Severe Course of COVID-19 and Long-COVID-19 in Children: Difficulties in Diagnosis

Abstract

The question of COVID-19 and long-COVID-19 course in children remains unsolved. This infection in children, which is associated with COVID-19, can vary from asymptomatic to systemic damage of various systems. Multisystem inflammatory syndrome in children, associated with SARS-CoV-2 (MIS-C), is a serious condition in children and adolescents after experiencing COVID-19. Published data on MIS-C have indicated that the inflammation can be registered in the gastrointestinal tract (60–100%), as well as in cardiovascular (80%), nervous (29–58%), and respiratory (21–65%) systems. However, with the changing characteristics of SARS-CoV-2, the manifestations of COVID-19 and long-COVID-19 in children have also been changing. Currently, there is no clear understanding of the development of severe COVID-19 and MIS-C in children, especially after being exposed to patients with COVID-19. We presented two new clinical courses of multisystem inflammatory syndrome in children with severe multisystem damage after close contact to relatives with COVID-19 or long-COVID-19. Thus, high-risk children, who are positive for SARS-CoV-2 infection after contact with COVID-19 patients, should be clinically managed during the first few months. The identification of the disease complexity requires the involvement of neurologists, cardiologists, and other specialists.

Morphological Changes in the Myocardium of Patients with Post-Acute Coronavirus Syndrome: A Study of Endomyocardial Biopsies

“…In our previous study, we showed that the expression levels of these markers increase in the acute phase of coronavirus infection [ 28 ]. This is consistent with the literature data that myocardial damage in the acute phase of the coronavirus infection is due to systemic manifestations of cytokine storm and generalized angiopathy [ 19 , 29 , 30 , 31 ]. Moreover, a hypothesis that PASC is only associated with the recovery from the angiopathy consequences is supported by the fact that in some patients, cardiac manifestations of PASC disappear spontaneously.…”

Relação entre sintomas gastrointestinais e infecção por COVID-19 na população pediátrica: revisão de escopo

“…Crianças de 4 a 6 anos. Retrospectivo, observacional descritivo e analítico Vasichkin et al (44) Relatar casos clínicos que demonstram dificuldades no diagnóstico de distúrbios poliorgânicos em crianças infectadas pelo SARS-CoV-2 em diferentes períodos da doença.…”

“…Vasichkina et al (44) Diminuição do apetite (100%), dor abdominal (100%), fezes semilíquidas (100%).…”

“…Desse modo, faz-se necessária atenção especial aos pacientes que exibem sintomas gastrointestinais e possuem história de exposição ou infecção por SARS-CoV-2, pois os dados sugerem que o contato com o vírus desencadeia a SIM-P, e os sintomas gastrointestinais se apresentam como sinais desta condição (44) .…”

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

“…Currently, it is still not possible to explain how severe COVID-19 and MIS-C occur, especially in children who have come into contact with people with COVID-19. Therefore, for high-risk children and adolescents who become positive for SARS-CoV-2 following contact with patients with COVID-19, appropriate multidisciplinary management measures for several months are required [ 32 , 64 , 65 , 66 ].…”