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COVID19

• Initial Decline: Pediatric infections dropped during COVID-19 due to safety measures.
• Post-Pandemic Surge: Infections rebounded as restrictions eased, with changes in severity, strains, and affected age groups.
• Key Cause: Immunity debt from reduced exposure, not new variants or resistance.
• Impact: Unusual symptoms emerged, offering new insights into disease spread and progression.

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 

“As the first treatment option in suspicion of PANS, proper psychotropic treatments and antibiotic agents (amoxicillin-clavulanate, 2 gr/day, for 21 days) were administered to both sisters. The more affected sibling was treated with fluoxetine (40 mg/day), risperidone (1 mg/day), and sodium valproate (20 mg/kg/day) while the less affected sibling with milder symptoms was treated with sertraline (50 mg/day). After one month following these treatment options, IVIG transfusion was required, because of mildly decreased, however, severely continuing psychiatric and somatic complaints. Surprisingly, the somatic complaints, restrictive food intake, OCD symptoms, severe anxiety with hallucinations, depression, and even mild neurologic symptoms were significantly decreased 1 week after the IVIG transfusion; and the patients had weight gain.”

Jyonouchi, H.; Geng, L.; Rossignol, D.A.; Frye, R.E. Long.COVID Syndrome Presenting as Neuropsychiatric Exacerbations in Autism Spectrum Disorder: Insights for Treatment. J. Pers. Med. 2022, 12,1815. https://doi.org/10.3390/jpm12111815

Neurological and neuropsychiatric symptoms are emerging as major long-term sequalae. In patients with pre-existing behavioral symptoms, such as individuals with autism spectrum disorders (ASD), the emergence of neuropsychiatric symptoms due to long COVID can be difficult to diagnose and manage. Herein, we present three ASD cases who presented with markedly worsening neuropsychiatric symptoms following COVID-19 exposure and subsequent difficulty in managing the post-COVID neuropsychiatric symptoms.

Szewczyk-Dąbrowska, A., Budziar, W., Harhala, M. et al. Correlation between COVID-19 severity and previous exposure of patients to Borrelia spp.. Sci Rep 12, 15944 (2022). https://doi.org/10.1038/s41598-022-20202-x

Also, read Medical News Today article.

V Nezgovorova, CJ Ferretti, S Pallanti, E Hollander. Modulating neuroinflammation in COVID-19 patients with obsessive-compulsive disorder. Journal of Psychiatric Research, 2021, DOI: 10.1016/j.jpsychires.2021.11.025.

Abstract: Exacerbation of symptoms of obsessive-compulsive disorder (OCD) during COVID-19 or new onset of the OCD symptoms resulting from COVID-19 infection is an understudied area of research. It is possible that increased proinflammatory immune status is associated with the onset of obsessive-compulsive symptoms in patients with COVID-19 and that targeted anti-inflammatory treatments for COVID-19 infection can mitigate the new onset of Obsessive-Compulsive (OC) spectrum symptoms. In this review, we cover OCD pathogenesis as related to COVID-19, summarize the impact of cytokines on behavior, and suggest that anti-cytokine treatments can help mitigate post-COVID-19 and new onset of the OC symptoms.

Sabine Hazan, MD, Sheldon Jordan, MD. SARS-CoV-2 as a Trigger in the Development of Tourette’s-Like Symptoms: A Case Report, 15 November 2021, PREPRINT (Version 1) available at Research Square DOI: 10.21203/rs.3.rs-1079406/v1  This case study has not been peer-reviewed.

• Case report describe Tourette’s-like symptoms resulting from SARS-CoV-2 disrupting gut microbiota
• SARS-CoV-2 could cause significant havoc in the enteric flora, damaging intestinal barrier, disrupting communication along the GMBA, imparing immune function, leading to neuropsychiatric symptoms
• Several possible therapeutic approaches change the microbiome including prebiotics, postbiotics, synbiotics, and fecal transplantation
• Using these therapies to modulate bacterial composition and enhance microbiota diversity is a pragmatic approach for enhanced protection against the acute morbidities associated with viral illnesses including COVID-19.

Piero Pavone, Manuela Ceccarelli, Silvia Marino, Daniela Caruso, Raffaele Falsaperla, Massimiliano Berretta, et al. Lancet Child Adolesc Health. 2021 . May 04, 2021 DOI:10.1016/S2352-4642(21)00135-8

“Post-infectious, autoimmune, and neuro-inflammatory events are the main mechanisms of Paediatric Acute-onset Neuropsychiatric Syndrome (PANS).4 PANS presents with a sudden onset of obsessive-compulsive disorder (OCD) or a severely restricted food intake, and concurrent neuropsychiatric symptoms and motor dysfunction.4 The estimated prevalence of OCD in childhood and adolescence is 0·25–4·00%, with those aged between 16–18 years (1%) having the highest prevalence.5, 6, 7 Here, we report on two unrelated children with PANS that started 2 weeks after a positive COVID-19 nasopharyngeal swab.”

• Two young adolescents Diagnosed with COVID-19 by a nasal swab
• PANS started 2 weeks after COVID-19 diagnosis
• Had acute new OCD, neuropsychiatric, and motor dysfunction symptoms
• SARS-CoV-2 needs to be acknowledged in the differential diagnosis of PANS

Full Study