Child after COVID - no longer just PIMS, now also PASC

To date, the only known consequence of Covid-19 infection in children has been PIMS, an acute and potentially dangerous generalized inflammatory syndrome caused by immune dysregulation that can lead to cardiac complications. Symptoms in the form of primarily high fever, signs of damage to at least two organs or systems, and high laboratory exponents of inflammation occurred about 4 weeks after symptomatic or asymptomatic infection in children averaging 8-9 years of age, primarily in boys.

The use of effective treatment allowed rapid recovery in most patients, although about 10% required hospitalization in an intensive care unit.

Today, in the context of Covid-19 in children and more often talked about long-covid, it is also a very serious and diagnostically difficult problem. According to data both in the U.S. and conducted in European countries, long-covid can affect from 4-5% to as much as 30% of children about 4-12 weeks after infection, and is more common in girls aged 12-16.

As early as March 2022, guidelines for the course and treatment ofpost-acute sequelae of SARS-CoV-2 infection ( PASC ) in children were published in the United States. However, the definition of PASC and the duration of clinical symptoms are not specified. The most common symptoms in children are systemic - fatigue, insomnia, on the part of the nervous system - headaches and dizziness, cognitive symptoms in the form of difficulty in concentration, memory disorders , worse school performance. In addition, there may be symptoms from the respiratory system (shortness of breath, coughing) or cardiovascular system (chest pain, exercise intolerance, palpitations require specialist consultation.

Due to the heterogeneity of clinical manifestations and the fact that infection cannot always be confirmed, extensive differential diagnosis is necessary to exclude organic causes. It is useful to know the warning signs of so-called red flags such as febrile states, weight loss, developmental regression, headaches in the morning, chronic cough, arthritis or enlargement of the liver and spleen.

Another issue is the sudden increase in cases of acute hepatitis of unknown etiology in young children, primarily in the UK in the first half of 2022.

It is believed that liver damage may have occurred due to an abnormal immune response. Children were also analyzed for the course of Covid-19 infection. The study showed that in 60% of children under 5 years of age the onset of the disease was preceded by Covid-19 infection within 8 weeks. However, to date, the link to Covid -19 infection has not been proven.

The text is based on a conversation with Prof. Urszula Grzybowska-Chlebowczyk, MD, head of the Department of Pediatrics, Department of Pediatrics, Faculty of Medicine, Katowice, Silesian Medical University, a specialist in pediatrics, gastroenterology and pediatric gastroenterology.

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