Features of post-infectious asthenic syndrome and neurocognitive status associated with previous coronavirus infection (COVID- 19) in children
https://doi.org/10.36604/1998-5029-2026-99-55-67
Abstract
Introduction. Post-infectious asthenic syndrome (PAS) and cognitive impairments are well-documented consequences of COVID-19 in adults; however, their characteristics in children remain insufficiently studied.
Aim. To characterize the features of asthenic syndrome and neurocognitive status in children following SARS-CoV-2 infection.
Materials and methods. A prospective single-center study included 209 children with confirmed COVID-19. Assessment was performed through medical record review, the Multidimensional Fatigue Inventory (MFI-20), and 6-month dynamic follow-up. Neurocognitive testing (assessing memory, attention, and executive function) was conducted in 46 children with PAS (main group) and compared with 12 apparently healthy children (control group).
Results. PAS was diagnosed in 31.6 % (n = 66) of children, with a median duration of 2 months. The predominant symptoms were generalized physical weakness (69.7 %) and increased mental fatigue (36.4 %). Statistical analysis revealed no significant association between the severity of acute COVID-19 and subsequent PAS development. Neurocognitive evaluation demonstrated significantly lower scores (p < 0.05) in motor-auditory and visual-auditory-motor memory domains in the main group compared to controls.
Conclusion. Previous COVID-19 infection in children is associated with a distinct post-infectious asthenic syndrome characterized by physical weakness, reduced tolerance to physical and mental exertion, excessive fatigue, impaired mnemonic functions, emotional lability, headache, dizziness, and specific memory deficits. These findings underscore the necessity for long-term monitoring and the development of targeted rehabilitation programs for pediatric patients recovering from COVID-19.
Keywords
Supporting agencies: This study was not sponsored
About the Authors
L. I. Zhmaeva
State Autonomous Healthcare Institution "Children's City Outpatients Clinic No. 1, Chelyabinsk"
Russian Federation
Russian Federation
Liliya I. Zhmaeva, Pediatrician
445048; 25 Khudyakova Str.; Chelyabinsk
E. N. Serebryakova
Federal State Budgetary Educational Institution of Higher Education "South Ural State Medical University" of the
Ministry of Healthcare of the Russian Federation
Russian Federation
Russian Federation
Elena N. Serebryakova, MD, PhD, DSc (Med.), Associate Professor, Professor
Department of Hospital Pediatrics
454092; 64 Vorovsky Str.; Chelyabinsk
S. V. Batueva
Federal State Budgetary Educational Institution of Higher Education "South Ural State Medical University" of the
Ministry of Healthcare of the Russian Federation
Russian Federation
Russian Federation
Svetlana V. Batueva, PhD (Ped.), Associate Professor, Associate Professor of the Department
Department of Psychology
454092; 64 Vorovsky Str.; Chelyabinsk
O. A. Shumakova
Federal State Budgetary Educational Institution of Higher Education "South Ural State Medical University" of the
Ministry of Healthcare of the Russian Federation
Russian Federation
Russian Federation
Olga A. Shumakova, PhD, DSc (Psych.), Professor, Head of the Department
Psychology Department
454092; 64 Vorovsky Str.; Chelyabinsk
S. N. Kryukov
Federal State Budgetary Educational Institution of Higher Education "South Ural State Medical University" of the
Ministry of Healthcare of the Russian Federation
Russian Federation
Russian Federation
Sergey N. Kryukov, PhD in Culturology, Associate Professor, 2nd Category Specialist
Psychology Department; Department of Research and Innovation
454092; 64 Vorovsky Str.; Chelyabinsk
References
1. Preedy V.R., Smith D.G., Salisbury J.R., Peters T. J. Biochemical and muscle studies in patients with acute onset post-viral fatigue syndrome. J. Clin. Pathol. 1993; 46(8):722–726. doi: 10.1136/jcp.46.8.722
2. Carruthers B. M., van de Sande M. I., De Meirleir K. L., Klimas N. G., Broderick G., Mitchell T., Staines D., Powles A. C., Speight N., Vallings R., Bateman L., Baumgarten-Austrheim B., Bell D.S., Carlo-Stella N., Chia J., Darragh A., Jo D., Lewis D., Light A. R., Marshall-Gradisnik S., Mena I., Mikovits J.A., Miwa K, Murovska M., Pall M.L., Stevens S. Myalgic encephalomyelitis/chronic fatigue syndrome: clinical working case definition, diagnostic and treatment protocols. Journal of Chronic Fatigue Syndrome 2003; 11(1):7–115. doi: 10.1300/J092v11n01_02
3. Logue J.K., Franko N.M., McCulloch D.J., McDonald D., Magedson A., Wolf C.R., Chu H.Y. Sequelae in adults at 6 months after COVID-19 infection. JAMA Netw. Open. 2021; 4(2):e210830. do: 10.1001/jamanetworkopen.2021.0830. Erratum in: JAMA Netw. Open. 2021; 4(3):e214572. doi: 10.1001/jamanetworkopen.2021.4572
4. Zolotovskaya I.A., Shatskaya P.R., Davydkin I.L., Shavlovskaya O.A. [Asthenic syndrome in patients who have undergone COVID-19]. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova = S.S. Korsakov Journal of Neurology and Psychiatry 2021; 121(4):25–30 (in Russian). doi: 10.17116/jnevro202112104125
5. Lopez-Leon S., Wegman-Ostrosky T., Ayuzo Del Valle N.C., Perelman C., Sepulveda R., Rebolledo P.A., Cuapio A., Villapol S. Long-COVID in children and adolescents : a systematic review and meta-analyses. Sci. Rep. 2022; 12(1):9950. doi: 10.1038/s41598-022-13495-5
6. Ceban F., Ling S., Lui L.M.W., Lee Y., Gill H., Teopiz K.M., Rodrigues N.B., Subramaniapillai M., Di Vincenzo J.D., Cao B., Lin K., Mansur R.B., Ho R.C., Rosenblat J.D., Miskowiak K.W., Vinberg M., Maletic V., McIntyre R.S. Fatigue and cognitive impairment in post-COVID-19 syndrome : a systematic review and meta-analysis. Brain Behav. Immun. 2022; 101:93–135. doi: 10.1016/j.bbi.2021.12.020
7. Hampshire A., Trender W., Chamberlain S.R., Jolly A.E., Grant J.E., Patrick F., Mazibuko N., Williams S. C., Barnby J.M., Hellyer P., Mehta M.A. Cognitive deficits in people who have recovered from COVID-19. EClinicalMedicine 2021; 39:101044. doi: 10.1016/j.eclinm.2021.101044
8. Swank Z., Senussi Y., Manickas-Hill Z., Yu X.G., Li J.Z., Alter G., Walt D.R. Persistent circulating severe acute respiratory syndrome coronavirus 2 spike is associated with post-acute coronavirus disease 2019 sequelae. Clin. Infect. Dis. 2023; 76(3):e487–e490. doi: 10.1093/cid/ciac722
9. Peluso M.J., Deeks S.G. Early clues regarding the pathogenesis of long-COVID. Trends Immunol. 2022; 43(4):268–270. doi: 10.1016/j.it.2022.02.008
10. Liu Q., Mak J.W.Y., Su Q., Yeoh Y.K., Lui G.C., Ng S.S.S., Zhang F., Li A.Y.L., Lu W., Hui D. S., Chan P. K., Chan F.K.L., Ng S.C. Gut microbiota dynamics in a prospective cohort of patients with post-acute COVID-19 syndrome. Gut 2022; 71(3):544–552. doi: 10.1136/gutjnl-2021-325989
11. Arthur J.M., Forrest J.C., Boehme K.W., Kennedy J.L., Owens S., Herzog C., Liu J., Harville T.O. Development of ACE2 autoantibodies after SARS-CoV-2 infection. PLoS One 2021; 16(9):e0257016. doi: 10.1371/journal.pone.0257016
12. Haffke M., Freitag H., Rudolf G., Seifert M., Doehner W., Scherbakov N., Hanitsch L., Wittke K., Bauer S., Konietschke F., Paul F., Bellmann-Strobl J., Kedor C., Scheibenbogen C., Sotzny F. Endothelial dysfunction and altered endothelial biomarkers in patients with post-COVID-19 syndrome and chronic fatigue syndrome (ME/CFS). J. Transl. Med. 2022; 20(1):138. doi: 10.1186/s12967-022-03346-2
13. Charfeddine S., Ibn Hadj Amor H., Jdidi J., Torjmen S., Kraiem S., Hammami R., Bahloul A., Kallel N., Moussa N., Touil I., Ghrab A., Elghoul J., Meddeb Z., Thabet Y., Kammoun S., Bouslama K., Milouchi S., Abdessalem S., Abid L. Long COVID 19 syndrome: is it related to microcirculation and endothelial dysfunction? Insights from TUN-EndCOV study. Front. Cardiovasc. Med. 2021; 8:745–758. doi: 10.3389/fcvm.2021.745758
14. Spudich S., Nath A. Nervous system consequences of COVID-19. Science 2022; 375(6578):267–269. doi: 10.1126/science.abm2052
15. Weinstock L.B., Brook J.B., Walters A.S., Goris A., Afrin L.B., Molderings G.J. Mast cell activation symptoms are prevalent in long-COVID. Int. J. Infect. Dis. 2021; 112:217–226. doi: 10.1016/j.ijid.2021.09.043
16. Bilichenko T.N. [Post-COVID syndrome: risk factors, pathogenesis, diagnosis and treatment of patients with respiratory damage after COVID-19 (research review)]. RMZh. Medicinskoe obozrenie = Russian medical inquiry 2022; 6(7):367–375 (in Russian). doi: 10.32364/2587-6821-2022-6-7-367-37517
17. Yeoh Y.K., Zuo T., Lui G.C., Zhang F., Liu Q., Li A.Y., Chung A.C., Cheung C.P., Tso E.Y., Fung K.S., Chan V., Ling L., Joynt G., Hui D.S., Chow K.M., Ng S.S.S., Li T.C., Ng R.W., Yip T.C., Wong G.L., Chan F.K., Wong C.K., Chan P.K., Ng S.C. Gut microbiota composition reflects disease severity and dysfunctional immune responses in patients with COVID-19. Gut 2021; 70(4):698–706. doi: 10.1136/gutjnl-2020-323020
18. Fujii H., Tsuji T., Yuba T., Tanaka S., Suga Y., Matsuyama A., Omura A., Shiotsu S., Takumi C., Ono S., Horiguchi M., Hiraoka, N. High levels of anti-SSA/Ro antibodies in COVID-19 patients with severe respiratory failure: a case-based review: high levels of anti-SSA/Ro antibodies in COVID-19. Clin. Rheumatol. 2020; 39(11):3171–3175. doi: 10.1007/s10067-020-05359-y
19. Subramanian A., Nirantharakumar K., Hughes S., Myles P., Williams T., Gokhale K.M., Taverner T., Chandan J.S., Brown K., Simms-Williams N., Shah A.D., Singh M., Kidy F., Okoth K., Hotham R., Bashir N., Cockburn N., Lee S.I., Turner G.M., Gkoutos G.V., Aiyegbusi O.L., McMullan C., Denniston A.K., Sapey E., Lord J.M., Wraith D.C., Leggett E., Iles C., Marshall T., Price M.J., Marwaha S., Davies E.H., Jackson L.J., Matthews K.L., Camaradou J., Calvert M., Haroon S. Symptoms and risk factors for long COVID in non-hospitalized adults. Nat. Med. 2022; 28(8):1706–1714. doi: 10.1038/s41591-022-01909-w
20. Smets E.M., Garssen B., Bonke B., De Haes J.C. The multidimensional fatigue inventory (MFI) psychometric qualities of an instrument to assess fatigue. J. Psychosom. Res. 1995; 39(3):315–325. doi: 10.1016/0022-3999(94)00125-o
21. Zak A.Z. [How to determine the level of development of schoolchildren's thinking]. Moscow: Znanie; 1982 (in Russian). EDN: RPQXML.
22. Rogov E.V. [Handbook of a practical psychologist. (Vol.1): The system of work of a psychologist with children of different ages]. Moscow: Gumanitarnyy izdatel'skiy tsentr VLADOS; 1999 (in Russian). ISBN: 5-691-00180-9.
23. Rogov E.I. [Handbook of a practical psychologist. The system of work of a psychologist with children of different ages : a practical guide (Vol.1)]. Moscow: Izdatel'stvo Yurayt; 2016 (in Russian). EDN: VTWIOF.
24. Rebrova O.Yu. [Statistical analysis of medical data. Application of the STATISTICA software package]. Moscow: Media Sfera; 2002 (in Russian). EDN: UISZQM.
25. Shakmaeva M.A., Chernova T.M., Timchenko V.N., Nachinkina T.A., Tetyushin K.V., Kaplina T.A., Subbotina M.D., Bulina O.V., Afanasyeva O.I. [Features of the new coronavirus infection in children of different ages]. Detskie infektsii = Children's Infections 2021; 20(2):5–9 (in Russian). doi: 10.22627/2072-8107-2021-20-2-5-9
26. [Methodological recommendations. Features of clinical manifestations and treatment of the disease caused by the novel coronavirus infection (COVID-19) in children]. 2020 (in Russian). Available at: https://static-0.minzdrav.gov.ru/system/attachments/attaches/000/050/914/original/03062020_%D0%B4%D0B5%D1%82%D0%B8_COVID-19_v2.pdf
27. Townsend L., Dyer A.H., Jones K., Dunne J., Mooney A., Gaffney F., O'Connor L., Leavy D., O'Brien K., Dowds J., Sugrue J.A., Hopkins D., Martin-Loeches I., Ni Cheallaigh C., Nadarajan P., McLaughlin A.M., Bourke N.M., Bergin C., O'Farrelly C., Bannan C., Conlon N. Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection. PLoS One 2020; 15(11):e0240784. doi: 10.1371/journal.pone.0240784
28. Hartung T.J., Neumann C., Bahmer T., Chaplinskaya-Sobol I., Endres M., Geritz J., Haeusler K.G., Heuschmann P.U., Hildesheim H., Hinz A., Hopff S., Horn A., Krawczak M., Krist L., Kudelka J., Lieb W., Maetzler C., Mehnert-Theuerkauf A., Montellano F.A., Morbach C., Schmidt S., Schreiber S., Steigerwald F., Störk S., Maetzler W., Finke C. Fatigue and cognitive impairment after COVID-19: a prospective multicentre study. EClinicalMedicine 2022; 53:101651. doi: 10.1016/j.eclinm.2022.101651
29. Buonsenso D., Espuny Pujol F., Munblit D., Pata D., McFarland S., Simpson F.K. Clinical characteristics, activity levels and mental health problems in children with long coronavirus disease: a survey of 510 children. Future Microbiol. 2022; 17(8):577–588. doi: 10.2217/fmb-2021-0285
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For citations:
Zhmaeva L.I., Serebryakova E.N., Batueva S.V., Shumakova O.A., Kryukov S.N. Features of post-infectious asthenic syndrome and neurocognitive status associated with previous coronavirus infection (COVID- 19) in children. Bulletin Physiology and Pathology of Respiration. 2026;(99):55-67. (In Russ.) https://doi.org/10.36604/1998-5029-2026-99-55-67
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