Long COVID in pediatrics—epidemiology, diagnosis, and management

Abstract

This review summarizes current knowledge on post-acute sequelae of COVID-19 (PASC) and post-COVID-19 condition (PCC) in children and adolescents. A literature review was performed to synthesize information from clinical studies, expert opinions, and guidelines. PASC also termed Long COVID — at any age comprise a plethora of unspecific symptoms present later than 4 weeks after confirmed or probable infection with severe respiratory syndrome corona virus type 2 (SARS-CoV-2), without another medical explanation. PCC in children and adolescents was defined by the WHO as PASC occurring within 3 months of acute coronavirus disease 2019 (COVID-19), lasting at least 2 months, and limiting daily activities. Pediatric PASC mostly manifest after mild courses of COVID-19 and in the majority of cases remit after few months. However, symptoms can last for more than 1 year and may result in significant disability. Frequent symptoms include fatigue, exertion intolerance, and anxiety. Some patients present with postural tachycardia syndrome (PoTS), and a small number of cases fulfill the clinical criteria of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). To date, no diagnostic marker has been established, and differential diagnostics remains challenging. Therapeutic approaches include appropriate self-management as well as the palliation of symptoms by non-pharmaceutical and pharmaceutical strategies. Conclusion: PASC in pediatrics present with heterogenous severity and duration. A stepped, interdisciplinary, and individualized approach is essential for appropriate clinical management. Current health care structures have to be adapted, and research was extended to meet the medical and psychosocial needs of young people with PASC or similar conditions. What is Known:• Post-acute sequelae of coronavirus 2019 (COVID-19) (PASC) — also termed Long COVID — in children and adolescents can lead to activity limitation and reduced quality of life.• PASC belongs to a large group of similar post-acute infection syndromes (PAIS). Specific biomarkers and causal treatment options are not yet available. What is New:• In February 2023, a case definition for post COVID-19 condition (PCC) in children and adolescents was provided by the World Health Organization (WHO), indicating PASC with duration of at least 2 months and limitation of daily activities. PCC can present as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).• Interdisciplinary collaborations are necessary and have been established worldwide to offer harmonized, multimodal approaches to diagnosis and management of PASC/PCC in children and adolescents.

The risks of autoimmune- and inflammatory post-acute COVID-19 conditions: a network cohort study in six European countries, the US, and Korea

“…Some patients present with postural tachycardia syndrome (PoTS), and a small number of cases fulfill the clinical criteria of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)." [40] Thus, our findings are consistent with the suggested existence of POTS and ME/CFS as post-acute COVID-19 conditions in paediatrics. In addition, our findings suggest absolute risks in paediatric populations of POTS and ME/CFS of 4-609/100'000 pys and 1-153/100'000 pys, respectively.…”

Experiences of physiotherapists working with adults living with Long COVID in Canada: a qualitative study

“…Furthermore, the diversity of clinical experiences among physiotherapists reflected in the interview data suggests Long COVID clinics may have used variable definitions of Long COVID which resulted in some physiotherapists having experiences working with people who met the WHO definition of Long COVID and others working with people with symptoms from acute COVID-19 persisting less than two months or prior to three months from the onset of COVID-19 (3). Since participants primarily worked with adults and practiced in urban settings in Canada, these study findings may have limited transferability to physiotherapists working with children (who also experience Long COVID) (64,65), practising in other geographical settings, including rural or remote areas or working within different healthcare systems. Future research may explore the experiences of physiotherapists working with diverse patient populations, other countries and healthcare settings in the context of Long COVID.…”

IL-8 (CXCL8) Correlations with Psychoneuroimmunological Processes and Neuropsychiatric Conditions

“…Patients with Long COVID often report fatigue, cognitive impairments, sensory dysfunctions, headaches, post-exertional malaise, and experience mood disorders. These symptoms can persist for months or even years, affecting memory, language, processing speed, and executive function [283,[293][294][295][296][297][298][299].…”