POSTCOVID SYNDROME IN CHILDREN. DOES IT HAVE A PLACE TO BE?

Full Text

RELEVANCE
The new coronavirus infection, known since 2019, still frightens the world not only with its contagiousness, but also with the frequency and severity of complications. Since the beginning of the pandemic, it was believed that children do not actually become infected with a coronavirus infection - their immunity immediately reacts to the virus and neutralizes it, blocking all ways of its reproduction in the body 1]. However, in 2021, the first cases of infection with a new “British” strain of COVID-19 were recorded in Russia [2, 3]. This juvenile SARS-CoV-2 strain was found to be more contagious than its predecessor. Given a number of studies, a new strain of coronavirus infection is most often noted among children under the age of 15 years [2, 4]. After suffering a coronavirus infection caused by the British strain of SARS-COV-2, the phenomena of post-covid syndrome (PCS) can be traced. It is worth paying special attention to the fact that COVID-19 can damage the most important cells of the brain and central nervous system — astrocytes and microglia [5, 6]. Neuronal damage is also possible, which contributes to the occurrence of long-term neurological consequences even after the leading symptoms have disappeared [7].
Basically, peripheral neuropathy occurs. Its leading manifestations are:
violations of smell and taste, various symptoms of polyneuropathy are possible, manifested by loss of sensitivity in the arms, legs and face.
At the same time, the majority of patients may show such symptoms as: headache, fatigue, decreased performance, memory problems [7, 8].
The proportion of children in the structure of the incidence of COVID-19 fluctuates within 1.7%. 90% of them carry this infection asymptomatically in mild or moderate forms. However, in some patients under 18 years of age, a hyperinflammatory reaction and multiple organ damage occur against the background of a coronavirus infection. This phenomenon has been called "childhood multisystem inflammatory syndrome" [8].
PURPOSE
To study the follow-up of children who have had COVID-19.
MATERIALS AND METHODS
The study was conducted in 50 children from 7 to 17 years old who had COVID-19 in the period with the highest incidence, on the basis of the VGKP No. 1, children's clinic No. 2. The outpatient cards of children were studied, a survey of children or their legal representatives was conducted in order to assess the severity of the condition of children during the illness, the presence of supporting symptoms, as well as pathological phenomena during the convalescence period.
All children, a month after the illness (with an error of 5-7 days), were examined in a children's clinic by a district pediatrician, neurologist, and other narrow specialists (depending on complaints) and sent for additional laboratory and instrumental examination (complete blood count, biochemical analysis blood, urinalysis, ECG).
RESULTS
The study revealed that 34 children (68%) had a mild form of a new coronavirus infection, 16 children (32%) had a moderate form. Olfactory disorders during illness in the form of anosmia or parosmia were noted in 14 children, mostly boys (71%), aged 13 ± 3.6 years.
19 children (and/or their legal representatives) agreed to participate in an additional study 1 month after the illness. There were no specific changes in general blood and urine tests, as well as biochemical blood tests.
All children were consulted by a neurologist, 8 out of 19 children were found to have neurological disorders. Four boys aged 13.5±3.5 years were diagnosed with parosmia, two girls aged 16±1 years were diagnosed with tension headache, two girls aged 13±1 years were diagnosed with neurocirculatory disorders against the background of ACS (including newly diagnosed migraine-like headaches - in one child). There was no statistically significant difference in the frequency of neurological changes after COVID-19 depending on the severity of the course of the disease itself.
Acquired cardiac disorders according to the ECG study were not identified.
DISCUSSION
The study showed that there are changes in the nervous system, but in different manifestations, in girls more often - neurocirculatory disorders against the background of PCD, as well as tension headache, and in boys there were prolonged disturbances of smell in the form of parosmia. Conducted laboratory and instrumental studies were not informative.
The advantage of this work is that it was possible to trace the occurrence of neurological disorders in this group of children, therefore, to send them under the supervision of a neurologist in time, and also to receive treatment and, possibly, prevent the occurrence of more severe disorders, as well as to control the general condition of the body through laboratory tests. The disadvantages include errors and ambiguities in the collection of anamnesis, lack of time and opportunity for additional examination methods.
CONCLUSION
In the course of the study, cases of a new coronavirus infection were studied in 50 children, in 19 children, follow-up was studied (after a month ± 5-7 days after the infection). CNS disturbances were revealed in the form, mainly, of parosmia in boys and neurocirculatory disorders against the background of PCS in girls. Unresolved aspects are the identification of various types of disorders after the transfer of COVID-19 in a wider range of children who have been ill, the opportunity to receive an extended examination, in particular, of the cardiovascular system on an outpatient basis. Of course, the results obtained in the course of scientific work did not give a completely complete, but relatively clear idea that there are neurological changes after a coronavirus infection in children (42.1%), and the manifestations are different depending on gender.
In conclusion, we can conclude that all children who have recovered from COVID-19 need dispensary observation to assess their condition and dynamically monitor the level of health and, if necessary, to carry out therapeutic, preventive and rehabilitation measures in the presence of PCS.

About the authors

Svetlana Kameneva

Author for correspondence.
Email: svetlanka_kameneva@inbox.ru
ORCID iD: 0000-0001-8047-2339
SPIN-code: 1111-1111
Russian Federation

References