
Affiliation(s)
- Francesco Iodice
- Institute of Neurology and Neurorehabilitation, IRCCS San Raffaele, Rome, Italy.
| | - Bianca Orlando
- Institute of Neurology and Neurorehabilitation, IRCCS San Raffaele, Rome, Italy
| | - Raffaella Selleri
- Institute of Neurology and Neurorehabilitation, IRCCS San Raffaele, Rome, Italy
| | - Giancarlo Zito
- Institute of Neurology and Neurorehabilitation, IRCCS San Raffaele, Rome, Italy
| | - Paolo Maria Rossini
- Institute of Neurology and Neurorehabilitation, IRCCS San Raffaele, Rome, Italy
| |
Collapse
|
32
|
Abstract
PURPOSE OF REVIEW This review describes recent findings about post-COVID condition (PCC, or Long COVID) in children, including current knowledge about its epidemiology, clinical presentation, pathogenesis and care. RECENT FINDINGS There is no internationally agreed definition of PCC, although now most researchers agree that it is a complex clinical symptomatology persisting for at least 3 months after COVID-19, without an alternative diagnosis. There are several uncertainties about paediatric PCC. So far, available literature suggest that 1-3% of recognized children with Severe Acute Respiratory Syndrome COronaVirus 2 (SARS-CoV-2) infection may develop PCC. Its pathogenesis is unknown, although there is increasing evidence about possible abnormalities in the immune responses, cellular metabolism and intestinal microbiota, along with chronic endothelitis. SUMMARY Management of PCC in children is complex and require a multidisciplinary approach, with the goal of offering the best care possible to support diagnostics, research, mental health and access to research projects.
Collapse
Affiliation(s)
- Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS
| | - Laura Martino
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS
- Centro di Salute Globale, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
33
|
Mariani F, Morello R, Traini DO, La Rocca A, De Rose C, Valentini P, Buonsenso D. Risk Factors for Persistent Anosmia and Dysgeusia in Children with SARS-CoV-2 Infection: A Retrospective Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10030597. [PMID: 36980155 PMCID: PMC10047825 DOI: 10.3390/children10030597] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/05/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Olfactory and gustative dysfunctions are two of the most common post-acute sequelae of SARS-CoV-2 infection in children, which can have a negative impact on the routines of children and families. As several children have had COVID-19 since the Omicron variant, it is important to investigate if this increase in infections is reflected in higher olfactory/taste disfunctions. The primary aim of this study was to characterize the presence of olfactory/gustative problems in a cohort of children, its evolution, and its association with risk factors such as COVID-19 variant, hospitalization, presence of olfactory/gustative dysfunction during the acute phase, and vaccination. METHODS This was a retrospective analysis of children with microbiologically confirmed SARS-CoV-2 infection evaluated in person at a referral pediatric post-COVID-19 clinic in Rome, Italy. We included children younger than 19 years old, evaluated from the beginning of the pandemic up to October 2022. At specific timepoints, we investigated the presence of olfactory/taste disfunctions and evaluated them according to the SARS-CoV-2 variants circulating at the time of infection. RESULTS A total of 1250 children (650 females; 52.0%) with a mean age of 6.77 (±4.12) years were included in the study. At 3, 6, 12, and 18 months, 12 (9.6%), 7 (5.6%), 2 (1.6%), and 1 (0.8%) of the children reported anosmia and dysgeusia post-COVID-19 infection, respectively. The presence of anosmia and dysgeusia during the acute phase of infection and being infected with a pre-Omicron variant were found to be significant risk factors for persistent olfactory and gustatory dysfunction during all follow-up periods. CONCLUSIONS anosmia and dysgeusia symptoms tended to decrease gradually over time, but not all children recovered quickly.
Collapse
Affiliation(s)
- Francesco Mariani
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | | | - Anna La Rocca
- Medicine and Surgery, Catholic University of Rome, 00168 Rome, Italy
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Centro di Salute Globale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| |
Collapse
|
34
|
Hansen J, Galimov A, Unger JB, Sussman SY, Hanewinkel R. Mental Health and Physical Complaints of German Children and Adolescents before and during the COVID-19 Pandemic: A Repeated Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20054478. [PMID: 36901485 PMCID: PMC10001698 DOI: 10.3390/ijerph20054478] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/01/2023] [Accepted: 03/01/2023] [Indexed: 06/01/2023]
Abstract
The potential impact of the COVID-19 pandemic on young people's mental and physical health is of increasing concern. We examined the levels of internalizing and externalizing problem behavior and physical complaints before and during the COVID-19 pandemic in Germany. Data came from a repeated cross-sectional study on child and youth health in schools in Germany. Assessments took place from November to February each year. Two data collections were conducted before the COVID-19 pandemic in 2018-2019 and in 2019-2020. Collections during the pandemic took place in 2020-2021 and 2021-2022. A total of 63,249 data observations were included in the analyses. Multilevel analyses were used to examine temporal trends in mean emotional problems (e.g., often unhappy, downhearted), hyperactivity-inattention (e.g., constantly fidgeting or squirming), conduct problems (e.g., fights with other children), and physical complaints. Models were adjusted for age, gender, school type, socioeconomic status, and sensation seeking. During the COVID-19 pandemic, children and adolescents in Germany experienced an increase in emotional problems from the pre-pandemic cohort 2019-2020 to the pandemic cohort 2021-2022 (β = 0.56, 95% CI (0.51-0.62)) and, over the course of the pandemic, reported elevated levels of physical complaints (β = 0.19, 95% CI (0.16-0.21)). Findings of increased emotional problems and physical complaints after the two years of the pandemic support the ongoing demand for low-threshold health promotion and prevention and the need for further monitoring of young people's health in Germany.
Collapse
Affiliation(s)
- Julia Hansen
- Institute for Therapy and Health Research, IFT-Nord, Harmsstraße 2, 24114 Kiel, Germany
| | - Artur Galimov
- Tobacco Center of Regulatory Science, Department of Population and Public Health Sciences, Institute for Health Promotion and Disease Prevention Research, Keck School of Medicine, University of Southern California, 1845 N. Soto Street, Los Angeles, CA 90033, USA
| | - Jennifer B. Unger
- Tobacco Center of Regulatory Science, Department of Population and Public Health Sciences, Institute for Health Promotion and Disease Prevention Research, Keck School of Medicine, University of Southern California, 1845 N. Soto Street, Los Angeles, CA 90033, USA
| | - Steve Y. Sussman
- Tobacco Center of Regulatory Science, Department of Population and Public Health Sciences, Institute for Health Promotion and Disease Prevention Research, Keck School of Medicine, University of Southern California, 1845 N. Soto Street, Los Angeles, CA 90033, USA
| | - Reiner Hanewinkel
- Institute for Therapy and Health Research, IFT-Nord, Harmsstraße 2, 24114 Kiel, Germany
| |
Collapse
|
35
|
Sonnweber T, Birgit S, Weiss G, Löffler-Ragg J. Pulmonary recovery after COVID-19 - a review. Expert Rev Respir Med 2023; 17:447-457. [PMID: 37449405 DOI: 10.1080/17476348.2023.2210837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/02/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION COVID-19 is caused by infection with the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). As the respiratory tract is the primary site of infection and host-mediated inflammatory responses, pathologies and dysfunction of the respiratory system characterize the severe disease and are typically associated with the need for oxygen supply or even ventilator support. In survivors of severe COVID-19, computed tomography follow-up frequently reveals structural lung abnormalities, and one-third of individuals who were hospitalized during acute COVID-19 demonstrate persisting lung abnormalities for at least 12 months after disease onset. AREAS COVERED This review summarizes current evidence on pulmonary recovery after COVID-19, focusing on adult patients who suffered from COVID-19 pneumonia. EXPERT OPINION Severe COVID-19 is associated with a high frequency of persisting lung abnormalities at follow-up. The long-term consequences of these findings remain elusive and urge further evaluation to identify individuals at risk for COVID-19 long-term consequences.
Collapse
Affiliation(s)
- Thomas Sonnweber
- Department of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria
| | - Sailer Birgit
- Department of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria
| | - Günter Weiss
- Department of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria
- Christian Doppler Laboratory for Iron Metabolism and Anaemia Research, Medical University Innsbruck, Innsbruck, Austria
| | - Judith Löffler-Ragg
- Department of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria
| |
Collapse
|
36
|
Mat Hassan N, Salim HS, Amaran S, Yunus NI, Yusof NA, Daud N, Fry D. Prevalence of mental health problems among children with long COVID: A systematic review and meta-analysis. PLoS One 2023; 18:e0282538. [PMID: 37195978 DOI: 10.1371/journal.pone.0282538] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/16/2023] [Indexed: 05/19/2023] Open
Abstract
INTRODUCTION The number of children with mental health problems has more than doubled since the COVID-19 pandemic. However, the effect of long Covid on children's mental health is still debatable. Recognising long Covid as a risk factor for mental health problems in children will increase awareness and screening for mental health problems following COVID-19 infection, resulting in earlier intervention and lower morbidity. Therefore, this study aimed to determine the proportion of mental health problems post-COVID-19 infection in children and adolescents, and to compare them with the population with no previous COVID-19 infection. METHODOLOGY A systematic search was done in seven databases using pre-defined search terms. Cross-sectional, cohort and interventional studies reporting the proportion of mental health problems among children with long COVID in the English language from 2019 to May 2022 were included. Selection of papers, extraction of data and quality assessment were done independently by two reviewers. Studies with satisfactory quality were included in meta-analysis using R and Revman software programmes. RESULTS The initial search retrieved 1848 studies. After screening, 13 studies were included in the quality assessments. Meta-analysis showed children who had previous COVID-19 infection had more than two times higher odds of having anxiety or depression, and 14% higher odds of having appetite problems, compared to children with no previous infection. The pooled prevalence of mental health problems among the population were as follows; anxiety: 9%(95% CI:1, 23), depression: 15%(95% CI:0.4, 47), concentration problems: 6%(95% CI: 3, 11), sleep problems: 9%(95% CI:5, 13), mood swings: 13% (95%CI:5, 23) and appetite loss: 5%(95% CI:1, 13). However, studies were heterogenous and lack data from low- and middle-income countries. CONCLUSION Anxiety, depression and appetite problems were significantly increased among post-COVID-19 infected children, compared to those without a previous infection, which may be attributed to long COVID. The findings underscore the importance of screening and early intervention of children post-COVID-19 infection at one month and between three to four months.
Collapse
Affiliation(s)
- Nurulhuda Mat Hassan
- University of Edinburgh, Edinburgh, Scotland, United Kingdom
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Terengganu, Malaysia
| | - Hani Syahida Salim
- Faculty of Medicine, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Safiya Amaran
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Terengganu, Malaysia
| | - Nurul Izza Yunus
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Terengganu, Malaysia
| | - Nurul Azreen Yusof
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Terengganu, Malaysia
| | - Norwati Daud
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Terengganu, Malaysia
| | - Deborah Fry
- University of Edinburgh, Edinburgh, Scotland, United Kingdom
| |
Collapse
|
37
|
Pharmacological trials for long COVID: first light at the end of the tunnel. THE LANCET REGIONAL HEALTH. EUROPE 2023; 24:100544. [PMID: 36407125 PMCID: PMC9647474 DOI: 10.1016/j.lanepe.2022.100544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022]
|
38
|
Affiliation(s)
- Ellen Porter
- Future Science Group. Unitec House, 2 Albert Place, London, N3 1QB, UK
| |
Collapse
|
39
|
Camporesi A, Soares Lanziotti V, Bulut Y, Behrens D, Buonsenso D. Editorial: Covid, Long Covid, Mental Health, Schools and Masks: how and why we failed child health communication during a pandemic. Front Pediatr 2023; 11:1104518. [PMID: 36846164 PMCID: PMC9946450 DOI: 10.3389/fped.2023.1104518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/04/2023] [Indexed: 02/11/2023] Open
Affiliation(s)
- Anna Camporesi
- Pediatric Anesthesia and Intensive Care, Vittore Buzzi Children's Hospital, Milano, Italy
| | - Vanessa Soares Lanziotti
- Pediatric Intensive Care Unit, Institute of Pediatrics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Yonca Bulut
- Pediatric Intensive Care, UCLA Mattel Children's Hospital, Los Angeles, CA, United States
| | - Deanna Behrens
- Pediatric Anesthesia and Intensive Care, Vittore Buzzi Children's Hospital, Milano, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Centro di Salute Globale, Università Cattolica del Sacro Cuore, Roma, Italy
| |
Collapse
|
40
|
Brasseler M, Schönecker A, Steindor M, Della Marina A, Bruns N, Dogan B, Felderhoff-Müser U, Hebebrand J, Dohna-Schwake C, Goretzki SC. Development of restrictive eating disorders in children and adolescents with long-COVID-associated smell and taste dysfunction. Front Pediatr 2022; 10:1022669. [PMID: 36518782 PMCID: PMC9743173 DOI: 10.3389/fped.2022.1022669] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background Absent or abnormal senses of smell and taste have been frequently reported during both acute and long COVID in adult patients. In contrast, pediatric patients who test positive for SARS-CoV-2 are often asymptomatic and the loss of smell and/or taste has been infrequently reported. After observing several young patients with COVID-associated anosmia and ageusia at our clinic, we decided to investigate the incidence of subsequent eating disorders in these patients and in SARS-CoV-2 positive patients who did not experience anosmia and ageusia during the same period. Material and methods A single-site retrospective cohort study of 84 pediatric patients with suspected long COVID who were treated in the Pediatric Infectious Diseases Outpatient Clinic at the University Hospital Essen were evaluated for persistent symptoms of COVID-19. Smell and taste dysfunction as well as eating behaviors were among the signs and symptoms analyzed in this study. Results 24 out of 84 children and adolescents described smell and taste dysfunction after confirmed or suspected SARS-CoV-2 infections. A large number of these patients (6 out of 24) demonstrated increased fixation on their eating behavior post-COVID and over time these patients developed anorexia nervosa. Discussion/Conclusion In this study we saw a possible association of long-lasting post-COVID smell and taste dysfunction with subsequent development of eating disorders. This observation is worrisome and merits further investigation by healthcare providers at multiple clinical sites.
Collapse
Affiliation(s)
- Maire Brasseler
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Infectiology, Pediatric Neurology, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences C-TNBS, University Duisburg-Essen, Essen, Germany
- West German Centre for Infectious Diseases (WZI), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Anne Schönecker
- Department of Pediatrics III, Pediatric Pulmonology and Sleep Medicine, University of Duisburg-Essen, Essen, Germany
| | - Mathis Steindor
- Department of Pediatrics III, Pediatric Pulmonology and Sleep Medicine, University of Duisburg-Essen, Essen, Germany
| | - Adela Della Marina
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Infectiology, Pediatric Neurology, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences C-TNBS, University Duisburg-Essen, Essen, Germany
| | - Nora Bruns
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Infectiology, Pediatric Neurology, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences C-TNBS, University Duisburg-Essen, Essen, Germany
| | - Burcin Dogan
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Infectiology, Pediatric Neurology, University of Duisburg-Essen, Essen, Germany
- West German Centre for Infectious Diseases (WZI), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Ursula Felderhoff-Müser
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Infectiology, Pediatric Neurology, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences C-TNBS, University Duisburg-Essen, Essen, Germany
| | - Johannes Hebebrand
- Center for Translational Neuro- and Behavioral Sciences C-TNBS, University Duisburg-Essen, Essen, Germany
- Department for Psychiatry, Psychosomatic Medicine and Psychotherapy of Children and Adolescents, LVR, Essen, Germany
| | - Christian Dohna-Schwake
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Infectiology, Pediatric Neurology, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences C-TNBS, University Duisburg-Essen, Essen, Germany
- West German Centre for Infectious Diseases (WZI), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Sarah C. Goretzki
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Infectiology, Pediatric Neurology, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences C-TNBS, University Duisburg-Essen, Essen, Germany
- West German Centre for Infectious Diseases (WZI), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| |
Collapse
|
41
|
Volgina SY, Sachkova OG, Sadykov MM, Gamirova RG, Kurmaeva EA. Features of COVID-19 in children. ROSSIYSKIY VESTNIK PERINATOLOGII I PEDIATRII (RUSSIAN BULLETIN OF PERINATOLOGY AND PEDIATRICS) 2022. [DOI: 10.21508/1027-4065-2022-67-5-118-122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The novel SARS-CoV-2 coronavirus infection is predominantly asymptomatic or presenting few symptoms in children, and life-threatening complications are rare. In most cases, symptoms of ARVI are observed, such as fever, cough, myalgia, or weakness, which are milder than in adult patients. In addition, most laboratory and radiographic findings in children with COVID-19 are nonspecific. However, some children may develop prolonged forms of COVID-19, as well as long-term symptoms (post-COVID syndrome) after the illness, which significantly affect the quality of life. There are different data regarding the prevalence and duration of long-term effects of a new coronavirus infection in children. The most common symptoms following COVID-19 in children/teens are fatigue, lack of concentration, and muscle pain. The review presents the latest literature data on the duration and course of COVID-19 in children. It should be remembered that long-term symptoms could affect the physical, social, and psychological well-being of children and adolescents in the future.
Collapse
Affiliation(s)
| | | | - M. M. Sadykov
- Kazan State Medical University;
Children’s City Polyclinic No. 9
| | | | | |
Collapse
|
42
|
Buonsenso D, Pazukhina E, Gentili C, Vetrugno L, Morello R, Zona M, De Matteis A, D’Ilario F, Lanni R, Rongai T, del Balzo P, Fonte MT, Valente M, De Rose C, Munblit D, Sigfrid L, Valentini P. The Prevalence, Characteristics and Risk Factors of Persistent Symptoms in Non-Hospitalized and Hospitalized Children with SARS-CoV-2 Infection Followed-Up for up to 12 Months: A Prospective, Cohort Study in Rome, Italy. J Clin Med 2022; 11:6772. [PMID: 36431250 PMCID: PMC9692851 DOI: 10.3390/jcm11226772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/06/2022] [Accepted: 11/10/2022] [Indexed: 11/19/2022] Open
Abstract
Previous studies assessing the prevalence of COVID-19 sequelae in children have included either a small number of children or a short follow-up period, or have only focused on hospitalized children. We investigated the prevalence of persistent symptoms amongst children and assessed the risk factors, including the impact of variants. A prospective cohort study included children (≤18 years old) with PCR-confirmed SARS-CoV-2 infection. The participants were assessed via telephone and face-to-face visits at 1-5, 6-9 and 12 or more months post-SARS-CoV-2 diagnosis using the ISARIC COVID-19 follow-up survey. Of the 679 children enrolled, 51% were female; 488 were infected during the wild virus wave, and 29 were infected with the Alpha, 42 with the Delta and 120 with the Omicron variants. Fatigue (19%), headache (12%), insomnia (7.5%), muscle pain (6.9%) and confusion with concentration issues (6.8%) were the most common persistent symptoms. Families reported an overall improvement over time, with 0.7% of parents interviewed at 12 months or more of the follow-up period reporting a poor recovery. Patients that had not recovered by 6-9 months had a lower probability of recovering during the next follow-up period. Children infected with a variant or the wild virus had an overall similar rate of persistent symptoms (although the pattern of reported symptoms differed significantly) and recovery rates. Conclusions: Recovery rates after SARS-CoV-2 infection improved as time passed from the initial infection, ranging from 4% of children having poor recovery at 1-5 months' follow-up to 1.3% at 6-9 months and 0.7% at 12 months. The patterns of persistence changed according to the variants involved at the time of infection. This study reinforces that a subgroup of children develop long-lasting persistent symptoms and highlights the need for further studies investigating the reasons behind the development of PCC.
Collapse
Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy
- Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e, Perioperatorie–Sezione di Microbiologia, Università Cattolica del S. Cuore, 00168 Rome, Italy
| | - Ekaterina Pazukhina
- Laboratory of Health Economics, Institute of Applied Economic Studies, The Russian Presidential Academy of National Economy and Public Administration, 127006 Moscow, Russia
- Center for Advanced Financial Planning, Macroeconomic Analysis and Financial Statistics, Financial Research Institute of the Ministry of Finance of the Russian Federation, 127006 Moscow, Russia
| | - Carolina Gentili
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Margherita Zona
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Alessia De Matteis
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Federico D’Ilario
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Roberta Lanni
- Pediatra di Libera Scelta, Federazione Italiana Medici Pediatri (FIMP), 00168 Rome, Italy
| | - Teresa Rongai
- Pediatra di Libera Scelta, Federazione Italiana Medici Pediatri (FIMP), 00168 Rome, Italy
| | - Patrizia del Balzo
- Pediatra di Libera Scelta, Federazione Italiana Medici Pediatri (FIMP), 00168 Rome, Italy
| | - Maria Teresa Fonte
- Pediatra di Libera Scelta, Federazione Italiana Medici Pediatri (FIMP), 00168 Rome, Italy
| | - Michele Valente
- Pediatra di Libera Scelta, Federazione Italiana Medici Pediatri (FIMP), 00168 Rome, Italy
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child’s Health, Sechenov First Moscow State Medical University (Sechenov University), 123337 Moscow, Russia
- Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London W2 1PG, UK
- Research and Clinical Center for Neuropsychiatry, 115419 Moscow, Russia
| | - Louise Sigfrid
- International Severe Acute and emerging Infection Consortium (ISARIC), Global Research Collaboration for Infectious Disease Preparedness, Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy
- Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| |
Collapse
|
43
|
Nielsen TB, Leth S, Pedersen M, Harbo HD, Nielsen CV, Laursen CH, Schiøttz-Christensen B, Oestergaard LG. Mental Fatigue, Activities of Daily Living, Sick Leave and Functional Status among Patients with Long COVID: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192214739. [PMID: 36429458 PMCID: PMC9690484 DOI: 10.3390/ijerph192214739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/01/2022] [Accepted: 11/07/2022] [Indexed: 06/01/2023]
Abstract
Studies suggest that persistent symptoms after COVID-19 (long COVID) influence functioning and activities of daily living (ADL). However, it is still uncertain how and to what extent. This study aimed to describe patient-reported mental fatigue, ADL problems, ADL ability, sick leave and functional status among patients with long COVID. In this cross-sectional study, 448 patients, ≥18 years old and referred to occupational therapy at a Danish Post-COVID-19 Clinic, were included. Mental fatigue was measured by the Mental Fatigue Scale, ADL problems and ability were measured by the Canadian Occupational Performance Measure, sick leave was self-reported and functional status was evaluated by the Post-COVID-19 Functional Status Scale. Mean age was 46.8 years, 73% of the patients were female, and 75% suffered from moderate to severe mental fatigue. The majority reported difficulties performing productive and leisure activities. The median performance and satisfaction scores were 4.8 and 3, respectively. In total, 56% of the patients were on sick leave, and 94% were referred to rehabilitation. A decrease in functional status was found between pre-COVID-19 and assessment. Conclusively, the patients were highly affected in their everyday life and had distinct rehabilitation needs. Future research is needed to address causalities and rehabilitation for this patient group.
Collapse
Affiliation(s)
- Trine Brøns Nielsen
- DEFACTUM, Central Denmark Region, 8000 Aarhus, Denmark
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Steffen Leth
- Department of Infectious Diseases, Aarhus University Hospital, 8200 Aarhus, Denmark
- Department of Infectious Diseases and Internal Medicine, Gødstrup Regional Hospital, 7400 Herning, Denmark
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
| | - Mathilde Pedersen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Helle Dahl Harbo
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, 8200 Aarhus, Denmark
- AmbuFlex—Center for Patient-Reported Outcomes, Gødstrup Regional Hospital, 7400 Herning, Denmark
| | - Claus Vinther Nielsen
- DEFACTUM, Central Denmark Region, 8000 Aarhus, Denmark
- Department of Clinical Social Medicine and Rehabilitation, Gødstrup Regional Hospital, 7400 Herning, Denmark
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
| | - Cecilia Hee Laursen
- DEFACTUM, Central Denmark Region, 8000 Aarhus, Denmark
- Department of Clinical Social Medicine and Rehabilitation, Gødstrup Regional Hospital, 7400 Herning, Denmark
| | - Berit Schiøttz-Christensen
- Department of Infectious Diseases, Aarhus University Hospital, 8200 Aarhus, Denmark
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - Lisa Gregersen Oestergaard
- DEFACTUM, Central Denmark Region, 8000 Aarhus, Denmark
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, 8200 Aarhus, Denmark
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
| |
Collapse
|
44
|
Ogonowska-Slodownik A, Labecka MK, Kaczmarczyk K, McNamara RJ, Starczewski M, Gajewski J, Maciejewska-Skrendo A, Morgulec-Adamowicz N. Water-Based and Land-Based Exercise for Children with Post-COVID-19 Condition (postCOVIDkids)-Protocol for a Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14476. [PMID: 36361362 PMCID: PMC9659109 DOI: 10.3390/ijerph192114476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
The most common symptoms of post-COVID-19 condition in children are fatigue, shortness of breath, exercise intolerance, and weakness. The post-COVID-19 condition in children can be very debilitating and lead to prolonged school absences, high morbidity, and limitations in daily functioning. The aim of this research project is to determine the effectiveness of land-based and water-based exercise interventions on exercise capacity, fatigue, health-related quality of life, and pulmonary function in children with post-COVID-19 condition. This study is a prospective randomized controlled study with pre- and post-intervention assessment. Participants will be recruited from Warsaw's primary schools and primary healthcare units according to the inclusion criteria: (i) symptoms of post-COVID-19 condition lasting more than one month following initial COVID-19 infection confirmed by the diagnosis by general practitioner (including obligatory fatigue and shortness of breath/respiratory problems); (ii) age 10-12 years old. Participants meeting the inclusion criteria will be randomized to one of three groups: water-based exercise, land-based exercise, or control (no exercise). We hope this study will provide guidance for long-COVID-19 rehabilitation in children.
Collapse
Affiliation(s)
- Anna Ogonowska-Slodownik
- Faculty of Rehabilitation, Jozef Pilsudski University of Physical Education in Warsaw, Marymoncka 34, 00-968 Warsaw, Poland
| | - Marta Kinga Labecka
- Faculty of Rehabilitation, Jozef Pilsudski University of Physical Education in Warsaw, Marymoncka 34, 00-968 Warsaw, Poland
| | - Katarzyna Kaczmarczyk
- Faculty of Rehabilitation, Jozef Pilsudski University of Physical Education in Warsaw, Marymoncka 34, 00-968 Warsaw, Poland
| | - Renae J. McNamara
- Physiotherapy, Prince of Wales Hospital, Sydney, NSW 2031, Australia
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW 2006, Australia
- Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia
| | - Michał Starczewski
- Faculty of Rehabilitation, Jozef Pilsudski University of Physical Education in Warsaw, Marymoncka 34, 00-968 Warsaw, Poland
| | - Jan Gajewski
- Faculty of Rehabilitation, Jozef Pilsudski University of Physical Education in Warsaw, Marymoncka 34, 00-968 Warsaw, Poland
| | - Agnieszka Maciejewska-Skrendo
- Faculty of Physical Culture, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland
- Institute of Physical Culture Sciences, University of Szczecin, 70-453 Szczecin, Poland
| | - Natalia Morgulec-Adamowicz
- Faculty of Rehabilitation, Jozef Pilsudski University of Physical Education in Warsaw, Marymoncka 34, 00-968 Warsaw, Poland
| |
Collapse
|
45
|
Buonsenso D. A call to invest in immunological determinants of pediatric post-COVID conditions: Insights from a post-COVID pANCA+ diffuse alveolar hemorrhage in an adolescent. Pediatr Pulmonol 2022; 57:2861-2862. [PMID: 35931658 PMCID: PMC9538831 DOI: 10.1002/ppul.26097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/09/2022] [Accepted: 07/16/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Centro di Salute Globale, Università Cattolica Del Sacro Cuore, Roma, Italia
| |
Collapse
|
46
|
Di Gennaro L, Valentini P, Sorrentino S, Ferretti MA, De Candia E, Basso M, Lancellotti S, De Cristofaro R, De Rose C, Mariani F, Morello R, Lazzareschi I, Sigfrid L, Munblit D, Buonsenso D. Extended coagulation profile of children with Long Covid: a prospective study. Sci Rep 2022; 12:18392. [PMID: 36319840 PMCID: PMC9626616 DOI: 10.1038/s41598-022-23168-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/26/2022] [Indexed: 11/18/2022] Open
Abstract
Emerging data suggests that endotheliopathy changes can be associated with post covid condition (PCC) in adults. Research on the matter in children is lacking. We analyzed an extended coagulation profile including biomarkers of endothelial damage in children with PCC and compared it with a control group of children that fully recovered post- SARS-CoV-2 infection. A case-control study enrolling children below 18 years of age with previous microbiologically confirmed SARS-CoV-2 infection in a pediatric post-covid unit in Italy ≥ 8 weeks after the initial infection. Samples were taken at 8 and 12 weeks after the SARS-CoV-2 diagnosis and analyzed for coagulation profiling (fibrinogen, prothrombin time, international normalized ratio, activated partial thromboplastin time, d-dimers, factor VIII coagulant activity, plasma von Willebrand factor (VWF) antigen and VWF ristocetin cofactor (RC)). We compared coagulation profiles in samples from children identified with PCC (at least one, or three or more symptoms, which could not be explained by an alternative diagnosis, at the 8- and 12-week follow-up assessment using the pediatric Long Covid International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) survey. Seventy-five children were enrolled, 49.3% were females, the median age was 10.2 (IQR 4.9) years. Forty-six (61%) of the children had at least one persisting symptom at the eight weeks post-onset, (PCC8); 39/75 (52%) had persistent symptoms for more than 12 weeks (PCC12) and 15/75(32%) had at least three persisting symptoms (PCC ≥ 3) at 12 weeks. Children with PCC presented more frequently with abnormal D-Dimer levels above the reference range compared to children that had fully recovered at the 8-12 weeks (39.1% vs. 17.2%, p = 0.04), and 12 week follow up or more (41% vs. 17.2%, p = 0.05), and in children with three or more symptoms at 12 weeks follow up compared to those that had recovered (64.3% vs. 22.2%, p = 0.002). For the other coagulation profiles, there were abnormal values detected for VWF, FVIII, RC and Fibrinogen but no significant differences between children with PCC compared to controls. Although the majority of children in our cohort showed coagulation profile within or close to normal ranges, we found that a higher proportion of children with PCC, and specifically those with a more severe spectrum characterized with three or more persisting symptoms, had abnormal D-dimer levels compared to other children that fully recovered from an acute SARS-CoV-2 infection.
Collapse
Affiliation(s)
- Leonardo Di Gennaro
- Department of Diagnostic Imaging, Radiotherapy, Oncology and Haematology, Hemorrhagic and Thrombotic Diseases Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Silvia Sorrentino
- Department of Diagnostic Imaging, Radiotherapy, Oncology and Haematology, Hemorrhagic and Thrombotic Diseases Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Antonietta Ferretti
- Department of Diagnostic Imaging, Radiotherapy, Oncology and Haematology, Hemorrhagic and Thrombotic Diseases Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Erica De Candia
- Department of Diagnostic Imaging, Radiotherapy, Oncology and Haematology, Hemorrhagic and Thrombotic Diseases Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Basso
- Department of Diagnostic Imaging, Radiotherapy, Oncology and Haematology, Hemorrhagic and Thrombotic Diseases Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stefano Lancellotti
- Department of Diagnostic Imaging, Radiotherapy, Oncology and Haematology, Hemorrhagic and Thrombotic Diseases Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Raimondo De Cristofaro
- Department of Diagnostic Imaging, Radiotherapy, Oncology and Haematology, Hemorrhagic and Thrombotic Diseases Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Mariani
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ilaria Lazzareschi
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Louise Sigfrid
- Nuffield Department of Medicine, International Severe Acute Respiratory and Emerging Infection Consortium Global Support Centre, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University, Moscow, Russia
- Inflammation, Repair and Development Section, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, W2 1PG, UK
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
- Centro di Salute Globale, Università Cattolica del Sacro Cuore, Rome, Italy.
| |
Collapse
|
47
|
Lactoferrin as Possible Treatment for Chronic Gastrointestinal Symptoms in Children with Long COVID: Case Series and Literature Review. CHILDREN 2022; 9:children9101446. [PMID: 36291381 PMCID: PMC9600357 DOI: 10.3390/children9101446] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/12/2022] [Accepted: 09/19/2022] [Indexed: 11/17/2022]
Abstract
Long COVID is an emergent, heterogeneous, and multisystemic condition with an increasingly important impact also on the pediatric population. Among long COVID symptoms, patients can experience chronic gastrointestinal symptoms such as abdominal pain, constipation, diarrhea, vomiting, nausea, and dysphagia. Although there is no standard, agreed, and optimal diagnostic approach or treatment of long COVID in children, recently compounds containing multiple micronutrients and lactoferrin have been proposed as a possible treatment strategy, due to the long-standing experience gained from other gastrointestinal conditions. In particular, lactoferrin is a pleiotropic glycoprotein with antioxidant, anti-inflammatory, antithrombotic, and immunomodulatory activities. Moreover, it seems to have several physiological functions to protect the gastrointestinal tract. In this regard, we described the resolution of symptoms after the start of therapy with high doses of oral lactoferrin in two patients referred to our post-COVID pediatric unit due to chronic gastrointestinal symptoms after SARS-CoV-2 infection.
Collapse
|
48
|
Li X, Tu B, Zhang X, Xu W, Chen J, Xu B, Zheng J, Hao P, Cole R, Jalloh MB, Lu Q, Li C, Sevalie S, Liu W, Chen W. Dysregulation of glutamine/glutamate metabolism in COVID-19 patients: A metabolism study in African population and mini meta-analysis. J Med Virol 2022; 95:e28150. [PMID: 36112136 PMCID: PMC9538869 DOI: 10.1002/jmv.28150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/25/2022] [Accepted: 09/13/2022] [Indexed: 01/11/2023]
Abstract
Coronavirus disease 2019 (COVID-19) remains a serious global threat. The metabolic analysis had been successfully applied in the efforts to uncover the pathological mechanisms and biomarkers of disease severity. Here we performed a quasi-targeted metabolomic analysis on 56 COVID-19 patients from Sierra Leone in western Africa, revealing the metabolomic profiles and the association with disease severity, which was confirmed by the targeted metabolomic analysis of 19 pairs of COVID-19 patients. A meta-analysis was performed on published metabolic data of COVID-19 to verify our findings. Of the 596 identified metabolites, 58 showed significant differences between severe and nonsevere groups. The pathway enrichment of these differential metabolites revealed glutamine and glutamate metabolism as the most significant metabolic pathway (Impact = 0.5; -log10P = 1.959). Further targeted metabolic analysis revealed six metabolites with significant intergroup differences, with glutamine/glutamate ratio significantly associated with severe disease, negatively correlated with 10 clinical parameters and positively correlated with SPO2 (rs = 0.442, p = 0.005). Mini meta-analysis indicated elevated glutamate was related to increased risk of COVID-19 infection (pooled odd ratio [OR] = 2.02; 95% confidence interval [CI]: 1.17-3.50) and severe COVID-19 (pooled OR = 2.28; 95% CI: 1.14-4.56). In contrast, elevated glutamine related to decreased risk of infection and severe COVID-19, the pooled OR were 0.30 (95% CI: 0.20-0.44), and 0.44 (95% CI: 0.19-0.98), respectively. Glutamine and glutamate metabolism are associated with COVID-19 severity in multiple populations, which might confer potential therapeutic target of COVID-19, especially for severe patients.
Collapse
Affiliation(s)
- Xiao‐kun Li
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and EpidemiologyBeijingChina
| | - Bo Tu
- Fifth Medical Center of Chinese PLA General HospitalBeijing100039China
| | - Xiao‐Ai Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and EpidemiologyBeijingChina
| | - Wen Xu
- Fifth Medical Center of Chinese PLA General HospitalBeijing100039China
| | - Jia‐hao Chen
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and EpidemiologyBeijingChina
| | - Biao Xu
- Fifth Medical Center of Chinese PLA General HospitalBeijing100039China
| | - Jun‐Jie Zheng
- Fifth Medical Center of Chinese PLA General HospitalBeijing100039China
| | - Peng‐fei Hao
- Department of Laboratorial Science and Technology School of Public HealthPeking University
| | - Reginald Cole
- Joint Medical Unit, Republic of Sierra Leone Armed Forces34 Military Hospital Wilberforce FreetownFreetownSierra Leone
| | - Mohamed Boie Jalloh
- Joint Medical Unit, Republic of Sierra Leone Armed Forces34 Military Hospital Wilberforce FreetownFreetownSierra Leone
| | - Qing‐bin Lu
- Department of Laboratorial Science and Technology School of Public HealthPeking University
| | - Chang Li
- Department of Laboratorial Science and Technology School of Public HealthPeking University
| | - Stephen Sevalie
- Joint Medical Unit, Republic of Sierra Leone Armed Forces34 Military Hospital Wilberforce FreetownFreetownSierra Leone
| | - Wei Liu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and EpidemiologyBeijingChina
| | - Wei‐wei Chen
- Fifth Medical Center of Chinese PLA General HospitalBeijing100039China
| |
Collapse
|
49
|
Pierce CA, Herold KC, Herold BC, Chou J, Randolph A, Kane B, McFarland S, Gurdasani D, Pagel C, Hotez P, Cobey S, Hensley SE. COVID-19 and children. Science 2022; 377:1144-1149. [PMID: 36074833 PMCID: PMC10324476 DOI: 10.1126/science.ade1675] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
There has been substantial research on adult COVID-19 and how to treat it. But how do severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections afflict children? The COVID-19 pandemic has yielded many surprises, not least that children generally develop less severe disease than older adults, which is unusual for a respiratory disease. However, some children can develop serious complications from COVID-19, such as multisystem inflammatory syndrome in children (MIS-C) and Long Covid, even after mild or asymptomatic COVID-19. Why this occurs in some and not others is an important question. Moreover, when children do contract COVID-19, understanding their role in transmission, especially in schools and at home, is crucial to ensuring effective mitigation measures. Therefore, in addition to nonpharmaceutical interventions, such as improved ventilation, there is a strong case to vaccinate children so as to reduce possible long-term effects from infection and to decrease transmission. But questions remain about whether vaccination might skew immune responses to variants in the long term. As the experts discuss below, more is being learned about these important issues, but much more research is needed to understand the long-term effects of COVID-19 in children.
Collapse
Affiliation(s)
- Carl A Pierce
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kevan C Herold
- Departments of Immunobiology and of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Betsy C Herold
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Janet Chou
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Adrienne Randolph
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Anaesthesia, Harvard Medical School, Boston, MA, USA
| | - Binita Kane
- Manchester University Foundation Trust and School of Biological Sciences, University of Manchester, Manchester, UK
| | | | - Deepti Gurdasani
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Christina Pagel
- Clinical Operational Research Unit, University College London, London, UK
| | - Peter Hotez
- Texas Children's Hospital Center for Vaccine Development, Departments of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
- Department of Biology, Baylor University, Waco, TX, USA
- Hagler Institute for Advanced Study, Texas A&M University, College Station, TX, USA
- Scowcroft Institute of International Affairs, Texas A&M University, College Station, TX, USA
- James A. Baker III Institute for Public Policy, Rice University, Houston, TX, USA
- School of Public Health, University of Texas, Houston, TX, USA
| | - Sarah Cobey
- Department of Ecology and Evolution, University of Chicago, Illinois, USA
| | - Scott E Hensley
- Department of Microbiology, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
50
|
Chronic Olfactory Dysfunction in Children with Long COVID: A Retrospective Study. CHILDREN 2022; 9:children9081251. [PMID: 36010141 PMCID: PMC9406427 DOI: 10.3390/children9081251] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 01/14/2023]
Abstract
Olfactory dysfunction is one of the long-term consequences of acute SARS-CoV-2 infection in adults. This study aims to analyze the prevalence of chronic anosmia among COVID-19 children and to bring to light its impact on their families’ quality of life and wellbeing. Children younger than 18 years old, who were detected as being COVID-19-positive by RT-PCR and were assessed in a pediatric post-COVID outpatient clinic at least 28 days after the onset of the acute infection, were included in the study. The patients suffering from persisting smell disorders were asked to answer a questionnaire about their symptoms and how they influence their daily life. Out of the 784 children evaluated, 13 (1.7%) presented olfactory impairment at a mean follow-up since the acute infection of more than three months. Parents’ answers showed that they were worried about their children’s health, in particular they wanted to know if and when they would recover and if these disorders would have long-term consequences. They also wanted to share their experiences, in order to help other people who are experiencing the same disorders in everyday life. Our study highlights that smell disorders can significantly upset children’s eating habits and everyday activities. Furthermore, these findings suggest that future research should try to better understand the mechanisms causing loss of smell in COVID-19 patients and find the most appropriate treatment.
Collapse
|