Critical pediatric neurological illness associated with COVID-19 (Omicron BA.2.3.7 variant) infection in Taiwan: immunological assessment and viral genome analysis in tertiary medical center

Chen, Chi-Sheng; Chang, Chia-Ning; Hu, Chih-Fen; Jian, Ming-Jr; Chung, Hsing-Yi; Chang, Chiung‐Wen; Perng, Cherng‐Lih; Hung, Kuo‐Sheng; Chang, Feng–Yee; Wang, Chih‐Hung; Chen, Shyi-Jou; Shang, Hung‐Sheng

doi:10.1016/j.ijid.2022.09.001

Cited by 26 publications

(26 citation statements)

References 11 publications

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“…31 Recently, five cases of Omicron BA.2.3.7 subvariant infection with severe neurological symptoms were also identified in Taiwan. 32 As a result of our study, the clinical progression scale, need for oxygen support, and PICU admission were not different according to SARS-CoV-2 periods in children hospitalized with COVID-19. Our findings support previous observations in other countries.…”

Section: Discussionmentioning

confidence: 50%

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The diversity in the clinical features of children hospitalized with COVID‐19 during the nonvariant, Alpha (B.1.1.7), Delta (B.1.617.2), and Omicron (B.1.1.529) variant periods of SARS CoV‐2: Caution for neurological symptoms in Omicron variant

Şahin

Karadağ‐Öncel

Buyuksen

et al. 2023

Journal of Medical Virology

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Since the COVID-19 pandemic began, various severe acute respiratory syndrome coronavirus 2 variants have been identified with different characteristics than the nonvariant strain. We retrospectively evaluated the demographic and clinical differences in the cohort of hospitalized COVID-19 children (1 month-18 years old) between March 11, 2020, and September 31, 2022, by the time the variants identified in our country predominate. Bonferroni post hoc analysis was performed to compare the differences between the periods. Of the 283 children in this study, 142 (50.2%) were females. The median age was 36 (interquartile range [IQR]: 7-132) months. Sixty-three (22.2%) patients were hospitalized in the nonvariant period, 24 (8.5%) in the Alpha period, 93 (32.9%) in the Delta period, and 103 (36.4%) in the Omicron period. Fever was the most common symptom in all groups, with no statistically significant differences (p = 0.25). In the Omicron period, respiratory and gastrointestinal symptoms decreased, and neurological symptoms increased significantly compared to other periods: [respiratory symptoms; nonvariant (65.1%) vs. Omicron (41.7%), (p = 0.024)], [gastrointestinal symptoms; Delta (41.9%) vs. Omicron (22.3%), (p = 0.018), [neurological symptoms; Delta (14.5%) vs. Omicron (31.1%), (p = 0.03]. Altered mental status and seizures were more common during the Omicron period compared to the pre-Omicron (nonvariant, Alpha, and Delta) period (p = 0.017 and p = 0.005, respectively). Although the main symptoms in children with COVID-19 were fever and respiratory symptoms, an increase in severe neurological manifestations was seen throughout the Omicron variant period.

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Section: Discussionmentioning

confidence: 50%

“…Apart from convulsion, a patient with severe encephalopathy associated with COVID‐19 in the neonatal and early infancy periods due to Omicron BA.1 subvariant has been identified 31 . Recently, five cases of Omicron BA.2.3.7 subvariant infection with severe neurological symptoms were also identified in Taiwan 32 …”

Section: Discussionmentioning

confidence: 99%

The diversity in the clinical features of children hospitalized with COVID‐19 during the nonvariant, Alpha (B.1.1.7), Delta (B.1.617.2), and Omicron (B.1.1.529) variant periods of SARS CoV‐2: Caution for neurological symptoms in Omicron variant

Şahin

Karadağ‐Öncel

Buyuksen

et al. 2023

Journal of Medical Virology

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“…46 The cerebrospinal fluid samples from COVID-19 patients with severe neurological symptoms were generally tested for SARS-CoV-2 RNA negative. 47,57 The above observations suggest that neurological symptoms are unlikely to be driven by direct neural invasion. Certain genetic variants of antioxidant enzymes, including GST family and NRF2, were identified to affect the development of long COVID neurological sequelae.…”

Section: Neurological Involvementmentioning

confidence: 91%

“…Nevertheless, studies found that SARS‐CoV‐2 demonstrated its viral tropism for choroid plexus epithelial cells rather than neurons or glial cells, 56 and biomarkers of central nervous system recovered to normal at convalescence, suggesting the neurological sequelae were not accompanied by neurodegeneration and astrocytic injury 46 . The cerebrospinal fluid samples from COVID‐19 patients with severe neurological symptoms were generally tested for SARS‐CoV‐2 RNA negative 47,57 . The above observations suggest that neurological symptoms are unlikely to be driven by direct neural invasion.…”

Section: Manifestations Of Long Covid In Multiple Organsmentioning

confidence: 99%

Long COVID: The latest manifestations, mechanisms, and potential therapeutic interventions

Cheng

et al. 2022

MedComm

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COVID‐19 caused by SARS‐CoV‐2 infection affects humans not only during the acute phase of the infection, but also several weeks to 2 years after the recovery. SARS‐CoV‐2 infects a variety of cells in the human body, including lung cells, intestinal cells, vascular endothelial cells, olfactory epithelial cells, etc. The damages caused by the infections of these cells and enduring immune response are the basis of long COVID. Notably, the changes in gene expression caused by viral infection can also indirectly contribute to long COVID. We summarized the occurrences of both common and uncommon long COVID, including damages to lung and respiratory system, olfactory and taste deficiency, damages to myocardial, renal, muscle, and enduring inflammation. Moreover, we provided potential treatments for long COVID symptoms manifested in different organs and systems, which were based on the pathogenesis and the associations between symptoms in different organs. Importantly, we compared the differences in symptoms and frequency of long COVID caused by breakthrough infection after vaccination and infection with different variants of concern, in order to provide a comprehensive understanding of the characteristics of long COVID and propose improvement for tackling COVID‐19.

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“…Long COVID is now well described for many variants of concern 5 , and also occurs after infection with BA.5 6 . Neurological and psychiatric manifestations represent a major component of COVID-19 and long COVID [7][8][9] and these remain for patients infected with omicron viruses [10][11][12][13] , although data specifically for BA.5 neurological manifestations has not yet emerged. The large number of changes in spike for omicron and omicron sub-lineages has rendered vaccination [14][15][16] , many monoclonal antibody treatments 17 , and prior exposure with other variants 18 less protective.…”

Section: Introductionmentioning

confidence: 99%

Increased neurovirulence of omicron BA.5 and XBB variants over BA.1 in K18-hACE2 mice and human brain organoids

Stewart

Ellis

Yan

et al. 2022

Preprint

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A frequently repeated premise is that viruses evolve to become less pathogenic. This appears also to be true for SARS-CoV-2, although the increased level of immunity in human populations makes it difficult to distinguish between reduced intrinsic pathogenicity and increasing protective immunity. The reduced pathogenicity of the omicron BA.1 sub-lineage compared to earlier variants is well described and appears to be due to reduced utilization of TMPRRS2. That this reduced pathogenicity remains true for omicron BA.5 was recently reported. In sharp contrast, we show that a BA.5 isolate was significantly more pathogenic in K18-hACE2 mice than a BA.1 isolate, with BA.5 infection showing increased neurovirulence, encephalitis and mortality, similar to that seen for an original strain isolate. BA.5 also infected human cortical brain organoids to a greater extent than a BA.1 and original strain isolate. Neurons were the target of infection, with increasing evidence of neuron infection in COVID-19 patients. These results argue that while omicron virus may be associated with reduced respiratory symptoms, BA.5 shows increased neurovirulence compared to earlier omicron sub-variants.

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Critical pediatric neurological illness associated with COVID-19 (Omicron BA.2.3.7 variant) infection in Taiwan: immunological assessment and viral genome analysis in tertiary medical center

Cited by 26 publications

References 11 publications

The diversity in the clinical features of children hospitalized with COVID‐19 during the nonvariant, Alpha (B.1.1.7), Delta (B.1.617.2), and Omicron (B.1.1.529) variant periods of SARS CoV‐2: Caution for neurological symptoms in Omicron variant

The diversity in the clinical features of children hospitalized with COVID‐19 during the nonvariant, Alpha (B.1.1.7), Delta (B.1.617.2), and Omicron (B.1.1.529) variant periods of SARS CoV‐2: Caution for neurological symptoms in Omicron variant

Long COVID: The latest manifestations, mechanisms, and potential therapeutic interventions

Increased neurovirulence of omicron BA.5 and XBB variants over BA.1 in K18-hACE2 mice and human brain organoids

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