Long-term outcomes of pediatric infections: from traditional infectious diseases to long Covid

Abstract

There is limited evidence available on the long-term impact of SARS-CoV-2 infection in children. In this article, the authors analyze the recent evidence on pediatric long Covid and lessons learnt from a pediatric post-Covid unit in Rome, Italy. To gain a better understanding of the concerns raised by parents and physicians in relation to the potential long-term consequences of this novel infection, it is important to recognize that long-term effect of a post-infectious disease is not a new phenomenon.

Keywords: COVID-19; SARS-CoV-2; children; long Covid; microclots; post-COVID-19 condition; viral persistence.

Figure 1.. Possible outcomes of SARS-CoV-2 infection.

While most children recover from acute infection (which is usually mild or asymptomatic), it is well established that some can rarely develop the multisystem inflammatory syndrome (MIS-C), or subacute sequelae (e.g., the neuropsychiatric symptoms). However, there is a subgroup of patients that apparently recover from initial infection but present a subtle clinical presentation. These children which have symptoms that impact on their return to usual activities, and usually having other signs and symptoms, are those that might better fit the diagnosis of long covid (or post-covid condition).

Figure 2.. Main cluster of clinical presentation of children with long covid (personal experience).

PEM: Post-exertional malaise.

Figure 3.. The Gemelli Hospital pediatric post-covid follow-up.

EEG: Electroencephalogram. Adapted from Buonsenso et al. [82].

Figure 4.. Possible mechanisms behind long covid.

Organ damage due to severe acute disease can result in loss of function, which can explain chronic symptoms. Other patients, however, may have symptoms due to other less-recognized events, such as chronic inflammation, viral persistence, auto-immunity. These two main groups, however, can overlap in each patient. In general, it is possible to speculate that younger patients most probably belong to group 2, as they usually have less severe disease.

Figure 5.. Implications of counting long covid as a possible outcome of SARS-CoV-2 infection on the risk/benefits assessment of preventive strategies.