As there is no established definition, many researchers define “post-acute covid-19” as the persistence of a patient’s symptoms for 3 weeks after the onset of the disease, while we talk about chronic Covid-19 when the symptoms persist for at least 12 weeks. As in many children the diagnosis has not been confirmed in the laboratory and there may be false negative tests, a positive test is not required to diagnose the syndrome.
The incidence of the syndrome varies in different studies, while references in the literature for children and adolescents are limited. According to the latest data, it seems that 1 in 7 children diagnosed with Covid-19 disease may develop long Covid syndrome.
Why does chronic Covid-19 occur?
It is not known why some patients may have a delayed recovery. Factors such as persistent viremia due to low antibody response, relapse or re-infection, inflammatory or other immune-type reactions, as well as emotional factors such as post-traumatic stress after infection may contribute to the persistence of symptoms. In addition, similar persistent respiratory, musculoskeletal and neuropsychiatric symptoms have been reported following infection with other viruses of the coronavirus family (SARS and MERS).
What are the symptoms that a child may have with chronic Covid-19 syndrome?
Respiratory
• Chest pain
• Cough
• Shortness of breath during exercise
The time of remission of the symptoms depends on the condition of the respiratory tract before the infection and its severity. Some of these symptoms can last up to 3 months or more. Radiographic imaging is required for persistent respiratory symptoms or for patients who have been diagnosed with abnormal radiological findings during the acute phase of the disease. Children over 6 years of age who have persistent symptoms should have a spirometry test to assess their respiratory function.
Cardiovascular system
• Chest pain
• Shortness of breath
• Pulsation / Arrhythmia
• Fatigue
One of the most serious complications of SARS-CoV-2 infection in children is the risk of heart attack (myocarditis), either in the context of Multisystem Inflammatory Syndrome (MIS-C) or in the form of symptoms that persist for weeks. after the onset of the disease. In addition to the usual symptoms mentioned above, in more severe cases myocarditis can lead to heart failure, myocardial infarction, stroke and obstruction. Although the exact mechanism leading to heart attack is not yet known, either the direct effect of the virus on the myocardium or the immune mechanisms that are activated after infection appear to be involved.
Although the exact incidence of myocarditis in children is not fully known, a recent study in 60% of patients who recovered from the infection and underwent cardiac MRI showed imaging findings of myocarditis, regardless of the severity of the symptoms. acute phase. These findings are of concern to pediatricians, parents and children, as the majority of children and adolescents with the disease have mild or no symptoms.
Immunity and tastelessness
Covid-19 can lead to taste and smell disorders, especially in adolescents. It is reported that 1 in 4 people between the ages of 10 and 19 develop anosmia during the course of the infection. In addition to the loss of the ability to detect dangerous odors, a reduction or loss of taste or smell can have a negative effect on food intake, patient nutrition, psychological well-being and ultimately on their quality of life.
Detecting such difficulties in younger children can be particularly difficult and usually indicative symptoms of olfactory and taste disturbances can be refusal of food intake, disturbances in their eating habits and manifestation of irritability or indifference during feeding. These disorders in children usually subside in a few weeks, but persistence of symptoms for a longer period of time, requires special treatment.
Neurodevelopmental disorders
These are disorders that concern:
• cognitive functions
• verbal ability
• academic skills
• motor functions
• changes in mood and behavior
Acute Covid-19 infection can lead to inflammatory processes in the brain (eg stroke, encephalitis), which in turn can result in impaired mental function as well as motor skills and language skills. child’s. Persistent symptoms that do not improve over time usually require imaging and the cooperation of a team of specialists (neurologist, developmentalist, speech therapist, speech therapist, occupational therapist, psychologist).
Memory and concentration disorders
• Difficulties in attention and concentration
• Memory loss or difficulty memorizing and learning
• Difficulties in reading and spelling
• Need for study breaks
Fatigue
A number of children report several weeks after the acute infection physical fatigue, myalgias and decreased physical endurance even in mild activities to which they responded easily before the infection. In this case it is necessary to exclude complications from the respiratory and circulatory system. Post-infection fatigue usually subsides after a few weeks and a specific daily personalized activity program and a gradual increase in the child’s physical activity is usually recommended.
Headache
Headache is a common symptom both during the acute phase of the infection and in the context of long-Covid syndrome. The approach is the same as that followed in any patient with persistent headache (history taking, assessment of the nature of the headache, findings from the neurological examination).
Other rarer symptoms have been described
Gastrointestinal disorders (diarrhea, irritable bowel syndrome)
• Skin rash
• Depression
• Insomnia
• Thromboembolic events
MITERA Children, with the aim of offering comprehensive care to patients, has created the pioneering monitoring program for children and adolescents with Long Covid-19 syndrome.
The program offers an assessment of the child’s condition by a pediatrician-infectious disease specialist, who will inform the family about the ultimate complications that the infection may have and will be able to give detailed instructions for the return of the child to his daily activities (school, activities , sports, etc.).
Learn more here
Writes:
Chara Asimaki
Pediatrician – Infectious Diseases Specialist
MITERA Children’s Scientific Associate
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