Long COVID Throughout the Lifespan: A Comparative Review of Clinical Manifestations, Pathophysiological Mechanisms, and Multidisciplinary Management in Pediatric and Adult Populations
DOI:
https://doi.org/10.64784/252Palabras clave:
Long COVID, post-COVID condition, SARS-CoV-2, pediatric, adults, multisystem disease, persistent symptoms, pathophysiology, diagnosis, rehabilitation, multidisciplinary care, public healthResumen
Long COVID has become a major global health concern due to the persistence of symptoms that continue for weeks or months after acute SARS-CoV-2 infection. This review aimed to compare the clinical manifestations, pathophysiological mechanisms, diagnostic approaches, risk factors, and management strategies of Long COVID in pediatric and adult populations. An integrative literature review was conducted using publications retrieved from PubMed, Scopus, Google Scholar, and international health organizations, including the World Health Organization, the Centers for Disease Control and Prevention, and the National Institute for Health and Care Excellence. Current evidence indicates that Long COVID is a heterogeneous multisystem condition involving neurological, respiratory, cardiovascular, musculoskeletal, gastrointestinal, and psychological systems. Adults generally present a greater frequency and severity of persistent symptoms; however, children and adolescents also experience clinically significant long-term sequelae that may interfere with growth, education, and psychosocial development. The available evidence supports a multifactorial pathophysiological model involving viral persistence, immune dysregulation, autoimmunity, endothelial dysfunction, dysautonomia, and mitochondrial impairment. Diagnosis remains primarily clinical because no validated biomarker currently exists, making individualized assessment and exclusion of alternative diagnoses essential. Effective management requires multidisciplinary collaboration and rehabilitation strategies adapted to patient age, symptom profile, and functional limitations. Although scientific knowledge has expanded considerably, further standardized prospective studies, particularly in underrepresented regions such as Latin America, are needed to improve diagnosis, treatment, and long-term outcomes.
Referencias
• Al-Aly, Z., Bowe, B., & Xie, Y. (2022). Long COVID after breakthrough SARS-CoV-2 infection. Nature Medicine, 28(7), 1461–1467. https://doi.org/10.1038/s41591-022-01840-0
• Buonsenso, D., & Tantisira, K. G. (2024). Long COVID and SARS-CoV-2 persistence: New answers, more questions. The Lancet Infectious Diseases, 24(8), 796–798. https://doi.org/10.1016/S1473-3099(24)00216-0
• 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. (2022). Fatigue and cognitive impairment in post-COVID-19 syndrome: A systematic review and meta-analysis. Brain, Behavior, and Immunity, 101, 93–135.
• Centers for Disease Control and Prevention. (2025). Long COVID or post-COVID conditions. Centers for Disease Control and Prevention.
• Chen, C., Haupert, S. R., Zimmermann, L., Shi, X., Fritsche, L. G., & Mukherjee, B. (2022). Global prevalence of post-COVID-19 condition: A systematic review and meta-analysis. The Journal of Infectious Diseases, 226(9), 1593–1607.
• Crook, H., Raza, S., Nowell, J., Young, M., & Edison, P. (2021). Long COVID—Mechanisms, risk factors, and management. BMJ, 374, n1648. https://doi.org/10.1136/bmj.n1648
• Davis, H. E., McCorkell, L., Vogel, J. M., & Topol, E. J. (2023). Long COVID: Major findings, mechanisms and recommendations. Nature Reviews Microbiology, 21(3), 133–146. https://doi.org/10.1038/s41579-022-00846-2
• Global Burden of Disease Long COVID Collaborators. (2023). Global burden of post-COVID-19 condition. The Lancet.
• Greenhalgh, T., Sivan, M., Perlowski, A., & Nikolich, J. Ž. (2024). Long COVID: A clinical update. The Lancet, 404(10453), 707–724. https://doi.org/10.1016/S0140-6736(24)01136-X
• Nalbandian, A., Sehgal, K., Gupta, A., Madhavan, M. V., McGroder, C., Stevens, J. S., Cook, J. R., Nordvig, A. S., Shalev, D., Sehrawat, T. S., Ahluwalia, N., Bikdeli, B., Dietz, D., Der-Nigoghossian, C., Liyanage-Don, N., Rosner, G. F., Bernstein, E. J., Mohan, S., Beckley, A. A., … Wan, E. Y. (2023). Post-acute COVID-19 syndrome. Nature Medicine, 29(4), 751–763. https://doi.org/10.1038/s41591-021-01283-z
• National Institute for Health and Care Excellence. (2024). COVID-19 rapid guideline: Managing the long-term effects of COVID-19 (NG188). NICE.
• Rayner, D. G., Wang, E., Su, C., Patel, O. D., Aleluya, S., Giglia, A., Zhu, E., & Siddique, M. (2024). Risk factors for long COVID in children and adolescents: A systematic review and meta-analysis. World Journal of Pediatrics, 20(2), 133–142. https://doi.org/10.1007/s12519-023-00765-z
• Rothensteiner, M., Leeb, F., Götzinger, F., Tebruegge, M., & Zacharasiewicz, A. (2024). Long COVID in children and adolescents: A critical review. Children, 11(8), 972. https://doi.org/10.3390/children11080972
• Soriano, J. B., Murthy, S., Marshall, J. C., Relan, P., & Diaz, J. V. (2022). A clinical case definition of post-COVID-19 condition by a Delphi consensus. The Lancet Infectious Diseases, 22(4), e102–e107. https://doi.org/10.1016/S1473-3099(21)00703-9
• Stephenson, T., Pinto Pereira, S. M., Shafran, R., De Stavola, B., Rojas, N., McOwat, K., Simmons, R., Zavala, M., O'Mahoney, L., Chalder, T., & Heyman, I. (2022). Physical and mental health 3 months after SARS-CoV-2 infection among adolescents. Nature Communications, 13, 3495.
• Taquet, M., Sillett, R., Zhu, L., Mendel, J., Camplisson, I., Dercon, Q., & Harrison, P. J. (2022). Neurological and psychiatric risk trajectories after SARS-CoV-2 infection. The Lancet Psychiatry, 9(10), 815–827.
• Toepfner, N., Brinkmann, F., & Augustin, S. (2024). Long COVID in pediatrics: Epidemiology, diagnosis, and management. European Journal of Pediatrics, 183(4), 1543–1553. https://doi.org/10.1007/s00431-023-05360-y
• World Health Organization. (2024). Post COVID-19 condition (Long COVID). World Health Organization.
• Xie, Y., Choi, T., & Al-Aly, Z. (2022). Nirmatrelvir and the risk of post-acute sequelae of COVID-19. JAMA Internal Medicine, 183(6), 554–564.
• Zimmermann, P., & Pittet, L. F. (2022). Long COVID in children and adolescents. Pediatric Infectious Disease Journal, 41(12), e477–e480.
