High Prevalence of Alternative Diagnoses in Children and Adolescents with Suspected Long COVID—A Single Center Cohort Study

Abstract

Background: Long COVID (LC) is a diagnosis that requires exclusion of alternative somatic and mental diseases. The aim of this study was to examine the prevalence of differential diagnoses in suspected pediatric LC patients and assess whether adult LC symptom clusters are applicable to pediatric patients. Materials and Methods: Pediatric presentations at the Pediatric Infectious Diseases Department of the University Hospital Essen (Germany) were assessed retrospectively. The correlation of initial symptoms and final diagnoses (LC versus other diseases or unclarified) was assessed. The sensitivity, specificity, negative and positive predictive values of adult LC symptom clusters were calculated. Results: Of 110 patients, 32 (29%) suffered from LC, 52 (47%) were diagnosed with alternative somatic/mental diseases, and 26 (23%) remained unclarified. Combined neurological and respiratory clusters displayed a sensitivity of 0.97 (95% CI 0.91–1.00) and a negative predictive value of 0.97 (0.92–1.00) for LC. Discussion/Conclusions: The prevalence of alternative somatic and mental diseases in pediatric patients with suspected LC is high. The range of underlying diseases is wide, including chronic and potentially life-threatening conditions. Neurological and respiratory symptom clusters may help to identify patients that are unlikely to be suffering from LC.

Long COVID in pediatrics—epidemiology, diagnosis, and management

“…No biomarker is available yet for the diagnosis of PASC which therefore has to be differentiated from other medical conditions that may elicit similar symptoms, including other PAIS. Of 110 pediatric patients with suspected PASC admitted to a specialized outpatient clinic, only 29% received a final PASC diagnosis while 47% were diagnosed with alternative somatic/mental diseases, and 23% with diagnosis unclarified [ 61 ]. Differential diagnoses include a broad variety of somatic (e.g., pulmonary, cardiovascular, neurological, rheumatic, oncological, gastrointestinal, and metabolic) and psychiatric (e.g., depression, anxiety, attention deficit (hyperactivity), somatization, conversion, and eating) disorders as well as mental distress due to social distancing or loss of relatives during the pandemic (“long-lockdown,” “post-pandemic-syndrome”).…”

Infection, Dysbiosis and Inflammation Interplay in the COVID Era in Children

“…The positive diagnosis of LC must be finalized only by excluding other entities and only after symptomatic treatment. The use of clinical criteria and LC clusters from adults would be beneficial in early detection of patients with a low probability of this disease [ 89 ].…”

COVID-19 Vaccine for Children: Determinants and Beliefs Contributing to Vaccination Decision of Parents in Germany 2021/2022

“…Children may transmit the infection to their (vulnerable) environment and may suffer long-term consequences [ 15 ]. Current components of COVID-19 studies in children are pediatric inflammatory multisystem syndrome, long COVID-19, and post COVID-19 syndromes [ 8 , 16 , 17 ]. Although these consequences are less frequent in children, COVID-19 vaccination uptake for children remains a controversial issue for both parents and authorities [ 8 ].…”