Several persistent but nonspecific symptoms have been reported in people who have already recovered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This phenomenon has been termed long coronavirus disease 2019 (COVID-19), post-COVID syndrome and post-acute sequelae of SARS-CoV-2 infection (PASC).
Although no viral load is detected in these patients, they present with various symptoms ranging from respiratory problems and neurological disorders to gastrointestinal (GI) diseases and orthostatic intolerance. To date, the risk factors associated with the development of PASC have not been fully elucidated.
Study: Ongoing dizziness after acute COVID-19 infection: a single-center pediatric case series. Image Credit: 9nong / Shutterstock.com
A new Pediatrics describes the experience of treating pediatric PASC patients with persistent dizziness.
About the study
The current study involved preparing a retrospective chart review of patients who were referred for persistent dizziness to Pediatric Cardiology between July 2021 and December 2021. All referred patients underwent active position testing (AST) during the initial consultation. The complete patient history was obtained by the pediatric cardiologist at each visit.
An initial electrocardiogram (ECG) was performed for all patients. Several patients also underwent additional tests which included cardiopulmonary exercise testing, cardiac monitoring, echocardiogram, and/or lab tests.
Symptom severity was categorized as mild, moderate, or severe according to guidelines provided by the US National Institutes of Health (NIH). All patients were followed one to two weeks after initial treatment or a change in treatment. The total follow-up period was approximately two months.
A total of nine patients with a median age of 14 years were included in the study. Daily dizziness, unsteadiness and lightheadedness were reported by all patients.
The time from acute SARS-CoV-2 infection to onset of symptoms was seven days. All patients attended school and even participated in competitive sports before the onset of their symptoms.
Of the nine patients, four had previously been diagnosed with anxiety and one reported occasional positional dizziness prior to their COVID-19 diagnosis. Mild acute symptoms of SARS-CoV-2 infection were experienced by all patients, most of which included fever and upper respiratory tract symptoms. A patient was reportedly fully vaccinated before being diagnosed with COVID-19.
Many patients have also reported extreme fatigue, as well as alterations in their daily activities. Of the four patients with pre-COVID anxiety, two reported a significant increase in their anxiety symptoms, while one required hospitalization.
In five patients, AST results were consistent with a diagnosis of postural orthostatic tachycardia syndrome (POTS), while the other four were diagnosed with orthostatic intolerance. ECG results for all patients were reported as normal.
All patients initially received non-pharmacological therapy (NPT), which included increased fluid intake, exercise, use of compression garments, improved sleep, and increased fluid absorption. calories. Thereafter, patients continued their treatment through the COVID Recovery Clinic followed by some complementary therapies.
No improvement in dizziness was observed with NPT alone. Thus, all POTS patients, as well as three patients without POTS, were prescribed various medications such as beta-blockers, fludrocortisone, and midodrine, depending on the clinical scenario.
Four of five POTS patients, as well as one patient without POTS, experienced complete resolution of their dizziness within a week of starting treatment. Several patients also reported improved concentration, as well as reduced fatigue, and were able to return to school and sports.
Taken together, the current study found that a combination of medications and lifestyle changes can help combat dizziness in pediatric patients who have recovered from COVID-19. Further studies are needed to understand the causes of dizziness in these patients, as well as to develop more effective treatments.
The current study had a small sample size, lacked a control group, and was only conducted for a short time. In addition, the material used throughout the study was limited. Additionally, an association between POTS and anxiety could not be established.
- Drogalis-Kim, D., Kramer, C., & Duran, S. (2022). Ongoing dizziness after acute COVID-19 infection: a single-center pediatric case series. Pediatrics. doi:10.1542/peds.2022-056860.
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