tetano
Editor, Senior Moderator
J Med Virol
. 2023 Jul;95(7):e28895.
doi: 10.1002/jmv.28895. Clinical characteristics of unvaccinated or incompletely vaccinated children with neurological manifestations due to SARS-CoV-2 Omicron infection
Winnie Wan-Yee Tso[SUP] 1 2 [/SUP], Mike Yat-Wah Kwan[SUP] 3 [/SUP], Janette Siu-Yin Kwok[SUP] 4 [/SUP], Jessica Oi-Ling Tsang[SUP] 5 6 [/SUP], Cyril Chik-Yan Yip[SUP] 5 [/SUP], Lok-Kan Leung[SUP] 1 [/SUP], Cuixin Li[SUP] 1 [/SUP], Yuliang Wang[SUP] 1 [/SUP], Mathew Siu-Chun Chow[SUP] 1 [/SUP], Anita Man-Ching Tsang[SUP] 1 [/SUP], Stella Chim[SUP] 1 [/SUP], Chin-Ying Chow[SUP] 1 [/SUP], Alvin Chi-Chung Ho[SUP] 1 [/SUP], Sophelia Hoi-Shan Chan[SUP] 1 [/SUP], Shuk-Mui Tai[SUP] 7 [/SUP], Wing-Cheong Lee[SUP] 7 [/SUP], Victor Chi-Man Chan[SUP] 7 [/SUP], Eric Kin-Cheong Yau[SUP] 3 [/SUP], Jacquelyne Ka-Li Sun[SUP] 8 [/SUP], Hei-Man Chow[SUP] 8 9 [/SUP], Yu-Lung Lau[SUP] 1 [/SUP], Patrick Ip[SUP] 1 [/SUP], Jasper Fuk-Woo Chan[SUP] 5 6 10 [/SUP]
Affiliations
Omicron generally causes milder disease than previous strains of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), especially in fully vaccinated individuals. However, incompletely vaccinated children may develop Omicron-related complications such as those affecting the central nervous system. To characterize the spectrum of clinical manifestations of neuro-COVID and to identify potential biomarkers associated with clinical outcomes, we recruited 15 children hospitalized for Omicron-related neurological manifestations in three hospitals in Hong Kong (9 boys and 6 girls aged 1-13 years). All were unvaccinated or incompletely vaccinated. Fourteen (93.3%) were admitted for convulsion, including benign febrile seizure (n = 7), complex febrile seizure (n = 2), seizure with fever (n = 3), and recurrent breakthrough seizure (n = 2), and the remaining nonconvulsive patient developed encephalopathic state with impaired consciousness. None of the seven children with benign febrile seizure and six of eight children with other neurological manifestations had residual deficits at 9-month follow-up. SARS-CoV-2 RNA was undetectable in the cerebrospinal fluid (CSF) specimens of seven patients who underwent lumbar puncture. Spike-and-wave/sharp waves affecting the frontal lobes were detected in four of seven (57.1%) patients who underwent electroencephalogram. Children with Omicron-related neurological manifestations had significantly higher blood levels of IL-6 (p < 0.001) and CHI3L1 (p = 0.022) than healthy controls, and higher CSF levels of IL-6 (p = 0.002) than children with non-COVID-19-related febrile illnesses. Higher CSF-to-blood ratios of IL-8 and CHI3L1 were associated with longer length of stay, whereas higher ratios of IL-6 and IL-8 were associated with higher blood tau level. The role of CSF:blood ratio of IL-6, IL-8, and CHI3L1 as prognostic markers for neuro-COVID should be further evaluated.
Keywords: COVID-19; Omicron; SARS-CoV-2; children; neurological; seizure.
. 2023 Jul;95(7):e28895.
doi: 10.1002/jmv.28895. Clinical characteristics of unvaccinated or incompletely vaccinated children with neurological manifestations due to SARS-CoV-2 Omicron infection
Winnie Wan-Yee Tso[SUP] 1 2 [/SUP], Mike Yat-Wah Kwan[SUP] 3 [/SUP], Janette Siu-Yin Kwok[SUP] 4 [/SUP], Jessica Oi-Ling Tsang[SUP] 5 6 [/SUP], Cyril Chik-Yan Yip[SUP] 5 [/SUP], Lok-Kan Leung[SUP] 1 [/SUP], Cuixin Li[SUP] 1 [/SUP], Yuliang Wang[SUP] 1 [/SUP], Mathew Siu-Chun Chow[SUP] 1 [/SUP], Anita Man-Ching Tsang[SUP] 1 [/SUP], Stella Chim[SUP] 1 [/SUP], Chin-Ying Chow[SUP] 1 [/SUP], Alvin Chi-Chung Ho[SUP] 1 [/SUP], Sophelia Hoi-Shan Chan[SUP] 1 [/SUP], Shuk-Mui Tai[SUP] 7 [/SUP], Wing-Cheong Lee[SUP] 7 [/SUP], Victor Chi-Man Chan[SUP] 7 [/SUP], Eric Kin-Cheong Yau[SUP] 3 [/SUP], Jacquelyne Ka-Li Sun[SUP] 8 [/SUP], Hei-Man Chow[SUP] 8 9 [/SUP], Yu-Lung Lau[SUP] 1 [/SUP], Patrick Ip[SUP] 1 [/SUP], Jasper Fuk-Woo Chan[SUP] 5 6 10 [/SUP]
Affiliations
- PMID: 37403902
- DOI: 10.1002/jmv.28895
Omicron generally causes milder disease than previous strains of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), especially in fully vaccinated individuals. However, incompletely vaccinated children may develop Omicron-related complications such as those affecting the central nervous system. To characterize the spectrum of clinical manifestations of neuro-COVID and to identify potential biomarkers associated with clinical outcomes, we recruited 15 children hospitalized for Omicron-related neurological manifestations in three hospitals in Hong Kong (9 boys and 6 girls aged 1-13 years). All were unvaccinated or incompletely vaccinated. Fourteen (93.3%) were admitted for convulsion, including benign febrile seizure (n = 7), complex febrile seizure (n = 2), seizure with fever (n = 3), and recurrent breakthrough seizure (n = 2), and the remaining nonconvulsive patient developed encephalopathic state with impaired consciousness. None of the seven children with benign febrile seizure and six of eight children with other neurological manifestations had residual deficits at 9-month follow-up. SARS-CoV-2 RNA was undetectable in the cerebrospinal fluid (CSF) specimens of seven patients who underwent lumbar puncture. Spike-and-wave/sharp waves affecting the frontal lobes were detected in four of seven (57.1%) patients who underwent electroencephalogram. Children with Omicron-related neurological manifestations had significantly higher blood levels of IL-6 (p < 0.001) and CHI3L1 (p = 0.022) than healthy controls, and higher CSF levels of IL-6 (p = 0.002) than children with non-COVID-19-related febrile illnesses. Higher CSF-to-blood ratios of IL-8 and CHI3L1 were associated with longer length of stay, whereas higher ratios of IL-6 and IL-8 were associated with higher blood tau level. The role of CSF:blood ratio of IL-6, IL-8, and CHI3L1 as prognostic markers for neuro-COVID should be further evaluated.
Keywords: COVID-19; Omicron; SARS-CoV-2; children; neurological; seizure.