51
|
Izquierdo-Pujol J, Moron-Lopez S, Dalmau J, Gonzalez-Aumatell A, Carreras-Abad C, Mendez M, Rodrigo C, Martinez-Picado J. Post COVID-19 Condition in Children and Adolescents: An Emerging Problem. Front Pediatr 2022; 10:894204. [PMID: 35633949 PMCID: PMC9130634 DOI: 10.3389/fped.2022.894204] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/31/2022] [Indexed: 01/08/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection became a pandemic in 2020 and by March 2022 had caused more than 479 million infections and 6 million deaths worldwide. Several acute and long-term symptoms have been reported in infected adults, but it remains unclear whether children/adolescents also experience persistent sequelae. Hence, we conducted a review of symptoms and pathophysiology associated with post-coronavirus disease 2019 (post-COVID-19) condition in children and adolescents. We reviewed the scientific literature for reports on persistent COVID-19 symptoms after SARS-CoV-2 infection in both children/adolescents and adults from 1 January 2020 to 31 March 2022 (based on their originality and relevance to the broad scope of this review, 26 reports were included, 8 focused on adults and 18 on children/adolescents). Persistent sequelae of COVID-19 are less common in children/adolescents than in adults, possibly owing to a lower frequency of SARS-CoV-2 infection and to the lower impact of the infection itself in this age group. However, cumulative evidence has shown prolonged COVID-19 to be a clinical entity, with few pathophysiological associations at present. The most common post-COVID-19 symptoms in children/adolescents are fatigue, lack of concentration, and muscle pain. In addition, we found evidence of pathophysiology associated with fatigue and/or headache, persistent loss of smell and cough, and neurological and/or cardiovascular symptoms. This review highlights the importance of unraveling why SARS-CoV-2 infection may cause post-COVID-19 condition and how persistent symptoms might affect the physical, social, and psychological well-being of young people in the future.
Collapse
Affiliation(s)
| | - Sara Moron-Lopez
- IrsiCaixa AIDS Research Institute, Badalona, Spain
- CIBER de Enfermedades Infecciosas, Madrid, Spain
| | | | - Alba Gonzalez-Aumatell
- Department of Pediatrics, Germans Trias i Pujol University Hospital, Autonomous University of Barcelona, Badalona, Spain
| | - Clara Carreras-Abad
- Department of Pediatrics, Germans Trias i Pujol University Hospital, Autonomous University of Barcelona, Badalona, Spain
| | - Maria Mendez
- Department of Pediatrics, Germans Trias i Pujol University Hospital, Autonomous University of Barcelona, Badalona, Spain
| | - Carlos Rodrigo
- Department of Pediatrics, Germans Trias i Pujol University Hospital, Autonomous University of Barcelona, Badalona, Spain
| | - Javier Martinez-Picado
- IrsiCaixa AIDS Research Institute, Badalona, Spain
- CIBER de Enfermedades Infecciosas, Madrid, Spain
- Department of Infectious Disease and Immunity, University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| |
Collapse
|
52
|
Buonsenso D, Piazza M, Boner AL, Bellanti JA. Long COVID: A proposed hypothesis-driven model of viral persistence for the pathophysiology of the syndrome. Allergy Asthma Proc 2022; 43:187-193. [PMID: 35524358 DOI: 10.2500/aap.2022.43.220018] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Long COVID (coronavirus disease 2019) syndrome includes a group of patients who, after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), exhibit lingering mild-to-moderate symptoms and develop medical complications that can have lasting health problems. In this report, we propose a model for the pathophysiology of the long COVID presentation based on increased proinflammatory cytokine production that results from the persistence of the SARS-CoV-2 virus or one of its molecular components. Associated with this hyperproduction of inflammatory cytokines is a heightened activity of nuclear factor κ B (NF-κB) and p38 mitogen-activated protein kinase signaling pathways that regulate cytokine production. Objective: The purpose of the present report was to review the causes of long COVID syndrome and suggest ways that can provide a basis for a better understanding of the clinical symptomatology for the of improved diagnostic and therapeutic procedures for the condition. Methods: Extensive research was conducted in medical literature data bases by applying terms such as "long COVID" associated with "persistence of the SARS-CoV-2 virus" "spike protein' "COVID-19" and "biologic therapies." Results and Conclusions: In this model of the long COVID syndrome, the persistence of SARS-CoV-2 is hypothesized to trigger a dysregulated immune system with subsequent heightened release of proinflammatory cytokines that lead to chronic low-grade inflammation and multiorgan symptomatology. The condition seems to have a genetic basis, which predisposes individuals to have a diminished immunologic capacity to completely clear the virus, with residual parts of the virus persisting. This persistence of virus and resultant hyperproduction of proinflammatory cytokines are proposed to form the basis of the syndrome.
Collapse
Affiliation(s)
- Danilo Buonsenso
- From the Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli Istituti di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Michele Piazza
- Pediatric Section, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Verona, Italy
| | - Attilio L. Boner
- Pediatric Section, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Verona, Italy
| | - Joseph A. Bellanti
- Department of Pediatrics, Georgetown University Medical Center, Washington D.C
| |
Collapse
|
53
|
Buonsenso D, Pujol FE, Munblit D, Pata D, McFarland S, Simpson FK. Clinical characteristics, activity levels and mental health problems in children with long coronavirus disease: a survey of 510 children. Future Microbiol 2022; 17:577-588. [PMID: 35360923 PMCID: PMC9248023 DOI: 10.2217/fmb-2021-0285] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/10/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Whether long coronavirus disease pertains to children as well is not yet clear. Methods: The authors performed a survey in children suffering from persistent symptoms since initial infection. A total of 510 children infected between January 2020 and January 2021 were included. Results: Symptoms such as fatigue, headache, muscle and joint pain, rashes and heart palpitations and issues such as lack of concentration and short-term memory problems were particularly frequent and confirm previous observations, suggesting that they may characterize this condition. Conclusion: A better comprehension of long coronavirus disease is urgently needed.
Collapse
Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - 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, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Davide Pata
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
- Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | | |
Collapse
|
54
|
Piazza M, Di Cicco M, Pecoraro L, Ghezzi M, Peroni D, Comberiati P. Long COVID-19 in Children: From the Pathogenesis to the Biologically Plausible Roots of the Syndrome. Biomolecules 2022; 12:556. [PMID: 35454144 PMCID: PMC9024951 DOI: 10.3390/biom12040556] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 02/04/2023] Open
Abstract
Long Coronavirus disease-19 (COVID-19) refers to the persistence of symptoms related to the infection with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). This condition is described as persistent and can manifest in various combinations of signs and symptoms, such as fatigue, headache, dyspnea, depression, cognitive impairment, and altered perception of smells and tastes. Long COVID-19 may be due to long-term damage to different organs-such as lung, brain, kidney, and heart-caused by persisting viral-induced inflammation, immune dysregulation, autoimmunity, diffuse endothelial damage, and micro thrombosis. In this review, we discuss the potential and biologically plausible role of some vitamins, essential elements, and functional foods based on the hypothesis that an individual's dietary status may play an important adjunctive role in protective immunity against COVID-19 and possibly against its long-term consequences.
Collapse
Affiliation(s)
- Michele Piazza
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37126 Verona, Italy; (M.P.); (L.P.)
| | - Maria Di Cicco
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, 56126 Pisa, Italy; (M.D.C.); (P.C.)
| | - Luca Pecoraro
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37126 Verona, Italy; (M.P.); (L.P.)
| | - Michele Ghezzi
- Allergology and Pneumology Unit, V. Buzzi Children’s Hospital, 20154 Milan, Italy;
| | - Diego Peroni
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, 56126 Pisa, Italy; (M.D.C.); (P.C.)
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, 56126 Pisa, Italy; (M.D.C.); (P.C.)
| |
Collapse
|
55
|
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
|
56
|
Suskun C, Kilic O, Yilmaz Ciftdogan D, Guven S, Karbuz A, Ozkaya Parlakay A, Kara Y, Kacmaz E, Sahin A, Boga A, Kizmaz Isancli D, Gulhan B, Kanik-Yuksek S, Kiral E, Bozan G, Arslanoglu MO, Kizil MC, Dinleyici M, Us T, Varis A, Kaya M, Vandenplas Y, Dinleyici EC. Intestinal microbiota composition of children with infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and multisystem inflammatory syndrome (MIS-C). Eur J Pediatr 2022; 181:3175-3191. [PMID: 35585256 PMCID: PMC9117086 DOI: 10.1007/s00431-022-04494-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/28/2022] [Accepted: 04/30/2022] [Indexed: 02/07/2023]
Abstract
UNLABELLED Microbiota composition may play a role in the development, prognosis, or post-infection of COVID-19. There are studies evaluating the microbiota composition at the time of diagnosis and during the course of COVID-19, especially in adults, while studies in children are limited and no study available in children with multisystem inflammatory syndrome in children (MIS-C). This study was planned to compare intestinal microbiota composition in children diagnosed with MIS-C and acute COVID-19 infection with healthy children. In this prospective multicenter study, 25 children diagnosed with MIS-C, 20 with COVID-19 infection, and 19 healthy children were included. Intestinal microbiota composition was evaluated by 16 s rRNA gene sequencing. We observed changes of diversity, richness, and composition of intestinal microbiota in MIS-C cases compared to COVID-19 cases and in the healthy controls. The Shannon index was higher in the MIS-C group than the healthy controls (p < 0.01). At phylum level, in the MIS-C group, a significantly higher relative abundance of Bacteroidetes and lower abundance of Firmicutes was found compared to the control group. Intestinal microbiota composition changed in MIS-C cases compared to COVID-19 and healthy controls, and Faecalibacterium prausnitzii decreased; Bacteroides uniformis, Bacteroides plebeius, Clostridium ramosum, Eubacterium dolichum, Eggerthella lenta, Bacillus thermoamylovorans, Prevotella tannerae, and Bacteroides coprophilus were dominant in children with MIS-C. At species level, we observed decreased Faecalibacterium prausnitzii, and increased Eubacterium dolichum, Eggerthella lenta, and Bacillus thermoamylovorans in children with MIS-C and increased Bifidobacterium adolescentis and Dorea formicigenerasus in the COVID-19 group. Our study is the first to evaluate the microbiota composition in MIS-C cases. There is a substantial change in the composition of the gut microbiota: (1) reduction of F. prausnitzii in children with MIS-C and COVID-19; (2) an increase of Eggerthella lenta which is related with autoimmunity; and (3) the predominance of E. dolichum is associated with metabolic dysfunctions and obesity in children with MIS-C. CONCLUSIONS Alterations of the intestinal microbiota might be part of pathogenesis of predisposing factor for MIS-C. It would be beneficial to conduct more extensive studies on the cause-effect relationship of these changes in microbiota composition and their effects on long-term prognosis. WHAT IS KNOWN • Microbiota composition may play a role in the development, prognosis, or post-infection of COVID-19. • However, the number of studies on children is limited, and no study on multisystem inflammatory syndrome in children is currently available (MIS-C). WHAT IS NEW • In individuals with MIS-C, the composition of the gut microbiota changed dramatically. • Decreased Faecalibacterium prausnitzii have been observed, increased Eggerthella lenta, which was previously linked to autoimmunity, and predominance of Eubacterium dolichum which was linked to metabolic dysfunction and obesity.
Collapse
Affiliation(s)
- Cansu Suskun
- grid.164274.20000 0004 0596 2460Department of Pediatrics, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, TR-26040 Turkey
| | - Omer Kilic
- grid.164274.20000 0004 0596 2460Department of Pediatric Infectious Disease, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Dilek Yilmaz Ciftdogan
- grid.411795.f0000 0004 0454 9420Department of Pediatric Infectious Disease, Izmir Katip Celebi University Faculty of Medicine, Izmir, Turkey
| | - Sirin Guven
- grid.414850.c0000 0004 0642 8921Department of Pediatrics, Prof. Dr Ilhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Adem Karbuz
- Department of Pediatric Infectious Disease, Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Aslinur Ozkaya Parlakay
- grid.512925.80000 0004 7592 6297Yildirim Beyazit University Faculty of Medicine Department of Pediatric Infectious Disease, Ankara City Hospital Department of Pediatric Infectious Disease, Ankara, Turkey
| | - Yalcın Kara
- grid.164274.20000 0004 0596 2460Department of Pediatric Infectious Disease, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Ebru Kacmaz
- grid.164274.20000 0004 0596 2460Pediatric Intensive Care Unit, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Aslihan Sahin
- grid.411795.f0000 0004 0454 9420Department of Pediatric Infectious Disease, Izmir Katip Celebi University Faculty of Medicine, Izmir, Turkey
| | - Aysun Boga
- grid.414850.c0000 0004 0642 8921Department of Pediatrics, Prof. Dr Ilhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Didem Kizmaz Isancli
- Department of Pediatric Infectious Disease, Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Belgin Gulhan
- grid.512925.80000 0004 7592 6297Department of Pediatric Infectious Disease, Ankara City Hospital, Ankara, Turkey
| | - Saliha Kanik-Yuksek
- grid.512925.80000 0004 7592 6297Department of Pediatric Infectious Disease, Ankara City Hospital, Ankara, Turkey
| | - Eylem Kiral
- grid.164274.20000 0004 0596 2460Pediatric Intensive Care Unit, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Gurkan Bozan
- grid.164274.20000 0004 0596 2460Pediatric Intensive Care Unit, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Mehmet Ozgür Arslanoglu
- grid.164274.20000 0004 0596 2460Pediatric Intensive Care Unit, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Mahmut Can Kizil
- grid.164274.20000 0004 0596 2460Department of Pediatric Infectious Disease, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Meltem Dinleyici
- grid.164274.20000 0004 0596 2460Department of Social Pediatrics, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Tercan Us
- grid.164274.20000 0004 0596 2460Department of Microbiology, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | | | | | - Yvan Vandenplas
- grid.8767.e0000 0001 2290 8069KidZ Health Castle, UZ Brussels, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ener Cagri Dinleyici
- grid.164274.20000 0004 0596 2460Department of Pediatrics, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, TR-26040 Turkey
| |
Collapse
|