ABSTRACT
As of June 2022, children represent 18.9% of total cumulated cases of COVID-19 in the United States. While most children have mild symptoms, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can affect the central and peripheral nervous system function. The most common neurological symptoms in children with COVID-19 are headache, fatigue, anosmia, dysgeusia, and myalgia. In hospitalized children, the most common symptoms are headache, encephalopathy, and seizures. Neurological symptoms are associated with a more severe disease course, and up to a third of hospitalized children with COVID-19 require intensive care intervention. A rare and feared complication is multisystem inflammatory syndrome (MIS-C), a serious condition that involves severe inflammation of different organs, including the brain. Treatment for MIS-C has not been validated and primarily consists of supportive care and immune modulation. Some children with a history of COVID-19 develop persistent symptoms, also known as long COVID. However, recent evidence suggests that long COVID symptoms appear as frequently as in children without a history of COVID-19. Similarly, birth during the pandemic, but not in utero exposure to maternal SARS-CoV-2, is associated with differences in neurodevelopmental milestones. Almost 3years into the pandemic, the evidence in children is limited. Large-scale studies with adequate pre- and post-pandemic control groups are needed to establish the associations between COVID-19 and short and long-term neurological complications. © 2023 Elsevier Inc. All rights reserved
ABSTRACT
Background and aims: Two years after onset of the pandemic, the precise nature and temporal evolution of the effects of COVID-19 on neurologic disorders remain uncharacterized. Studies have established an association with neurological syndromes, including anosmia, encephalopathy, and ischemic stroke, but it is unknown whether COVID-19 also influences the incidence of specific neurologic diseases and whether it differs from other respiratory infections. Methods: Using population-based electronic health records we investigated the association between COVID-19 and specific central and peripheral neurologic diseases. We compared patients with COVID-19 to individuals without, and to patients with influenza A/B and community-acquired bacterial pneumonia. We assessed the incidence of neurologic disease one, three, six, and twelve months after positive test results. Results: We identified 42,535 people with COVID-19, 8,329 with influenza, 1,566 with pneumonia, and 2,392,400 without COVID-19. Compared to individuals without COVID-19, patients with COVID-19 had increased relative risk (RR) of developing Guillain Barré syndrome (RR=3.1;95% CI=1.5-6.7), multiple sclerosis (RR=1.4;95% CI=1.2-1.7), narcolepsy (RR=3.2;95% CI=1.6-6.2), Parkinson's disease (RR=2.8;95% CI=2.4-3.2), Alzheimer's disease (RR=4.9;95% CI=4.0-6.0), dementia of any type (RR=5.2;95% CI=4.5-6.1), and ischemic stroke (RR=2.3;95% CI=2.1-2.5). However, compared to patients hospitalized with influenza, patients hospitalized with COVID-19 only had an increased risk of ischemic stroke at one (RR=1.9;95% CI=1.3-2.8), three (RR=1.8;95% CI=1.3-2.5) and six months (RR=1.9, 95% CI=1.3-2.7). Compared to patients hospitalized with pneumonia, the risk of neurologic diseases was not increased. Conclusion: COVID-19 increases the risk of a broad range of neurological disorders. However, except for ischemic stroke, there is no excess risk compared to influenza A/B and community-acquired pneumonia.
ABSTRACT
Much of routine cancer care has been disrupted due to the perceived susceptibility to SARS-CoV-2 infection in cancer patients. Here, we systematically review the current evidence base pertaining to the prevalence, presentation and outcome of COVID-19 in cancer patients, in order to inform policy and practice going forwards. A keyword-structured systematic search was conducted on Pubmed, Cochrane, Embase and MedRxiv databases for studies reporting primary data on COVID-19 in cancer patients. Studies were critically appraised using the NIH National Heart, Lung and Blood Institute's quality assessment tool set. The pooled prevalence of cancer as a co-morbidity in patients with COVID-19 and pooled in-hospital mortality risk of COVID-19 in cancer patients were derived by random-effects meta-analyses. In total, 110 studies from 10 countries were included. The pooled prevalence of cancer as a co-morbidity in hospitalised patients with COVID-19 was 2.6% (95% confidence interval 1.8%, 3.5%, I2: 92.0%). Specifically, 1.7% (95% confidence interval 1.3%, 2.3%, I2: 57.6.%) in China and 5.6% (95% confidence interval 4.5%, 6.7%, I2: 82.3%) in Western countries. Patients most commonly presented with non-specific symptoms of fever, dyspnoea and chest tightness in addition to decreased arterial oxygen saturation, ground glass opacities on computer tomography and non-specific changes in inflammatory markers. The pooled in-hospital mortality risk among patients with COVID-19 and cancer was 14.1% (95% confidence interval 9.1%, 19.8%, I2: 52.3%). We identified impeding questions that need to be answered to provide the foundation for an iterative review of the developing evidence base, and inform policy and practice going forwards. Analyses of the available data corroborate an unfavourable outcome of hospitalised patients with COVID-19 and cancer. Our findings encourage future studies to report detailed social, demographic and clinical characteristics of cancer patients, including performance status, primary cancer type and stage, as well as a history of anti-cancer therapeutic interventions.