Long-Term COVID 19 Sequelae in Adolescents: the Overlap with Orthostatic Intolerance and ME/CFS

Amanda K Morrow; Laura A Malone; Christina Kokorelis; Lindsay S Petracek; Ella F Eastin; Katie L Lobner; Luise Neuendorff; Peter C Rowe

doi:10.1007/s40124-022-00261-4

Long-Term COVID 19 Sequelae in Adolescents: the Overlap with Orthostatic Intolerance and ME/CFS

Curr Pediatr Rep. 2022;10(2):31-44. doi: 10.1007/s40124-022-00261-4. Epub 2022 Mar 9.

Authors

Amanda K Morrow^{1

2}, Laura A Malone^{1

2

3}, Christina Kokorelis^{1

2}, Lindsay S Petracek⁴, Ella F Eastin⁴, Katie L Lobner⁵, Luise Neuendorff⁶, Peter C Rowe⁴

Affiliations

¹ Kennedy Krieger Institute, Baltimore, MD USA.
² Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD USA.
³ Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD USA.
⁴ Department of Pediatrics, Division of Adolescent/Young Adult Medicine, Johns Hopkins University School of Medicine, 200 N Wolfe St, Room 2077, Baltimore, MD USA.
⁵ Welch Medical Library, Baltimore, USA.
⁶ Division of Cardiology, Department of Internal Medicine, University of Toronto, Toronto, Canada.

Abstract

Purpose of review: To discuss emerging understandings of adolescent long COVID or post-COVID-19 conditions, including proposed clinical definitions, common symptoms, epidemiology, overlaps with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and orthostatic intolerance, and preliminary guidance on management.

Recent findings: The recent World Health Organization clinical case definition of post-COVID-19 condition requires a history of probable or confirmed SARS-CoV-2 infection, with symptoms starting within 3 months of the onset of COVID-19. Symptoms must last for at least 2 months and cannot be explained by an alternative diagnosis. Common symptoms of the post-COVID-19 condition include, but are not limited to, fatigue, shortness of breath, and cognitive dysfunction. These symptoms generally have an impact on everyday functioning. The incidence of prolonged symptoms following SARS-CoV-2 infection has proven challenging to define, but it is now clear that those with relatively mild initial infections, without severe initial respiratory disease or end-organ injury, can still develop chronic impairments, with symptoms that overlap with conditions like ME/CFS (profound fatigue, unrefreshing sleep, post-exertional malaise, cognitive dysfunction, and orthostatic intolerance).

Summary: We do not yet have a clear understanding of the mechanisms by which individuals develop post-COVID-19 conditions. There may be several distinct types of long COVID that require different treatments. At this point, there is no single pharmacologic agent to effectively treat all symptoms. Because some presentations of post-COVID-19 conditions mimic disorders such as ME/CFS, treatment guidelines for this and related conditions can be helpful for managing post-COVID-19 symptoms.

Supplementary information: The online version contains supplementary material available at 10.1007/s40124-022-00261-4.

Keywords: Adolescent; Chronic fatigue syndrome; Long COVID; Myalgic encephalomyelitis; Orthostatic intolerance; Post-COVID-19 condition.

Publication types

Review