1
|
Vivisenco IC, Lescaie A, Dragomirescu A, Ioniță IC, Florescu I, Ciocea B, Grama AR, Crăciun MD, Chivu CD, Ulmeanu CE, Nițescu VG. Neurological Manifestations of Acute SARS-CoV-2 Infection in Pediatric Patients: A 3-Year Study on Differences between Pandemic Waves. Viruses 2024; 16:967. [PMID: 38932259 PMCID: PMC11209294 DOI: 10.3390/v16060967] [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: 05/14/2024] [Revised: 06/04/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
This study analyzed the neurological manifestation profiles of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across pandemic waves in pediatric patients. The study collected data on patients aged between 0 and 18 years, diagnosed with acute SARS-CoV-2 infection, admitted to a pediatric tertiary hospital between 1 March 2020 and 28 February 2023. This study included 1677 patients. Neurological manifestations were noted in 10% (n = 168) of patients with a median age of 3.2 years (interquartile range: 1-11.92). Neurological manifestations were significantly associated with the pandemic waves (p = 0.006) and age groups (p < 0.001). Seizures were noted in 4.2% of cases and reached an increasing frequency over time (p = 0.001), but were not associated with age groups. Febrile seizures accounted for the majority of seizures. Headache was reported in 2.6% of cases and had similar frequencies across the pandemic waves and age groups. Muscular involvement was noted in 2% of cases, reached a decreasing frequency over time (p < 0.001), and showed different frequencies among the age groups. Neurological manifestations of acute SARS-CoV-2 infection exhibit distinct patterns, depending on the pandemic wave and patient age group. The Wuhan and Omicron waves involved the nervous system more often than the other waves.
Collapse
Affiliation(s)
- Iolanda Cristina Vivisenco
- Discipline of Pediatrics, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 17-23 Plevnei Road, 010221 Bucharest, Romania; (I.C.V.); (A.R.G.); (C.E.U.); (V.G.N.)
- Department of Pediatrics, Grigore Alexandrescu Clinical Emergency Hospital for Children, 30-32 Iancu de Hunedoara Road, 011743 Bucharest, Romania; (A.D.); (I.C.I.)
| | - Andreea Lescaie
- Discipline of Pediatrics, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 17-23 Plevnei Road, 010221 Bucharest, Romania; (I.C.V.); (A.R.G.); (C.E.U.); (V.G.N.)
- Department of Pediatrics, Grigore Alexandrescu Clinical Emergency Hospital for Children, 30-32 Iancu de Hunedoara Road, 011743 Bucharest, Romania; (A.D.); (I.C.I.)
| | - Ana Dragomirescu
- Department of Pediatrics, Grigore Alexandrescu Clinical Emergency Hospital for Children, 30-32 Iancu de Hunedoara Road, 011743 Bucharest, Romania; (A.D.); (I.C.I.)
| | - Ioana Cătălina Ioniță
- Department of Pediatrics, Grigore Alexandrescu Clinical Emergency Hospital for Children, 30-32 Iancu de Hunedoara Road, 011743 Bucharest, Romania; (A.D.); (I.C.I.)
| | - Irina Florescu
- Department of Neurology, Grigore Alexandrescu Clinical Emergency Hospital for Children, 30-32 Iancu de Hunedoara Road, 011743 Bucharest, Romania; (I.F.); (B.C.)
| | - Bogdan Ciocea
- Department of Neurology, Grigore Alexandrescu Clinical Emergency Hospital for Children, 30-32 Iancu de Hunedoara Road, 011743 Bucharest, Romania; (I.F.); (B.C.)
| | - Andreea Rodica Grama
- Discipline of Pediatrics, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 17-23 Plevnei Road, 010221 Bucharest, Romania; (I.C.V.); (A.R.G.); (C.E.U.); (V.G.N.)
- Department of Pediatrics, Grigore Alexandrescu Clinical Emergency Hospital for Children, 30-32 Iancu de Hunedoara Road, 011743 Bucharest, Romania; (A.D.); (I.C.I.)
| | - Maria-Dorina Crăciun
- Department of Epidemiology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 17-23 Plevnei Road, 010221 Bucharest, Romania; (M.-D.C.); (C.-D.C.)
- Department of Infection Prevention and Control, Grigore Alexandrescu Clinical Emergency Hospital for Children, 30-32 Iancu de Hunedoara Road, 011743 Bucharest, Romania
| | - Carmen-Daniela Chivu
- Department of Epidemiology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 17-23 Plevnei Road, 010221 Bucharest, Romania; (M.-D.C.); (C.-D.C.)
- Department of Infection Prevention and Control, Grigore Alexandrescu Clinical Emergency Hospital for Children, 30-32 Iancu de Hunedoara Road, 011743 Bucharest, Romania
| | - Coriolan Emil Ulmeanu
- Discipline of Pediatrics, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 17-23 Plevnei Road, 010221 Bucharest, Romania; (I.C.V.); (A.R.G.); (C.E.U.); (V.G.N.)
- Department of Pediatrics, Grigore Alexandrescu Clinical Emergency Hospital for Children, 30-32 Iancu de Hunedoara Road, 011743 Bucharest, Romania; (A.D.); (I.C.I.)
| | - Viorela Gabriela Nițescu
- Discipline of Pediatrics, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 17-23 Plevnei Road, 010221 Bucharest, Romania; (I.C.V.); (A.R.G.); (C.E.U.); (V.G.N.)
- Department of Pediatrics, Grigore Alexandrescu Clinical Emergency Hospital for Children, 30-32 Iancu de Hunedoara Road, 011743 Bucharest, Romania; (A.D.); (I.C.I.)
| |
Collapse
|
2
|
Bildik O, Olgac Dundar N, Basarir G, Ersen A, Bozkaya Yilmaz S, Kusgöz F, Sahin A, Gencpinar P, Yılmaz Ciftdogan D. Coronavirus Disease 2019-Associated Neurological Manifestations in Children: A Large Single-Center Experience With Rare Cases. Pediatr Neurol 2023; 145:148-153. [PMID: 37369146 DOI: 10.1016/j.pediatrneurol.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 04/16/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND We aimed to analyze pediatric patients with coronavirus disease 2019 (COVID-19) with a diverse spectrum of neurological manifestations in a single center since neurological involvement in children is still poorly understood. METHODS We performed a retrospective study on 912 children aged between zero and 18 years who had a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test result and symptoms of COVID-19 from March 2020 to March 2021 in a single center. RESULTS Among 912 patients, 37.5% (n = 342) had neurological symptoms and 62.5% (n = 570) had no neurological symptoms. The mean age of patients with neurological symptoms was significantly higher (14.2 ± 3.7 vs 9.9 ± 5.7; P < 0.001). Three hundred and twenty-two patients had nonspecific symptoms (ageusia, anosmia, parosmia, headache, vertigo, myalgia), whereas 20 patients had specific involvement (seizures/febrile infection-related epilepsy syndrome, cranial nerve palsy, Guillain-Barré syndrome and variants, acute disseminated encephalomyelitis, central nervous system vasculitis). The mean age of the patients with nonspecific neurological symptoms was significantly higher (14.6 ± 3.1 vs 7.7 ± 5.7; P < 0.001). CONCLUSION This study presents a large number of patients with a diverse spectrum of neurological manifestations. The rare neurological manifestations reported in our study will contribute to better understanding the neurological involvement of SARS-CoV-2 in children. The study also points out the differences of SARS-CoV-2-related neurological manifestations between patients at different ages. Physicians should be alert about recognizing the early neurological manifestations of the SARS-CoV-2 in children.
Collapse
Affiliation(s)
- Olgay Bildik
- Department of Pediatric Neurology, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Nihal Olgac Dundar
- Department of Pediatric Neurology, Izmir Katip Celebi University, Izmir, Turkey.
| | - Gunce Basarir
- Department of Pediatric Neurology, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Atilla Ersen
- Department of Pediatric Neurology, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Sema Bozkaya Yilmaz
- Department of Pediatric Neurology, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Fatma Kusgöz
- Department of Pediatric Neurology, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Aslihan Sahin
- Department of Pediatric Infectious Diseases, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Pinar Gencpinar
- Department of Pediatric Neurology, Izmir Katip Celebi University, Izmir, Turkey
| | - Dilek Yılmaz Ciftdogan
- Department of Pediatric Infectious Diseases, Izmir Katip Celebi University, Izmir, Turkey
| |
Collapse
|
3
|
Perilli L, Fetta M, Capponi M, Guido CA, Grosso S, Iannetti P, Spalice A. Peripheral nervous system involvement in SARS-CoV-2 infection: a review of the current pediatric literature. Front Neurol 2023; 14:1134507. [PMID: 37305745 PMCID: PMC10249431 DOI: 10.3389/fneur.2023.1134507] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/19/2023] [Indexed: 06/13/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified as the pathogen responsible for the pandemic health emergency declared by the World Health Organization in March 2020. During the first part of the pandemic, adults showed mild to severe respiratory symptoms. Children seemed initially exempt, both from acute and subsequent complications. Hyposmia or anosmia were promptly identified as the main symptoms of acute infection, so neurotropism of SARS-CoV-2 was immediately suspected. (1, 2). As the emergency progressed, post infectious neurological complications were described also in pediatric population (3). Cases of cranial neuropathy in connection with acute SARS-CoV-2 infection have been reported in pediatric patients, as an isolate post infectious complication or in the context of the multisystem inflammatory syndrome in children (MIS-C) (4-6). Neuroinflammation is thought to be caused by several mechanisms, among which immune/autoimmune reactions (7), but so far, no specific autoantibody has been identified. SARS-CoV-2 can enter the central nervous system (CNS) directly and/or infect it retrogradely, through the peripheral nervous system (PNS), after replicating peripherally; several factors regulate invasion and subsequent neuroinflammation. Indeed, direct/secondary entry and replication can activate CNS-resident immune cells that, together with peripheral leukocytes, induce an immune response and promote neuroinflammation. In addition, as we will discuss in the following review, many cases of peripheral neuropathy (cranial and non-cranial) have been reported during or after SARS-CoV-2 infection. However, some authors have pointed out that the increase of cranial roots and ganglia in neurological imaging is not always observed in children with cranial neuropathy. (8). Even if a variety of case reports were published, opinions about an increased incidence of such neurologic diseases, linked to SARS-CoV-2 infection, are still controversial (9-11). Facial nerve palsy, ocular movements abnormalities and vestibular alterations are among the most reported issues in pediatric population (3-5). Moreover, an increased screen exposure imposed by social distancing led to acute oculomotion's disturbance in children, not primarily caused by neuritis (12, 13). The aim of this review is to suggest food for thought on the role of SARS-CoV-2 in neurological conditions, affecting the peripheral nervous system to optimize the management and care of pediatric patients.
Collapse
Affiliation(s)
- Lorenzo Perilli
- Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - Marina Fetta
- Department of Maternal, Infantile, and Urological Sciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Lazio, Italy
| | - Martina Capponi
- Department of Maternal, Infantile, and Urological Sciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Lazio, Italy
| | - Cristiana Alessia Guido
- Department of Maternal, Infantile, and Urological Sciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Lazio, Italy
| | - Salvatore Grosso
- Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - Paola Iannetti
- Department of Maternal, Infantile, and Urological Sciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Lazio, Italy
| | - Alberto Spalice
- Department of Maternal, Infantile, and Urological Sciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Lazio, Italy
| |
Collapse
|
4
|
Salleh H, Soon IS, Chong VH. Frequency and risk factors for febrile seizures during COVID-19 pandemic waves: an observational study. Eur J Pediatr 2023:10.1007/s00431-023-05021-0. [PMID: 37178360 PMCID: PMC10182340 DOI: 10.1007/s00431-023-05021-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Abstract
Febrile seizures (FS) are well-known manifestations of viral illnesses. The purpose of this study is to assess the prevalence and factors associated with FS among pediatric patients with COVID-19 admitted to the National Isolation Centre in Brunei Darussalam. All pediatric patients (< 12 years) during the first (n = 12), second (n = 418), and third (n = 219) waves were included in the study. In Brunei, the first, second, and third waves were caused by the original SARS-CoV-2, Delta, and Omicron variants, respectively. Data was extracted from a prospective database and the national electronic health record system. Patients with and without FS were compared to identify any significant risk factors. FS were only encountered in the third wave (n = 29, 13%) giving an overall prevalence of 4.5%; 24 (83%) occurring in the typical age group for FS (≥ 6 months to < 6 years). Five cases (17%) occurred in children 6 years and older. Comparing patients in the third wave, univariate analyses showed typical age group, previous history of FS, family history of FS, higher temperature (> 38.6 °C), and fewer symptoms on presentation (3 or less) were associated with FS. On multivariate analyses, typical age group, family history of FS, and fewer reported symptoms remained significant (all p < 0.05). Conclusions: The overall prevalence of FS in COVID-19 patients is comparable to rates reported. However, in Brunei Darussalam, FS only occurred in the third wave that has been associated with Omicron variant. Younger age group, family history of FS, and fewer symptoms on presentation are correlated with risk of FS. What is Known: • Viral infections are the most common cause of FS in children. •Young age and a personal and family history of FS are correlated with the risk of FS. What is New: • There were high rates of FS (13%) among pediatric patients admitted with COVID-19 due to the Omicron variant but not with the original and Delta variants. • FS with COVID-19 were correlated with reporting fewer symptoms on presentation.
Collapse
Affiliation(s)
- Hafizah Salleh
- Department of Paediatrics, RIPAS Hospital, Bandar Seri Begawan, BA1710, Brunei Darussalam.
| | - Ing Shian Soon
- Department of Paediatrics, RIPAS Hospital, Bandar Seri Begawan, BA1710, Brunei Darussalam
| | | |
Collapse
|
5
|
Paolin C, Zanetto L, Frison S, Boscolo Mela F, Tessari A, Amigoni A, Daverio M, Bonardi CM. Apneas requiring respiratory support in young infants with COVID-19: a case series and literature review. Eur J Pediatr 2023; 182:2089-2094. [PMID: 36912961 PMCID: PMC10009862 DOI: 10.1007/s00431-023-04856-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 01/26/2023] [Accepted: 02/01/2023] [Indexed: 03/14/2023]
Abstract
The objective of this study is to describe the clinical features of young infants with apneas as a clinical sign of COVID-19. We reported the cases of 4 infants who needed respiratory support in our PICU for a severe course of COVID-19 complicated with recurrent apneas. Moreover, we conducted a review of the literature about COVID-19 and apneas in infants ≤ 2 months of corrected age. A total of 17 young infants were included. Overall, in most of the cases (88%), apnea was an initial symptom of COVID-19, and in two cases, it recurred after 3-4 weeks. Regarding neurological workup, most children underwent a cranial ultrasound, while a minority underwent electroencephalography registration, neuroimaging, and lumbar punctures. One child showed signs of encephalopathy on electroencephalogram, with further neurological workup resulting normal. SARS-CoV-2 was never found in the cerebrospinal fluid. Ten children required intensive care unit admission, with five of them needing intubation and three non-invasive ventilation. A less invasive respiratory support was sufficient for the remaining children. Eight children were treated with caffeine. All patients had a complete recovery. Conclusion: Young infants with recurrent apneas during COVID-19 usually need respiratory support and undergo a wide clinical work-up. They usually show complete recovery even when admitted to the intensive care unit. Further studies are needed to better define diagnostic and therapeutic strategies for these patients. What is Known: • Although the course of COVID-19 in infants is usually mild, some of them may develop a more severe disease needing intensive care support. Apneas may be a clinical sign in COVID-19. What is New: • Infants with apneas during COVID-19 may require intensive care support, but they usually show a benign course of the disease and full recovery.
Collapse
Affiliation(s)
- Chiara Paolin
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
| | - Lorenzo Zanetto
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
| | - Sara Frison
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
| | - Federica Boscolo Mela
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
| | - Anna Tessari
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
| | - Angela Amigoni
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
| | - Marco Daverio
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy.
| | - Claudia Maria Bonardi
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
| |
Collapse
|
6
|
Costagliola G, Vallario MP, Santangelo A, Foiadelli T, Ragone MC, Battini R, Tinelli F, Di Cicco ME, Bonuccelli A, Gaeta G, Iozzi C, Peroni DG, Operto FF, Consolini R, Orsini A. Neurovisual Manifestations in Children with Mild COVID-19: An Association to Remember. Neuroophthalmology 2023; 47:75-78. [PMID: 36891409 PMCID: PMC9988337 DOI: 10.1080/01658107.2023.2174560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 01/11/2023] [Accepted: 01/19/2023] [Indexed: 02/18/2023] Open
Abstract
Neurovisual involvement has been reported in a number of patients with severe SARS-CoV-2 disease (COVID-19), mainly among adult patients. In children, such involvement has been reported in rare cases, often in those presenting with severe forms of COVID-19. The aim of this work is to explore the association between mild COVID-19 and neurovisual manifestations. We report the cases of three previously healthy children who developed neurovisual manifestations following mild acute COVID-19, analysing the clinical phenotype, the latency between the onset of acute COVID-19 and neurovisual involvement, and the kinetic of resolution. Our patients developed different clinical patterns, including visual impairment and ophthalmoplegia. In two cases, these clinical features occurred during acute COVID-19, while in the third patient their development was delayed after 10 days from disease onset. Furthermore, the dynamics of resolution were different, with one patient showing remission after 24 hours, the second after 30 days, and the third showing persistence of the strabismus after 2 months of follow-up. The spreading of COVID-19 among the paediatric population will probably lead to an increase of atypical disease forms, including those presenting with neurovisual involvement. Therefore, a better knowledge of the pathogenic and clinical features of these manifestations is warranted.
Collapse
Affiliation(s)
- Giorgio Costagliola
- Pediatric Immunology, Pediatric University Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Michele Pio Vallario
- Pediatric University Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Andrea Santangelo
- Pediatric University Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Thomas Foiadelli
- Pediatric Clinic, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Maria Cristina Ragone
- Ophthalmology Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Roberta Battini
- Department of Neuroscience, IRCSS Fondazione StellaMaris, Calambrone, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesca Tinelli
- Department of Neuroscience, IRCSS Fondazione StellaMaris, Calambrone, Italy
| | - Maria Elisa Di Cicco
- Pediatric University Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Alice Bonuccelli
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Giovanni Gaeta
- Department of Pediatrics, Pediatric Department, Cecina Hospital, Cecina, Italy
| | - Chiara Iozzi
- Department of Pediatrics, Pediatric Department, Cecina Hospital, Cecina, Italy
| | - Diego Giampiero Peroni
- Pediatric University Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Francesca Felicia Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Fisciano, Italy
| | - Rita Consolini
- Pediatric Immunology, Pediatric University Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Alessandro Orsini
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| |
Collapse
|
7
|
Zahed G, Karimzadeh P, Wissow LS, Arman S, Babaee M, Shervin Badv R, Zeinali V, Zarafshan H, Armin S, Nasiri S, Hashemi N, Moayedi A. Neuropsychiatric Manifestations of COVID-19 in Hospitalized Pediatrics: A Multicenter Cross-sectional Study. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2023. [DOI: 10.5812/apid-131511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Background: The large proportion of coronavirus disease 2019 (COVID-19) patients has been associated with a large number of neuropsychiatric manifestations. Despite the high prevalence of COVID-19, few studies have examined such manifestations, especially in children and adolescents. Objectives: This study investigated neuropsychiatric manifestations in hospitalized children and adolescents admitted for COVID-19 infection in Iran. Methods: This prospective observational study included admitted children and adolescents (4 - 18 years old) diagnosed with COVID-19 infection, pediatric neurologists, child and adolescent psychiatrists, and infectious disease specialists, and assessed 375 infected patients during August and December 2021. Results: Of the 375 patients, 176 (47%) were female, with a mean age of 9.0 ± 3.39 years. Psychiatric and neurological manifestations were reported in 58 (15.5%) and 58 (15.5%) patients, respectively. The most prevalent psychiatric disorders were separation anxiety disorder (SAD) (5.1%), major depressive disorder (MDD) (3.5%), generalized anxiety disorder (GAD) (2.7%), insomnia (2.4%), and oppositional defiant disorder (ODD) (2.4%). Regarding neurological complications, seizures were the most prevalent (13.1%), followed by encephalitis (1.9%), transverse myelitis (0.3%), acute ischemic stroke (0.3%), and Guillain-Barre syndrome (0.3%). There was no significant relationship between the duration of COVID-19 infection (P = 0.54) and ICU admission (P = 0.44) with the emergence of psychiatric symptoms. Conclusions: The most prevalent neurologic and psychiatric complications among children and adolescents with COVID-19 infection were seizures and the symptoms of anxiety/mood disorders, respectively.
Collapse
|
8
|
Coronavirus Infection in Neonates: Neurodevelopmental Outcomes at 18 Months of Age. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2023; 2023:6140085. [PMID: 36632169 PMCID: PMC9829449 DOI: 10.1155/2023/6140085] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 12/17/2022] [Accepted: 12/24/2022] [Indexed: 01/04/2023]
Abstract
Background Although most neonates with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection experience only mild disease, its impact on neurodevelopmental outcomes is unknown. This study aimed to assess the 18-month neurodevelopmental outcomes of infants who had SARS-CoV-2 infection as neonates. Methods The authors conducted a prospective cohort study of neonates diagnosed with SARS-CoV-2 infection from June 2020 to December 2020 through nasopharyngeal coronavirus disease 2019 (COVID-19). A total of 58 neonates were identified from the Kuwait National COVID-19 Registry and enrolled. Historical controls were selected from the neonatal follow-up registry and matched in a 2 : 1 ratio based on sex and gestational age. When the subjects were 18 months of age, their neurodevelopmental outcomes were assessed by two trained assessors using the Bayley Scales of Infant and Toddler Development-3rd Edition (BSID-III). Results Forty children diagnosed with SARS-CoV-2 infection were included in the final analysis. The median age at infection was 18 days (range: 10-26 days). Eighteen (45%) patients were asymptomatic, 15 (37.5%) had a sepsis-like presentation, 5 (12.5%) exhibited respiratory distress, and 2 (5%) had a multisystem inflammatory syndrome in children (MIS-C)-like presentation. At the 18 months follow-up, only one child showed a severe developmental delay and one child had a language delay. BSID-III outcomes did not differ significantly between the SARS-CoV-2-infected and control groups. Conclusions There was no difference in neurodevelopmental outcomes at 18 months in children infected with SARS-CoV-2 compared with controls, although longer neurodevelopmental follow-up studies are required.
Collapse
|
9
|
Scheuermeier M, Chaves KQ, Marín-Sanabria D, Acosta-Lazo H, Ulate-Campos A. First Pediatric Case of Autoimmune Encephalitis Associated With COVID-19 in Costa Rica. Cureus 2022; 14:e30616. [DOI: 10.7759/cureus.30616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2022] [Indexed: 11/07/2022] Open
|
10
|
Medication-resistant acute focal motor seizures in a child with COVID-19 affecting the CNS. Epileptic Disord 2022; 24:941-946. [PMID: 35792850 PMCID: PMC9878025 DOI: 10.1684/epd.2022.1461] [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] [Indexed: 01/28/2023]
Abstract
A perfectly healthy preschool girl presented with acute repetitive focal aware motor seizures, while her brain MRI showed a lesion in the left posterior cortex. After a number of investigations, her cerebrospinal fluid PCR was positive for SARS-CoV-2. Despite receiving at least four anti-seizure medications at appropriate dosages, the seizures continued, and just after administering intravenous immunoglobulin, her seizures stopped. This dramatic response to intravenous immunoglobulin may indicate a hypothetical inflammatory process in the patient's cortex caused by COVID-19.
Collapse
|
11
|
Archuleta C, Wade C, Micetic B, Tian A, Mody K. Maternal COVID-19 Infection and Possible Associated Adverse Neurological Fetal Outcomes, Two Case Reports. Am J Perinatol 2022; 39:1292-1298. [PMID: 34814196 DOI: 10.1055/a-1704-1929] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The long-term effects of prenatal coronavirus disease 2019 (COVID-19) infection on the fetal brain are mostly unknown at this time; however, there is increasing evidence being published. CASE REPORT Two cases of severe ventriculomegaly, neurological dysfunction, and seizures were found in neonates with prenatal exposure to COVID-19 infection during the first and third trimesters of pregnancy. CONCLUSION Inflammation during the prenatal and neonatal periods may be associated with neurological disorders or injury. Despite the presumed lack of vertical transmission, post-COVID-19 syndrome and its associated inflammation may have an impact on the unborn fetus. Hyper-vigilance and dissemination of adverse findings are of significant importance as we navigate through this evolving pandemic and its effects. KEY POINTS · Prenatal exposure to COVID-19 may affect the fetal brain.. · There is a possibility of neonatal neurological sequelae from maternal COVID-19.. · Does maternal COVID-19 infection cause infantile seizures?.
Collapse
Affiliation(s)
- Charlotte Archuleta
- College of Medicine, University of Arizona College of Medicine, Phoenix, Arizona.,Neonatal Intensive Care Unit, Banner - University Medical Center Phoenix, Phoenix, Arizona
| | - Christine Wade
- Neonatal Intensive Care Unit, Banner - University Medical Center Phoenix, Phoenix, Arizona.,Mednax/Arizona Neonatology, Phoenix, Arizona
| | - Becky Micetic
- Neonatal Intensive Care Unit, Banner - University Medical Center Phoenix, Phoenix, Arizona.,Mednax/Arizona Neonatology, Phoenix, Arizona
| | - Ashley Tian
- Neonatal Intensive Care Unit, Banner - University Medical Center Phoenix, Phoenix, Arizona.,Department of Neurology and Neurosurgery, Banner Children's Specialists Neurology and Neurosurgery Clinic, Mesa, Arizona
| | - Kartik Mody
- College of Medicine, University of Arizona College of Medicine, Phoenix, Arizona.,Neonatal Intensive Care Unit, Banner - University Medical Center Phoenix, Phoenix, Arizona.,Mednax/Arizona Neonatology, Phoenix, Arizona.,Department of Pediatrics, Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, Arizona
| |
Collapse
|
12
|
AlHendawi T, Jouhar L, Altaraqji S, Baker L, Ahmed M, Shaban A. Encephalitis and transverse myelitis associated with Covid-19 infection, a case report. BRAIN DISORDERS 2022; 7:100046. [PMID: 35937910 PMCID: PMC9339155 DOI: 10.1016/j.dscb.2022.100046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/19/2022] [Accepted: 07/28/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Lamia Jouhar
- Pediatric Department, Hamad Medical Corporation, Qatar
| | - Sondos Altaraqji
- Pediatric Neurology Department, Hamad Medical Corporation, Qatar
| | - Laila Baker
- Pediatric Neurology Department, Hamad Medical Corporation, Qatar
| | - Mayada Ahmed
- Radiology Department, Hamad Medical Corporation, Qatar
| | - Ahmad Shaban
- Radiology Department, Hamad Medical Corporation, Qatar
| |
Collapse
|
13
|
Sener Okur D. Neurological symptoms and signs associated with COVID-19 in pediatric patients: a single-center experience. Medicine (Baltimore) 2022; 101:e29920. [PMID: 35945769 PMCID: PMC9351517 DOI: 10.1097/md.0000000000029920] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
There is insufficient evidence on SARS-CoV-2 induced neurological effects. Studies on CNS involvement during COVID-19 in children are limited. This study aims to identify and manage the neurological signs and symptoms in COVID-19-infected pediatric patients during follow up and plan future follow-ups. Children diagnosed COVID-19 and hospitalized in the pediatric pandemic services, between March 18, 2020, and June 18, 2021, were included in the study. Children with underlying neurological disease were excluded from the study. Patient data retrieved from hospital files and medical records. Children divided into 2 groups, 1 and 2, based on the presence or absence of neurological findings. A total of 243 children received follow-ups in the pandemic wards, 35 (14.4%) of these patients had neurological findings. Major neurological manifestations were headache (n:17, 7%), seizure (n:4, 1.6%), and anosmia/hyposmia (n:17, 7%). The number of boys (n:13, 37.1%) was smaller than the number of girls (n:22, 62.9%) in Group 1. Group 1 showed higher blood leukocyte, lymphocyte, thrombocyte, AST, LDH, d-dimer values. Anosmia/hyposmia occurred more often in girls, anosmia and headache occurred more often over 9 years of age. Pulmonary and hematologic involvement was more common in children with anosmia and headache. Our study is one of the few studies on neurological involvement in COVID-19 in children. To the best of our knowledge, there is limited data on these subjects in the literature.
Collapse
Affiliation(s)
- Dicle Sener Okur
- State Hospital of Denizli, Department of Pediatrics, Division of Pediatric Infectious Diseases, Denizli, Turkey
- *Correspondence: Dicle Sener Okur, State Hospital of Denizli, Department of Pediatrics, Division of Pediatric Infectious Diseases Address: Pamukkale University Faculty of Medicine Department of Pediatrics Division of Pediatric Infectious Diseases, 20180, Pamukkale, Denizli, Turkey (e-mail: )
| |
Collapse
|
14
|
Riva A, Piccolo G, Balletti F, Binelli M, Brolatti N, Verrotti A, Amadori E, Spalice A, Giacomini T, Mancardi MM, Iannetti P, Vari MS, Piccotti E, Striano P, Brisca G. Acute Neurological Presentation in Children With SARS-CoV-2 Infection. Front Pediatr 2022; 10:909849. [PMID: 35899136 PMCID: PMC9309333 DOI: 10.3389/fped.2022.909849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background In the pediatric population, the knowledge of the acute presentation of SARS-CoV-2 infection is mainly limited to small series and case reports, particularly when dealing with neurological symptoms. We describe a large cohort of children with acute SARS-CoV-2 infection, focusing on the neurological manifestations and investigating correlations between disease severity and population demographics. Methods Patients aged 0-18 years with a positive molecular swab were recruited between April 2020 and March 2021 from a tertiary Italian pediatric centre. Clinical data, imaging, and laboratory test results were retrieved from our local dataset and statistically analyzed. Results A total of 237 patients with a median age of 3.2 years were eligible; thirty-two (13.5%) presented with neurological symptoms, including headache (65.6%), altered awareness (18.8%), ageusia/anosmia (12.5%), seizures (6.3%), and vertigo (6.3%), combined in 7 (21.9%) cases. Respiratory (59.5%) and gastrointestinal (25.3%) symptoms were the most common among the 205 (86.5%) patients without neurological involvement. Neurological symptoms did not significantly influence the severity of the triage access codes. Moreover, pre-existing medical conditions were not higher in the group with neurological manifestations. Overall, fifty-nine patients (25%, 14/59 with neurological symptoms) required treatment, being antibiotics, systemic steroids, and heparin those most prescribed. Conclusion Our study supports the overall benign course of the SARS-CoV-2 infection in children. Neurological manifestations, except for headache, remain a rare presenting symptom, and disease severity seems unrelated to pre-existing medical conditions.
Collapse
Affiliation(s)
- Antonella Riva
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Gianluca Piccolo
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Federica Balletti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Maria Binelli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Noemi Brolatti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Elisabetta Amadori
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Alberto Spalice
- Department of Pediatrics, Child Neurology Division, Sapienza University Rome, Rome, Italy
| | - Thea Giacomini
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maria Margherita Mancardi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Paola Iannetti
- Department of Paediatrics, University of Rome, Rome, Italy
| | - Maria Stella Vari
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Emanuela Piccotti
- Pediatric Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giacomo Brisca
- Subintensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| |
Collapse
|
15
|
Stafstrom CE. Neurological effects of COVID-19 in infants and children. Dev Med Child Neurol 2022; 64:818-829. [PMID: 35243616 PMCID: PMC9111795 DOI: 10.1111/dmcn.15185] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 12/13/2022]
Abstract
Neurological manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children are becoming increasingly apparent as the coronavirus disease (COVID-19) pandemic continues. While children manifest relatively milder features of the disease, accumulating evidence warrants concern that COVID-19 exacts both acute- and long-term effects on the developing central and peripheral nervous systems. This review focuses on the relatively underinvestigated topic of the effects of SARS-CoV-2 on the brain in infancy and childhood, concluding that clinicians should be attentive to both the acute effects and long-term consequences of COVID-19 from a neurological perspective.
Collapse
Affiliation(s)
- Carl E. Stafstrom
- Division of Pediatric NeurologyDepartments of Neurology and PediatricsThe Johns Hopkins University School of MedicineBaltimoreMDUSA
| |
Collapse
|
16
|
Yimenicioglu S, Ekici A. COVID-19, Symptoms with Pre-Existing and Not Pre-Existing Neurological Disorders in Pediatrics. J PEDIAT INF DIS-GER 2022. [DOI: 10.1055/s-0042-1748921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Abstract
Objective The symptoms of coronavirus disease 2019 (COVID-19) in children with pre-existing neurological disease are unknown. We aimed to find out the difference in the symptoms of children with pre-existing neurological disease and those without.
Methods In this single-center, retrospective, cohort study, 96 pediatric patients who had COVID-19 between March 2020 and April 2021 were enrolled.
Results There were 35 males and 61 females. The median age was 14 years (interquartile range [IQR] 10.25–16). Fever (38.5%), headache (35.4%), and cough (32.3%) were the most common symptoms. In 53.1%, neurological complaints (headache, taste-smell loss, vertigo, febrile seizure, coma, and ataxia), in 40.6%, respiratory symptoms (cough, dyspnea, rhinitis, and pharyngitis), and in 8.3%, gastrointestinal symptoms (gastroenteritis, vomiting, nausea, and abdominal pain) were seen. While 23 (62.2%) patients with fever did not have neurological complaints, 14 (37.8%) had neurological complaints (p = 0.017). Eight (21.6%) patients with fever were hospitalized (p = 0.067). Fever was seen significantly more frequently with pre-existing neurological disease (p < 0.001). Younger children were more likely to have fever (p = 0.008). Headaches and taste–smell loss were seen more frequently in patients with no pre-existing neurological disease (p < 0.001, p = 0.034, respectively). The patients with headaches were older than the ones without headaches (p < 0.001). Patients with headaches and loss of taste and smell were older than those without (p = 0.003).
Conclusion Neurological symptoms differed significantly between those who had pre-existing neurological disease and those who did not. Headaches and taste–smell loss were seen more frequently in patients with no pre-existing neurological disease. Fever was significantly higher in patients who had pre-existing neurological disease.
Collapse
Affiliation(s)
- Sevgi Yimenicioglu
- Department of Pediatric Neurology, Health Ministry Eskisehir City Hospital, Eskisehir, Turkey
| | - Arzu Ekici
- Department of Pediatric Neurology, Health Ministry Bursa Yüksek İhtisas Eğitim Arastirma Hastanesi, Bursa, Turkey
| |
Collapse
|
17
|
Castro ADP, Valencia MAAM, Padua JRO. SARS-CoV-2 Neurotropism in a 12-Year-Old Filipino Boy with Focal Encephalitis. ANNALS OF CHILD NEUROLOGY 2022. [DOI: 10.26815/acn.2022.00087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
18
|
A Comprehensive Review of Neuromuscular Manifestations of COVID-19 and Management of Pre-Existing Neuromuscular Disorders in Children. J Clin Med 2022; 11:jcm11040934. [PMID: 35207206 PMCID: PMC8876161 DOI: 10.3390/jcm11040934] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 02/04/2023] Open
Abstract
Since the emergence of SARS-CoV-2, several studies have been published describing neuromuscular manifestations of the disease, as well as management of pre-existing pediatric neuromuscular disorders during the COVID-19 pandemic. These disorders include muscular dystrophies, myasthenic syndromes, peripheral nerve disorders, and spinal muscular atrophy. Such patients are a vulnerable population due to frequent complications such as scoliosis, cardiomyopathy, and restrictive lung disease that put them at risk of severe complications of COVID-19. In this review, neuromuscular manifestations of COVID-19 in children and the management of pre-existing pediatric neuromuscular disorders during the COVID-19 pandemic are discussed. We also review strategies to alleviate pandemic-associated disruptions in clinical care and research, including the emerging role of telemedicine and telerehabilitation to address the continued special needs of these patients.
Collapse
|
19
|
Setia A, Bhatia J, Bhattacharya S. An Overview of Acute Flaccid Myelitis. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2022; 21:774-794. [PMID: 34823462 DOI: 10.2174/1871527320666211125101424] [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: 11/10/2020] [Revised: 04/19/2021] [Accepted: 06/20/2021] [Indexed: 06/13/2023]
Abstract
Acute Flaccid Myelitis is defined by the presence of Acute Flaccid Paralysis (AFP) and a spinal cord lesion on magnetic resonance imaging that is primarily limited to the grey matter. AFM is a difficult situation to deal with when you have a neurologic illness. According to the Centers for Disease Control and Prevention (CDC), a large number of cases were discovered in the United States in 2014, with 90% of cases occurring in children. Although the exact cause of AFM is unknown, mounting evidence suggests a link between AFM and enterovirus D68 (EV-D68). In 2014, an outbreak of AFM was discovered in the United States. The condition was initially linked to polioviruses; however, it was later found that the viruses were caused by non-polioviruses Enteroviruses D-68 (EV-D68). The number of cases has increased since 2014, and the disease has been declared pandemic in the United States. The sudden onset of muscle weakness, usually in an arm or leg, as well as pain throughout the body, the change in patient's facial expression (facial weakness), and shortness of breath, ingesting, and speaking are all common symptoms in patients suffering from neurologic disease. This article includes graphic and histogram representations of reported AFM incidents and criteria for causality, epidemiology, various diagnostic approaches, signs and symptoms, and various investigational guidelines. It also includes key statements about recent clinical findings related to AFM disease.
Collapse
Affiliation(s)
- Aseem Setia
- Department of Pharmaceutics, ISF College of Pharmacy, Moga, Punjab-142001, India
| | - Jasween Bhatia
- Department of Masters in Public Health Science, Symbiosis Institute of Health Science, Pune-411042, India
| | - Sankha Bhattacharya
- Department of Pharmaceutics, School of Pharmacy & Technology Management Shirpur, SVKM\'S NMIMS Deemed-to-be University, Shirpur, Maharashtra 425405, India
| |
Collapse
|
20
|
Postacute/Long COVID in Pediatrics: Development of a Multidisciplinary Rehabilitation Clinic and Preliminary Case Series. Am J Phys Med Rehabil 2021; 100:1140-1147. [PMID: 34793374 PMCID: PMC8594395 DOI: 10.1097/phm.0000000000001896] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
ABSTRACT The long-term sequelae after SARS-CoV-2 infections in children is unknown. Guidance is needed on helpful models of care for an emerging subset of pediatric patients with postacute/long COVID who continue to experience persistent symptoms after initial COVID-19 diagnosis. Here, we describe a pediatric multidisciplinary post-COVID-19 rehabilitation clinic model as well as a case series of the initial cohort of patients who presented to this clinic. A consecutive sample of nine patients (pediatric patients <21 yrs of age) who presented to our clinic are included. The most common presenting symptoms were fatigue (8 of 9 patients), headaches (6 of 9), difficulty with schoolwork (6 of 8), "brain fog" (4 of 9), and dizziness/lightheadedness (4 of 9). Most patients had decreased scores on self-reported quality-of-life measures compared with healthy controls. In the patients who participated in neuropsychological testing, a subset demonstrated difficulties with sustained auditory attention and divided attention; however, most of these patients had preexisting attention and/or mood concerns. There were also some who self-reported elevated depression and anxiety symptoms. Pediatric patients with postacute/long COVID may present with a variety of physical, cognitive, and mood symptoms. We present a model of care to address these symptoms through a multidisciplinary rehabilitation approach.
Collapse
|
21
|
Swartwood S, Nelson GR, Espinoza AC. Stroke as Presenting Feature of COVID-19 in a Pediatric Patient. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0041-1731396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractNeurologic manifestations of severe acute respiratory syndrome coronavirus 2, the virus responsible for novel coronavirus 2019 (COVID-19) infection, have been frequently reported in the adult population but remain relatively rare in pediatric patients, specifically in regard to cerebrovascular accidents (CVAs). We present the case of a previously healthy 16-year-old adolescent boy with no preceding infectious symptoms who developed acute onset of left-sided weakness and slurred speech subsequently diagnosed with acute ischemic stroke (AIS). After performing a thorough diagnostic work-up, no clear etiology for AIS was identified. He was found to be COVID-19 positive by reverse transcription polymerase chain reaction upon admission. Accumulating evidence supports a link between COVID-19 and a systemic prothrombotic state suggesting pediatric patients who present with AIS and no other risk factors should be screened for this novel virus and potentially for extracranial sources of thrombi. As the rates of positive COVID-19 infection increase in the pediatric population, pediatricians and other pediatric subspecialists should be aware of the potential neurological and cerebrovascular complications of this novel virus to avoid delays in evaluation and intervention.
Collapse
Affiliation(s)
- Shanna Swartwood
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Gary R. Nelson
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Audie C. Espinoza
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, United States
| |
Collapse
|
22
|
Emerging COVID-19 Neurological Manifestations: Present Outlook and Potential Neurological Challenges in COVID-19 Pandemic. Mol Neurobiol 2021; 58:4694-4715. [PMID: 34169443 PMCID: PMC8224263 DOI: 10.1007/s12035-021-02450-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 06/07/2021] [Indexed: 02/06/2023]
Abstract
The unremitting coronavirus disease 2019 (COVID-19) pandemic caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) marked a year-long phase of public health adversaries and has severely compromised healthcare globally. Early evidence of COVID-19 noted its impact on the pulmonary and cardiovascular functions, while multiple studies in recent time shed light on its substantial neurological complications, though a comprehensive understanding of the cause(s), the mechanism(s), and their neuropathological outcomes is scarce. In the present review, we conferred evidence of neurological complications in COVID-19 patients and shed light on the SARS-CoV-2 infection routes including the hematogenous, direct/neuronal, lymphatic tissue or cerebrospinal fluid, or infiltration through infected immune cells, while the underlying mechanism of SARS-CoV-2 invasion to the central nervous system (CNS) was also discussed. In an up-to-date manner, we further reviewed the impact of COVID-19 in developing diverse neurologic manifestations associated with CNS, peripheral nervous system (PNS), skeletal muscle, and also pre-existing neurological diseases, including Alzheimer's disease, Parkinson's disease, multiple sclerosis, epilepsy, and myasthenia gravis. Furthermore, we discussed the involvement of key factors including age, sex, comorbidity, and disease severity in exacerbating the neurologic manifestations in COVID-19 patients. An outlook of present therapeutic strategies and state of existing challenges in COVID-19 management was also accessed. Conclusively, the present report provides a comprehensive review of COVID-19-related neurological complications and emphasizes the need for their early clinical management in the ongoing COVID-19 pandemic.
Collapse
|
23
|
McLendon LA, Rao CK, Da Hora CC, Islamovic F, Galan FN. Post-COVID-19 Acute Disseminated Encephalomyelitis in a 17-Month-Old. Pediatrics 2021; 147:peds.2020-049678. [PMID: 33762311 DOI: 10.1542/peds.2020-049678] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 11/24/2022] Open
Abstract
Neurologic manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pediatric patients have been reported in the acute and postinfectious stages of coronavirus disease 2019. Acute disseminated encephalomyelitis (ADEM) typically presents in children after a viral illness at a mean age of 3 to 7 years. A total of 60% to 90% of literature-reported pediatric patients with ADEM have minimal to no neurologic deficits at long-term follow-up. We present a 17-month-old developmentally typical girl with parental complaints of irritability, upper extremity weakness, and gait disturbance. She presented to the hospital afebrile and irritable with right-sided nasolabial fold flattening, neck stiffness, left upper extremity rigidity, right upper extremity paresis, bilateral lower extremity hyperreflexia, and truncal ataxia. During her hospital course, she became somnolent with autonomic instability and was transferred to intensive care. Contrasted brain MRI revealed diffuse patchy T2 hyperintensities without contrast enhancement. Nasopharyngeal SARS-CoV-2 polymerase chain reaction and serum antibody testing results were positive. Cerebral spinal fluid analysis was unremarkable. Respiratory viral panel and autoimmune encephalitis and demyelinating disorders panel results were negative. She was started on high-dose methylprednisolone and intravenous immunoglobulin, with improvement in mental status, focal deficits, and ambulation. After hospital discharge, she received inpatient rehabilitation for 2 weeks and at 2 month follow-up had a full neurologic recovery. We report the youngest case of postinfectious ADEM due to SARS-CoV-2 in a toddler. Early recognition of autoimmune and inflammatory complications of SARS-CoV-2 is vital for early aggressive immunomodulatory treatment and, consequently, improved morbidity in these patients.
Collapse
Affiliation(s)
- Loren A McLendon
- Division of Child and Adolescent Neurology, Mayo Clinic College of Medicine and Science, Jacksonville, Florida.,Division of Pediatric Neurology, Nemours Children Specialty Clinic, Jacksonville, Florida; and
| | - Chethan K Rao
- Division of Child and Adolescent Neurology, Mayo Clinic College of Medicine and Science, Jacksonville, Florida.,Division of Pediatric Neurology, Nemours Children Specialty Clinic, Jacksonville, Florida; and
| | - Cintia Carla Da Hora
- Department of Pediatrics, College of Medicine - Jacksonville, University of Florida, Jacksonville, Florida
| | - Florinda Islamovic
- Department of Pediatrics, College of Medicine - Jacksonville, University of Florida, Jacksonville, Florida
| | - Fernando N Galan
- Division of Pediatric Neurology, Nemours Children Specialty Clinic, Jacksonville, Florida; and
| |
Collapse
|
24
|
Geis T, Brandstetter S, Toncheva AA, Laub O, Leipold G, Wagner R, Kabesch M, Kasser S, Kuhle J, Wellmann S. Serum neurofilament light chain (sNfL) values in a large cross-sectional population of children with asymptomatic to moderate COVID-19. J Neurol 2021; 268:3969-3974. [PMID: 33893540 PMCID: PMC8064423 DOI: 10.1007/s00415-021-10554-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 12/24/2022]
Abstract
Background Serum neurofilament light chain (sNfL) is an established biomarker of neuro-axonal damage in multiple neurological disorders. Raised sNfL levels have been reported in adults infected with pandemic coronavirus disease 2019 (COVID-19). Levels in children infected with COVID-19 have not as yet been reported. Objective To evaluate whether sNfL is elevated in children contracting COVID-19. Methods Between May 22 and July 22, 2020, a network of outpatient pediatricians in Bavaria, Germany, the Coronavirus antibody screening in children from Bavaria study network (CoKiBa), recruited healthy children into a cross-sectional study from two sources: an ongoing prevention program for 1–14 years, and referrals of 1–17 years consulting a pediatrician for possible infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We determined sNfL levels by single molecule array immunoassay and SARS-CoV-2 antibody status by two independent quantitative methods. Results Of the 2652 included children, 148 (5.6%) were SARS-CoV-2 antibody positive with asymptomatic to moderate COVID-19 infection. Neurological symptoms—headache, dizziness, muscle aches, or loss of smell and taste—were present in 47/148 cases (31.8%). Mean sNfL levels were 5.5 pg/ml (SD 2.9) in the total cohort, 5.1 (SD 2.1) pg/ml in the children with SARS-CoV-2 antibodies, and 5.5 (SD 3.0) pg/ml in those without. Multivariate regression analysis revealed age—but neither antibody status, antibody levels, nor clinical severity—as an independent predictor of sNfL. Follow-up of children with pediatric multisystem inflammatory syndrome (n = 14) showed no association with sNfL. Conclusions In this population study, children with asymptomatic to moderate COVID-19 showed no neurochemical evidence of neuronal damage.
Collapse
Affiliation(s)
- Tobias Geis
- University Children's Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, University of Regensburg, Steinmetzstr. 1-3, 93049, Regensburg, Germany
| | - Susanne Brandstetter
- University Children's Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, University of Regensburg, Steinmetzstr. 1-3, 93049, Regensburg, Germany
- Research and Development Campus Regensburg (WECARE), at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Antoaneta A Toncheva
- University Children's Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, University of Regensburg, Steinmetzstr. 1-3, 93049, Regensburg, Germany
| | - Otto Laub
- Pediatric Office Dr. Laub, Rosenheim, Germany
| | | | - Ralf Wagner
- Institute of Medical Microbiology and Hygiene, Molecular Microbiology (Virology), University of Regensburg, Regensburg, Germany
| | - Michael Kabesch
- University Children's Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, University of Regensburg, Steinmetzstr. 1-3, 93049, Regensburg, Germany
- Research and Development Campus Regensburg (WECARE), at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Severin Kasser
- Department of Pediatric Hematology and Oncology, University Children´s Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Jens Kuhle
- Neurology Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sven Wellmann
- University Children's Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, University of Regensburg, Steinmetzstr. 1-3, 93049, Regensburg, Germany.
| |
Collapse
|
25
|
Abstract
Most children with SARS-CoV-2 infection have relatively mild clinical symptoms without fever or pneumonia, although severe cases with multiple-organ failure have been reported. Neurological symptoms, which have been mainly reported in adults, are very rare in children. This article will review 2 different aspects of neurological involvement related to this infection in children. In the first part, we will review the neurological abnormalities reported in children caused by this viral infection. Adults frequently report muscle pain, headache, anosmia, dysgeusia, and occasionally more severe central or peripheral nervous system damage. Neurological involvement seems infrequent in children, although some cases have been reported. In the second part, we will discuss the COVID-19 pandemic impact on the healthcare system of some countries, causing collateral damage to general pediatric care and in particular to those children affected with chronic diseases, mainly neurological conditions, including autism, intellectual disability, attention deficit and hyperactivity disorder (ADHD), neuromuscular disorders, cerebral palsy, and epilepsy, and patients needing neurosurgical procedures.
Collapse
Affiliation(s)
- Susana Boronat
- Pediatric Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| |
Collapse
|