Inflammatory markers and pulmonary function in adolescents and young adults 6 months after mild COVID-19

Abstract

IntroductionBoth public and scientific attention have shifted from the acute COVID-19 illness to the chronic disability experienced by a proportion of COVID-19 convalescents. Post COVID-19 condition, a term used for long-lasting symptoms after COVID-19, can affect individuals across all disease severity and age groups. Data on post-COVID-19 symptomatology, epidemiology and pathophysiology in adolescents and young adults are scarce. To date, little is known on the immunological and pulmonary trends in these patients after COVID-19. This study investigated immunological markers and pulmonary function in non-hospitalized patients in this group at 6 months after initial mild COVID-19 infection.MethodsNon-hospitalized SARS-CoV-2 positive (n = 405) and SARS-CoV-2 negative (n = 111) adolescents and young adults (aged 12-25 years) were followed prospectively for six months after SARS-CoV-2 PCR testing. At baseline and at six months follow-up, all participants underwent an assessment including clinical examination, questionnaires, spirometry, and blood sampling. Cross-sectional comparisons of blood biomarkers; including white blood cell counts, CRP, GDF-15, a 27-multiplex cytokine assay, complement activation products and SARS-CoV-2 antibodies; and spirometry measures were performed after classification of all participants according to their COVID-19 status and adherence to post-COVID-19 case criteria. Associations between biomarkers and COVID-19 symptoms were explored.ResultsNo difference in pulmonary function was detected between the groups. COVID-19 convalescents had higher levels of chemokines eotaxin, MCP-1 and IP-10 than non-infected controls. The increase was modest and not associated with long-lasting COVID-19 symptoms.DiscussionElevated inflammatory mediators were found in adolescents and young adults six months after mild COVID-19, but there was no association with post-COVID-19 condition.

Bulk RNA sequencing for analysis of post COVID-19 condition in adolescents and young adults

“…However, upregulation of these transcripts at six months after the initial SARS-CoV-2 infection points to aberrant activation of antiviral innate immunity and interferon induction possibly due to a chronic SARS-CoV-2 infection or a sustained inflammatory response after clearance of the virus. In fact, low-grade inflammation in SARS-CoV-2 infected participants was previously reported in our study cohort, although no link with PCC could be established [ 20 ]. Evidence for viral persistence or insufficient clearance of viral remnants after SARS-CoV-2 infection has been hypothesized in studies showing ongoing evolution of specific immunity [ 12 , 13 , 55 ], elevated anti-viral immunity [ 11 ] and persistent viral antigen presence [ 14 , 56 – 58 ].…”

“…Blood samples were obtained from 80 participants enrolled in the Long-Term Effects of COVID-19 in Adolescents and Young Adults (LoTECA) study, a prospective, observational cohort study of non-hospitalized adolescents and young adults testing positive and negative for SARS-CoV-2 (ClinicalTrials.gov identifier: NCT04686734). A detailed recruitment procedure and selected data have been reported elsewhere [ 17 – 20 ]. All participants underwent a one-day investigational program at our study center (Akershus University Hospital, Norway) at inclusion and at 6-month follow-up.…”

“…The assessment included a standardized medical assessment, symptom surveys, biological sampling, and function testing. In this paper, results from a composite questionnaire containing validated inventories including the Chalder Fatigue Questionnaire[ 21 ], the De Paul Symptom Questionnaire [ 22 ], the Pediatric Quality of life Inventory (PedsQL) [ 23 ], the Hospital Anxiety and Depression Scale [ 24 ] and a modified COVID-19 symptom inventory [ 25 ] were used to chart fatigue, post-exertional malaise, quality of life, depression/anxiety symptoms and infectious/respiratory/cognitive symptoms respectively [ 19 , 20 ].…”

Neurological involvement among non-hospitalized adolescents and young adults 6 months after acute COVID-19

“…This argue against the notion of neuroinflammation as an explanation for the persisting symptoms. In a previous publication ( 58 ), we reported a distinct immune signature associated with COVID-19 at 6-month follow-up. However, this did not appear to be connected to PCC symptomatology.…”

Post-acute sequelae of SARS-CoV-2 infection in health care workers from South Africa

“…Although PASC is being increasingly reported in the global north, there remains limited data emerging from low and middle-income countries. A mounting body of evidence has underscored the prominence of PASC cases since the early stages of the Covid-19 pandemic [ 2 , 3 ]. In South Africa, the declaration of a National State of Disaster was implemented in March 2020 [ 4 ].…”