Posts by:
Gabriella True

Postacute Sequelae of SARS-CoV-2 in Children

Suchitra Rao, MBBS, MSCS; Rachel S. Gross, MD, MS; Sindhu Mohandas, MD; Cheryl R. Stein, PhD; Abigail Case, MD; Benard Dreyer, MD; Nathan M. Pajor, MD; H. Timothy Bunnell, PhD; David Warburton, MD; Elizabeth Berg, MD; Jonathan B. Overdevest, MD; Mark Gorelik, MD; Joshua Milner, MD; Sejal Saxena, BA; Ravi Jhaveri, MD; John C. Wood, MD, PhD; Kyung E. Rhee, MD, MSc, MA; Rebecca Letts, BA; Christine Maughan, BS; Nick Guthe, BA; Leah Castro-Baucom, MA; Melissa S. Stockwell, MD, MPH. Postacute Sequelae of SARS-CoV-2 in Children. AAP Publications, Feb 7, 2024, https://doi.org/10.1542/peds.2023-062570

  • The COVID-19 pandemic has had far-reaching impacts on health, society, and the economy, with some individuals experiencing lingering effects beyond the acute phase.
  • Emerging data on post-acute sequelae of SARS-CoV-2 infection (PASC) in children, or long COVID, is shedding light on persistent symptoms, new manifestations, and exacerbation of underlying conditions.
  • Children may develop new conditions such as postural orthostatic tachycardia syndrome (POTS), myalgic encephalomyelitis/chronic fatigue syndrome, autoimmune conditions, and multisystem inflammatory syndrome in children.
  • The review summarizes current knowledge on PASC in children, including its children, prevalence, epidemiology, risk factors, clinical characteristics, underlying mechanisms, and functional outcomes. It presents a framework based on NIH-funded research to understand PASC’s effect on children and young adults to guide treatments and prevention efforts. This research uses electronic health records and longitudinal studies to evaluate disease impact, progression, and clinical outcomes.

Section on Mental Health

  • The COVID-19 pandemic resulted in multiple mental health conditions among children, including anxiety, stress, depression, panic, irritability, impulsivity, sleep problems, emotional lability, posttraumatic stress disorder, eating disorders, and suicidal behavior.
    Research is needed to understand whether these conditions are directly related to the virus or influenced by pandemic-related factors like social distancing and school closures.
  • Large EHR cohort studies have shown a higher incidence of neurologic or psychiatric diagnoses in children in the 6 months after SARS-CoV-2 compared with those without confirmed infection.
  • A COVID-19 diagnosis is associated with experiencing a new mental health condition (within a median of 33 days after infection) compared with negative controls in children.
  • The common mental health issues seen in children post-COVID-19 infection are anxiety, attention-deficit/hyperactivity disorder, and trauma-related disorders. Additionally, there are reports of acute-onset neuropsychiatric syndrome in children following COVID-19 infection.
  • There have also been case reports of pediatric acute-onset neuropsychiatric syndrome in children after SARS-CoV-2 infection.72,73 
Folate Receptor Alpha Autoantibodies in the Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) Population

Wells L, O’Hara N, Frye RE, Hullavard N, Smith E. Folate Receptor Alpha Autoantibodies in the Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) Population. Journal of Personalized Medicine. 2024; 14(2):166. https://doi.org/10.3390/jpm14020166

Folate receptor alpha autoantibodies (FRAAs) are linked to two conditions: cerebral folate deficiency (CFD) and autism spectrum disorder (ASD). These conditions share similarities with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) and Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS).

  • The research suggests that FRAAs might play a role in PANS/PANDAS symptoms.
  • Blood samples from 47 young patients diagnosed with PANS/PANDAS were sent for FRAA analysis.
  • 63.8% of these patients had FRAAs, with various types present.
  • Surprisingly, lower FRAA levels were associated with ASD, while higher levels were linked to severe tics.
  • A case study shows treatment with leucovorin improved symptoms in a FRAA-positive PANS/PANDAS patient.
  • These findings suggest that FRAAs are linked to PANS/PANDAS and that issues with folate metabolism might contribute to symptoms. Further research on leucovorin’s potential in treating PANS/PANDAS is necessary, offering a promising alternative treatment option
Sensory processing in children with Paediatric Acute-onset Neuropsychiatric Syndrome
Newby, M. J., Lane, S. J., Haracz, K., Tona, J., Palazzi, K., & Lambkin, D. (2024). Sensory processing in children with Paediatric Acute-onset Neuropsychiatric Syndrome. Australian Occupational Therapy Journal, 1–11. https://doi.org/10.1111/1440-1630.12935
Conclusion:
  • Children with PANS experience significant sensory reactivity differences during exacerbation and remission across multiple sensory domains, with a decline in performance during exacerbation.
  • Where occupational performance challenges exist, occupational therapists should consider administering sensory assessments so that effective intervention plans can be developed to address the unique sensory reactivity needs of children with PANS.
Baseline characteristics of children in the International PANS Registry (IPR) Epidemiology Study
Masterson EE, Gavin JM. Baseline characteristics of children in the International PANS Registry (IPR) Epidemiology Study. BMJ Open. 2024 Jan 24;14(1):e072743. doi: 10.1136/bmjopen-2023-072743. PMID: 38267248; PMCID: PMC10824037.
  • Participants & Household Composition: 1,781 individuals (1,179 cases, 602 siblings) from 1,010 households; 39% include a sibling, and 20% have multiple cases.
  • Enrollment Age: Mean age was 11.3 years for cases and 10.1 years for siblings.
  • PANS-like Features: Anxiety (94%), emotional lability (92%), and obsessions (90%) were the most common symptoms.
  • Onset Patterns: 95% had a sudden or dramatic onset, either initially or following gradual progression; early signs began around age 4, with dramatic increases around age 7.
  • Symptom Triggers & Treatment: Infection/illness triggered symptoms in 84% of cases; 88% were treated with antibiotics and 79% with NSAIDs.
  • Immune-related Conditions: Reported in 18% of cases and 48% of nuclear, biological families, with 39% in biological mothers.
Case report: Diagnosis and intervention of a non-24-h sleep–wake disorder in a sighted child with a psychiatric disorder

Carla Estivill-Domènech, Carla Estivill-Domènech. Case report: Diagnosis and intervention of a non-24-h sleep–wake disorder in a sighted child with a psychiatric disorder. Front. Psychiatry, 05 January 2024. Sec. Sleep Disorders. Volume 14 – 2023 | https://doi.org/10.3389/fpsyt.2023.1129153

Overview:

  • Circadian Rhythm Sleep-Wake Disorders (CRSWD) are sleep issues linked to circadian function. These disorders cause insomnia or excessive sleepiness due to the circadian pacemaker not aligning with a 24-hour light/dark cycle. Free-running disorder or Hypernycthemeral Syndrome (N24SWD) leads to a prolonged sleep-wake cycle, often seen in blind individuals. N24SWD is rare among those with healthy vision but affects 70% of blind individuals. In sighted cases, it mostly occurs in young men (80%), with 28% having a psychiatric disorder.

Specific Case:

  • The patient, a 14-year-old boy with psychiatric pathology and PANDAS syndrome, experienced sudden intense anxiety, mood swings, and obsessive-compulsive-like issues associated with a streptococcal A infection. He also had a non-24-hour sleep-wake disorder (N24SWD), leading to severe insomnia and irregular sleep patterns.
  • The patient’s irregular sleep pattern worsened daily routines, including school attendance, and exacerbated psychiatric symptoms.
  • The association of PANDAS and N24SWD in the same case is unique and not previously reported in the literature.

Treatment:

  • The initial treatment focused on acute infection and psychiatric symptoms.
  • Sleep pathology was addressed with light therapy and melatonin.
  • After 8 months of various trials, a treatment plan normalized symptoms, established a regular sleep pattern, and reduced daytime anxious symptoms
    Tafenoquine-Atovaquone Combination Achieves Radical Cure and Confers Sterile Immunity in Experimental Models of Human Babesiosis

    Pratap Vydyam, Anasuya C Pal, Isaline Renard, Meenal Chand, Vandana Kumari, Joseph C Gennaro, Choukri Ben Mamoun, Tafenoquine-Atovaquone Combination Achieves Radical Cure and Confers Sterile Immunity in Experimental Models of Human Babesiosis, The Journal of Infectious Diseases, 2024;, jiad315, https://doi.org/10.1093/infdis/jiad315

    • The 8-aminoquinoline antimalarial drug tafenoquine inhibits the growth of different Babesia species in vitro, is highly effective against Babesia microti and Babesia duncani in mice and protects animals from lethal infection caused by atovaquone-sensitive and -resistant B. duncani strains.
    • A combination of tafenoquine and atovaquone achieves cure with no recrudescence in both models of human babesiosis.
    • The elimination of B. duncani infection in animals following drug treatment also confers immunity to subsequent challenge.
    • The data demonstrate superior efficacy of tafenoquine plus atovaquone combination over current therapies for the treatment of human babesiosis and highlight its potential in providing protective immunity against Babesia following parasite clearance.