Sanatorium Rehabilitation of post-COVID Asthenic Syndrome in School-Age Children

Aim. To study the effects of sanatory rehabilitation factors for the intensity of asthenic manifestations of post-COVID syndrome in school-aged children.

Design. A non-randomized controlled study was conducted.

Materials and methods. We examined 60 children aged 8 to 13 years old with asthenic manifestations of post-COVID syndrome; 20 healthy children were used as controls. Rehabilitation was organised at Svetlana health camp (a branch of the Territorial Clinical Hospital, Perm). All children shared their complaints and medical history as well as had their somatic and neurological status checked before and after rehabilitation. The degree of asthenia was determined using the Multidimensional Fatigue Scale; the functional status was evaluated using the functional status scale for post-COVID-19 patients; vegetative manifestations were recorded in a questionnaire and a pattern developed by A. M. Wein. Saliva levels of monocytic chemotactic protein-1 were determined with ELISA.

Results. Children with past COVID-19 demonstrated a higher level of asthenia seen on the fatigue sub-scale — 81.22 [50.0; 100.0] points (р = 0.02 vs. controls), together with vegetative disorders; and saliva levels of monocytic chemotactic protein-1 (18.0 [12.5; 29.7] pg/mL) were higher than in controls (16.35 [11.00; 22.60] pg/mL; р = 0.012). After rehabilitation in a health camp, the intensity of asthenia decreased to 87.18 [75.0; 100.0] (р = 0.02), vegetative dysfunction improved, and functional status class changed from 1.74 [1.0; 3.0] to 0.77 [0; 1.0] (р = 0.02); saliva levels of monocytic chemotactic protein-1 increased to 23.1 [13.7; 43.7] pg/mL (p = 0.04). Quantitative changes are associated with improved clinical manifestations of post-COVID syndrome; therefore, elevated levels of this protein are a positive change.

Conclusion. Post-COVID syndrome in school-aged children manifested with asthenic and vegetative disorders. Rehabilitation sanatory factors have favourable effect on the clinical manifestations of post-COVID syndrome, as well as the saliva concentration of monocytic chemotactic protein.

1. Vosoughi F., Makuku R., Tantuoyir M.M., Yousefi F. et al. A systematic review and meta-analysis of the epidemiological characteristics of COVID-19 in children. BMC Pediatr. 2022;22(1):613. DOI: 10.1186/s12887-022-03624-4

2. Halpin S.J., McIvor C., Whyatt G., Adams A. et al. Postdischarge symptomsand rehabilitation needsin survivors ofCOVID-19 infection: a cross-sectional evaluation. J. Med. Virol. 2021;93(2):1013–22. DOI: 10.1002/jmv.26368

3. Fugazzaro S., Contri A., Esseroukh O., Kaleci S. et al. Rehabilitation interventions for Post-Acute COVID-19 syndrome: a systematic review. Int. J. Environ. Res. Public Health. 2022;19(9):5185. DOI: 10.3390/ijerph19095185

4. Groven N., Fors E.A., Stunes A.K., Reitan S.K. MCP-1 is increased in patients with CFS and FM, whilst several other immune markers are significantly lower than healthy controls. Brain Behav. Immun. Health. 2020;28(4):100067. DOI: 10.1016/j.bbih.2020.100067

5. Sahoo O.S., Pethusamy K., Nayek A., Minocha R. et al. Paradigm of immune dysregulation in COVID-19 infection. Explor. Immunol. 2024;4: 1–33. DOI: 10.37349/ei.2024.00126

6. Abdullah M., Ali A., Usman M., Naz A. et al. Post COVID-19 complications and follow up biomarkers. Nanoscale Adv. 2023; 5(21):5705–16. DOI: 10.1039/d3na00342f

7. Kim J., Lee C.H., Park C.S., Kim B.G. et al. Plasma levels of MCP-1 and adiponectin in obstructive sleep apnea syndrome. Arch. Otolaryngol. Head Neck Surg. 2010;136(9):896–9. DOI: 10.1001/archoto.2010.142

8. Nisha K.J., Suresh A., Anilkumar A., Padmanabhan S. MIP-1α and MCP-1 as salivary biomarkers in periodontal disease. Saudi Dent. J. 2018;30(4):292–8. DOI: 10.1016/j.sdentj.2018.07.002

9. Yui S., Sasayama D., Yamaguchi M., Washizuka S. Altered levels of salivary cytokines in patients with major depressive disorder. Clin. Neurol. Neurosurg. 2022;221:107390. DOI: 10.1016/j.clineuro.2022.107390

10. Kolotov K.A., Rasputin P.G. Monocyte chemotactic protein-1 in physiology and medicine. Perm Medical Journal. 2018;3:99–105. (in Russian). DOI: 10.17816/pmj35399-105

11. Singh S., Anshita D., Ravichandiran V. MCP-1: function, regulation, and involvement in disease. Int. Immunopharmacol. 2021;101(PtB):107598. DOI: 10.1016/j.intimp.2021.107598

12. Pasrija R., Naime M. The deregulated immune reaction and cytokines release storm (CRS) in COVID-19 disease. Int. Immunopharmacol. 2021;90:107225. DOI: 10.1016/j.intimp.2020.107225

13. Chen Y., Jinglan W., Chenxi L., Su L. et al. IP-10 and MCP-1 as biomarkers predicting disease severity of COVID-19. Mol. Med. 2020;26(1):97. DOI: 10.1186/s10020-020-00230-x

14. Huang C., Wang Y., Li X., Ren L. et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395(10223):497–506. DOI: 10.1016/S0140-6736(20)30183-5

15. Behnood S.A., Shafran R., Bennett S.D., Zhang A.X.D. et al. Persistent symptoms following SARS-CoV-2 infection amongst children and young people: a meta-analysis ofcontrolled and uncontrolled studies. J. Infect. 2022;84(2):158–70. DOI: 10.1016/j.jinf.2021.11.011

16. Spruit M.A., Holland A.E., Singh S.J., Tonia T. et al. COVID-19: interim guidance on rehabilitation in the hospital and post-hospital phase from a European Respiratory Society and American Thoracic Society-coordinated International Task Force. Eur. Respir. J. 2020;56(6):2002197. DOI: 10.1183/13993003.02197-2020

17. Barker-Davies R.M., O'Sullivan O., Senaratne K.P.P., Baker P. et al. The Stanford Hall consensus statement for post-COVID-19 rehabilitation. Br. J. Sports Med. 2020;54(16):949–59. DOI: 10.1136/bjsports-2020-102596