Pediatric long COVID and Myalgic Encephalomyelitis/ Chronic Fatigue
Syndrome: overlaps and 0pportunities, by Vikram GR Siberry MS and Peter C Rowe MD in The Pediatric Infectious Disease Journal: February 4, 2022 [doi:10.1097/INF.0000000000003477]
Extracts from Commentary:
Zimmermann et al provide a masterful application of Spodick’s exhortation. Their review of the existing evidence regarding long COVID in children enumerates important methodologic challenges in interpreting this literature… Despite such limitations, it is clear that pediatric patients are at risk for prolonged symptoms following acute SARS-CoV-2 infection.
Although many persistent symptoms, such as anosmia, dysgeusia and shortness of breath are unique to the post-COVID state, many other symptoms such as fatigue, cognitive dysfunction, lightheadedness and postexertional malaise overlap with symptoms found in myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS).
In this commentary, we review case definitions for long COVID and ME/CFS, emphasize recent research findings on the biologic basis of ME/CFS, discuss the overlap with long COVID, and consider opportunities posed by the pandemic to improve the understanding of both conditions.
Overlaps between Long COVID and ME/CFS
The overlap of symptoms between long COVID and ME/CFS is substantial and includes fatigue, postexertional malaise, cognitive impairment, sleep disturbance and lightheadedness. Both conditions are more frequent in females than males. Neither condition can be reliably diagnosed with laboratory findings, although such testing
can help exclude other similar conditions.
Diagnosis for both consists of a thorough history to elicit symptoms along with a full physical exam; to identify orthostatic intolerance, we recommend at least a 10-minute period of orthostatic stress, such as with a passive standing test. Treatment focuses on symptom management.
While no single pharmacologic agent is effective for all long COVID or ME/CFS patients, this should not encourage therapeutic nihilism, as many effective treatments exist for the common features such as orthostatic intolerance, pain, headaches and insomnia.
More work will be needed to identify whether the prevalence of orthostatic intolerance is as high in long COVID as it is in ME/CFS, and whether the risk factors for pediatric ME/CFS (including allergic inflammation, female sex, peak onset in adolescence and heritable risk factors such as joint hypermobility) apply to post-COVID conditions.
