Somatosensory abnormalities after infection with SARS-CoV-2 – A prospective case-control study in children and adolescents

Abstract

BackgroundLong-term neurological complaints after SARS-CoV-2 infection occur in 4–66% of children and adolescents. Controlled studies on the integrity of the peripheral nerve system are scarce. Therefore, we examined the somatosensory function in children and adolescents after SARS-CoV-2 infection in a case-control study compared with age-matched individuals.Materials and MethodsEighty-one subjects after SARS-CoV-2 infection (n = 44 female, 11.4 ± 3.5 years, n = 75 SARS-CoV-2 seropositive, n = 6 PCR positive during infection and SARS-CoV-2 seronegative at the time point of study inclusion, n = 47 asymptomatic infection) were compared to 38 controls without SARS-CoV-2 infection (26 female, 10.3 ± 3.4 years, n = 15 with other infection within last 6 months). After standardised interviews and neurological examinations, large fibre (tactile and vibration detection thresholds) and small fibre (cold and warm detection thresholds, paradoxical heat sensation) functions were assessed on both feet following a validated protocol. After z-transformation of all values, all participants were compared to published reference values regarding the number of abnormal results. Additionally, the mean for all sensory parameters values of both study groups were compared to an ideal healthy population (with z-value 0 ± 1), as well as with each other, as previously described. Statistical analyses: t-test, Chi-squared test, and binominal test.FindingsNone of the controls, but 27 of the 81 patients (33%, p < 0.001) reported persistent complaints 2.7 ± 1.9 (0.8–8.5) months after SARS-CoV-2 infection, most often reduced exercise capacity (16%), fatigue (13%), pain (9%), or paraesthesia (6%). Reflex deficits or paresis were missing, but somatosensory profiles showed significantly increased detection thresholds for thermal (especially warm) and vibration stimuli compared to controls. Approximately 36% of the patients after SARS-CoV-2, but none of the controls revealed an abnormal sensory loss in at least one parameter (p < 0.01). Sensory loss was characterised in 26% by large and 12% by small fibre dysfunction, the latter appearing more frequently in children with prior symptomatic SARS-CoV-2 infection. Myalgia/paraesthesia was indicative of somatosensory dysfunction. In all eight re-examined children, the nerve function recovered after 2–4 months.InterpretationThis study provides evidence that in a subgroup of children and adolescents previously infected with SARS-CoV-2, regardless of their complaints, the function of large or small nerve fibres is presumably reversibly impaired.

Musculoskeletal system symptoms in patients with COVID-19 and the impact of these symptoms on quality of life

“…The prevalence of neuropathic pain in patients with COVID-19 infection reported in the literature varies between 0.4% and 25% [14,29,30,35,36], whereas the prevalence of paresthesia varies between 6% and 33% [15,37]. Miller et al [36] detected peripheral nerve injury in the upper extremity in 15 of the 114 COVID-19 patients hospitalized in the prone position and treated in the intensive care unit for an average of 32.5 days.…”

Subclinical finding in the perception of tactile sensation involvement after SARS-CoV2 infection: comparison with healthy controls using Semmes–Weinstein monofilament testing

“…Moreover, the sensory symptoms attributed to the PACS seem unrelated to the gravity of the previous infection (7). Interestingly, a recent case-control study on children and adolescents with previous SARS-CoV2 infection reported increased thermal and vibration thresholds; the mechanical detection threshold with SWMT did not differ from the control group, but there was a significant difference within the SARS-CoV2 group when the patients with previous symptomatic infection and those with asymptomatic infection were compared (10). These studies highlight the involvement of small-diameter sensory fibers (C-fibers and A-delta fibers) due to SARS-CoV2 infection; moreover, the involvement of large sensory fibers was evident only when they compared the patients with previous symptomatic SARS-CoV2 infection to those who had The SPG was in the normality range in every subject.…”

Long COVID in children and adolescents: prevalence, clinical manifestations, and management strategies

“…A. Neurological symptoms Fatigue (tiredness) 0.7-71.1 Borch 42), † , Stephenson 35), † , Sterky 41) , Ashkenazi-Hoffnung 18) , Brackel 19) , Say 8) , Roge 39) , Buonsenso 9) , Molteni 25) , Osmanov 27) , Radtke 22) , Katsuta 32) , Eitner 73) , Petersen 75) Headache 6.9-80 Brackel 19) , Molteni 25) , Smane 26) , Borch 42), † , Stephenson 35), † , Roge 39) , Kikkenborg 15), † , Ashkenazi-Hoffnung 18) Confusion 5.6-6.5 Zavala 43), † , Stephenson 35), † Dizziness 3-8.9 Borch 42), † , Stephenson 35), † , Brackel 19) , Kikkenborg 15), † , Ashkenazi-Hoffnung 18) Memory loss 13-17.8 Brackel 19) , Ashkenazi-Hoffnung 18) Brain fog 2 Brackel 19) B. Neurosensory symptoms Anosmia (loss of smell) 1.1-84 Borch 42), † , Stephenson 35), † , Sterky 41) , Molteni 25) , Smane 26) , Zavala 43), † , Katsuta 32) , Petersen 75) , Ashkenazi-Hoffnung 18) Ageusia (loss of taste) 1.0-16.7 Borch 42), † , Sterky 41) , Ashkenazi-Hoffnung 18) , Smane 26) , Katsuta 32) , Petersen 75) Eye pain 2.8-5.9…”