Tag: long covid symptoms

A Cross-Sectional Study of Symptom Prevalence, Frequency, Severity, and Impact of Long-COVID in Scotland: Part I

Abstract:

Background: Commonly reported symptoms of long-COVID may have different patterns of prevalence and presentation across different countries. While some limited data has been reported for the UK, national specificity for Scotland is less clear. We present a cross-sectional survey to examine the symptom prevalence, frequency and severity of long-COVID for people living with the condition in Scotland.

Methods: An online survey was created in the English language and was available between 21st April 2022 and 5th August 2022. Participants were included if they were ≥18 years old, living in Scotland, and had self-diagnosed or confirmed Long-COVID; and excluded if they were hospitalised during their initial infection. Within this article we quantify symptom prevalence, frequency, severity, and duration.

Results: Participants (n=253) reported the most prevalent long-COVID symptoms to be post-exertional malaise (95%), fatigue/tiredness (85%), and cognitive impairment (68%). Fatigue/tiredness, problems with activities of daily living (ADL), and general pain were most frequently occurring, whilst sleep difficulties, problems with ADL, and nausea were the most severe. Scottish Index of Multiple Deprivation associated with symptom number, severity and frequency, while vaccine status, age, sex, and smoking status had limited or no association.

Conclusions: These findings outline the challenges faced for those living with long COVID and highlight the need for longitudinal research to ascertain a better understanding of the condition and its longer-term societal impact.

Source: Mclaughlin M, Cerexhe L, Macdonald E, Ingram J, Sanal-Hayes NEM, Hayes LD, Meach R, Carless D, Sculthorpe N. A Cross-Sectional Study of Symptom Prevalence, Frequency, Severity, and Impact of Long-COVID in Scotland: Part I. Am J Med. 2023 Jul 20:S0002-9343(23)00460-6. doi: 10.1016/j.amjmed.2023.07.004. Epub ahead of print. PMID: 37481021. https://www.amjmed.com/article/S0002-9343(23)00460-6/fulltext (Full text)

Cortical thickness alterations and systemic inflammation define long-COVID patients with cognitive impairment

Abstract:

As the heterogeneity of symptoms is increasingly recognized among long-COVID patients, it appears highly relevant to study potential pathophysiological differences along the different subtypes. Preliminary evidence suggests distinct alterations in brain structure and systemic inflammatory patterns in specific groups of long-COVID patients.

To this end, we analyzed differences in cortical thickness and peripheral immune signature between clinical subgroups based on 3T-MRI scans and signature inflammatory markers in n=120 participants comprising healthy never-infected controls, healthy COVID-19 survivors, and subgroups of long-COVID patients with and without cognitive impairment according to screening with Montreal Cognitive Assessment.

Whole-brain comparison of cortical thickness between the 4 groups was conducted by surface-based morphometry. We identified distinct cortical areas showing a progressive increase in cortical thickness across different groups, starting from healthy individuals who had never been infected with COVID-19, followed by healthy COVID-19 survivors, long-COVID patients without cognitive deficits (MoCA ≥ 26), and finally, long-COVID patients exhibiting significant cognitive deficits (MoCA < 26). These findings highlight the continuum of cortical thickness alterations associated with COVID-19, with more pronounced changes observed in individuals experiencing cognitive impairment (p<0.05, FWE-corrected).

Affected cortical regions covered prefrontal and temporal gyri, insula, posterior cingulate, parahippocampal gyrus, and parietal areas. Additionally, we discovered a distinct immunophenotype, with elevated levels of IL-10, IFNg, and sTREM2 in long-COVID patients, especially in the group suffering from cognitive impairment.

We demonstrate lingering cortical and immunological alterations in healthy and impaired subgroups of COVID-19 survivors. This implies a complex underlying pathomechanism in long-COVID and emphasizes the necessity to investigate the whole spectrum of post-COVID biology to determine targeted treatment strategies targeting specific sub-groups.

Source: Bianca Besteher, Tonia Rocktaeschel, Alejandra Patricia Garza, Marlene Machnik, Johanna Ballez, Dario Lucas Helbing, Katrhin Finke, Philipp Reuken, Daniel Guellmar, Christian Gaser, Martin Walter, Nils Opel, Ildiko Rita Dunay. Cortical thickness alterations and systemic inflammation define long-COVID patients with cognitive impairment. medRxiv 2023.07.21.23292988; doi: https://doi.org/10.1101/2023.07.21.23292988 https://www.medrxiv.org/content/10.1101/2023.07.21.23292988v1v (Full text available as PDF file)

Post COVID-19 symptoms are common, also among young adults in the general population

Abstract:

Post coronavirus disease-19 (post COVID-19) is mainly studied in clinical populations and less is known about post COVID-19 in a young general population. The aim of the study is to investigate the prevalence and symptoms of post COVID-19 and its potential risk factors in young adults.

Participants from the Swedish population-based birth cohort BAMSE were included (n = 2022, mean age 26.5 years). Post COVID-19 was assessed through a questionnaire and defined as symptoms after confirmed COVID-19 (registry-based or self-reported positive test) lasting for ≥ 2 months. In total, 681 participants had had confirmed COVID-19. Among them, 112 (16.5%) fulfilled the definition of post COVID-19 (17.8% in females, 14.5% in males, p = 0.26).

The most common post COVID-19 symptoms were altered smell and taste (68.8%), dyspnea (33.7%) and fatigue (30.4%). Overall, no major risk factors for post COVID-19 were identified except for being bedbound during COVID-19. However, asthma and rhinitis were associated with the post COVID-19 symptom dyspnea, migraine with altered smell and taste, and lower self-rated health with fatigue. In conclusion, post COVID-19 symptoms are common, also among young adults in the general population. Although not life-threatening, it could have a considerable impact on public health due to the high prevalence and long-term symptoms.

Source: Mogensen I, Ekström S, Hallberg J, Georgelis A, Melén E, Bergström A, Kull I. Post COVID-19 symptoms are common, also among young adults in the general population. Sci Rep. 2023 Jul 12;13(1):11300. doi: 10.1038/s41598-023-38315-2. PMID: 37438424; PMCID: PMC10338459. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10338459/ (Full text)

Fatigue presentation, severity, and related outcomes in a prospective cohort following post-COVID-19 hospitalization in British Columbia, Canada

Abstract:

Introduction: Increasing evidence on long-term health outcomes following SARS CoV-2 infection shows post-viral symptoms can persist for months. These symptoms are often consistent with those of Myalgic Encephalomyelitis or Chronic Fatigue Syndrome (ME/CFS). The aim of the present study was to examine the prevalence and outcome predictors of post-viral fatigue and related symptoms 3- and 6-months following symptom onset.

Methods: A prospective cohort of patients hospitalized with Coronavirus disease (COVID-19) (n = 88) were recruited from a Post-COVID-19 Respiratory Clinic (PCRC) in Vancouver, Canada to examine predictors of long-term fatigue and substantial fatigue. Multivariable mixed effects analyses examined the relationship between patient predictors, including pre-existing comorbidities, patient reported outcome measures, and fatigue and substantial fatigue at follow-up.

Results: The number of patients experiencing fatigue or substantial fatigue at 3 months post-infection were 58 (67%) and 14 (16%) respectively. At 6 months these numbers declined to 47 (60%) patients experiencing fatigue and 6 (6%) experiencing substantial fatigue. Adjusted analysis, for sex, age, and time, revealed the number of pre-existing comorbidities to be associated with fatigue (OR 2.21; 95% CI 1.09-4.49; 0.028) and substantial fatigue (OR 1.73; 95% CI 1.06-2.95; 0.033) at 3 months follow-up. Except for shortness of breath, self-care, and follow-up time, all follow-up variables were found to be associated with fatigue and substantial fatigue at 3 months.

Conclusion: Fatigue and substantial fatigue are common after COVID-19 infection but often diminish over time. A significant number of patients continue to exhibit long-term fatigue at 6 months follow-up. Further research is needed to clarify the causality of viral infections in the development and severity of fatigue as a symptom and in meeting post-viral fatigue syndrome or ME/CFS diagnostic criteria.

Source: Magel T, Meagher E, Boulter T, Albert A, Tsai M, Muñoz C, Carlsten C, Johnston J, Wong AW, Shah A, Ryerson C, Mckay RJ, Nacul L. Fatigue presentation, severity, and related outcomes in a prospective cohort following post-COVID-19 hospitalization in British Columbia, Canada. Front Med (Lausanne). 2023 Jun 29;10:1179783. doi: 10.3389/fmed.2023.1179783. PMID: 37457578; PMCID: PMC10344448. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10344448/ (Full text)

Carotid body dysregulation contributes to the enigma of long COVID

Abstract:

The symptoms of long COVID, which include fatigue, breathlessness, dysregulated breathing, and exercise intolerance, have unknown mechanisms. These symptoms are also observed in heart failure and are partially driven by increased sensitivity of the carotid chemoreflex. As the carotid body has an abundance of ACE2 (the cell entry mechanism for SARS-CoV-2), we investigated whether carotid chemoreflex sensitivity was elevated in participants with long COVID. During cardiopulmonary exercise testing, the VE/VCO2 slope (a measure of breathing efficiency) was higher in the long COVID group than in the controls, indicating excessive hyperventilation.

The hypoxic ventilatory response, which measures carotid chemoreflex sensitivity, was increased in long COVID participants and correlated with the VE/VCO2 slope, suggesting that excessive hyperventilation may be related to carotid body hypersensitivity. Therefore, the carotid chemoreflex is sensitized in long COVID and may explain dysregulated breathing and exercise intolerance in these participants. Tempering carotid body excitability may be a viable treatment option for long COVID patients.

Source: Ahmed El-Medany, Zoe H Adams, Hazel C Blythe, Katrina A Hope, Adrian H Kendrick, Ana Paula Abdala Sheikh, Julian FR Paton, Angus K Nightingale, Emma C Hart. Carotid body dysregulation contributes to the enigma of long COVID. medRxiv 2023.05.25.23290513; doi: https://doi.org/10.1101/2023.05.25.23290513 https://www.medrxiv.org/content/10.1101/2023.05.25.23290513v1.full-text (Full text)

Role of Vitamin D Supplementation for Symptoms and Lung Function Improvement in Long COVID Patient

Abstract:

Post-Acute COVID-19 Syndrome (PACS) or acute post-COVID-19 syndrome or also known as “Long Covid”, is a collection of persistent symptoms and long-term complications more than four weeks after the onset of initial symptoms. One of the leading causes of these long-term complications is pulmonary fibrosis, with an incidence of almost 25% in patients a year after hospitalization. Vitamin D is an important substance to our body homeostasis and regulation. Vitamin D has pleiotropic effect as pulmonary antifibrosis. This research aims to directly provide vitamin D3 supplements, especially in improving lung function in pulmonary fibrosis patients after COVID-19 infection.

This study was a one-group, quasiexperimental pretest-posttest design conducted at Labuang Baji hospitals in the eastern part of Indonesia. The population of this study was patients post-covid-19 infection with negative PCR results at least three months, had persistent symptoms of covid 19, and a CT scan confirmed pulmonary fibrosis or destroyed lung results. Lung function was measured using spirometry before and after the intervention (Vitamin D3 5000 IU supplementation with a frequency of once per day for two months). This study included 20 cases of Lung Fibrosis post-Covid-19. The majority of respondents were women and between the ages of 40 and 49. Among 20 patients, most of them fatigue or dyspneu or shortness of breath as their main symptoms.

After 2-months supplementation of Vitamin D 5000 IU, number of patients who had shortness of breath and fatigue reduced significantly (From 11 to 3 and from 11 to 2 patients, respectively). 85% of our patient had deficient-insufficient status of vitamin D. We found restrictive pattern as a dominant lung function in our patient. There was significant improvement in lung function status after 2-months vitamin D supplementation (p=0.02). Vitamin D supplementation for Long COVID may have benefit for symptoms and lung function improvement.

Source: Irawaty Djaharuddin, Muzakkir Amir, Jamaluddin Madolangan, Ahmad Fachry Toaha, Muthiah Nur Afifah, Muhammad Zaki Rahmani, Izza fauziah Irfan.Role of Vitamin D Supplementation for Symptoms and Lung Function Improvement in Long COVID Patient. Teikyo Medical Journal. Volume 45, Issue 09, November, 2022 https://www.teikyomedicaljournal.com/volume/TMJ/45/10/role-of-vitamin-d-supplementation-for-symptoms-and-lung-function-improvement-in-long-covid-patient-638db40f96abb.pdf (Full text)

Antihistamines improve cardiovascular manifestations and other symptoms of Long-COVID attributed to Mast Cell Activation

Abstract:

Introduction: Long-COVID is a hardly defined condition and there are no effective therapies. Cardiovascular manifestations of Long-COVID include high heart rate, postural tachycardia, and palpitations. Previous studies have suggested that mast cell activation (MCA) may play a role in the pathophysiology of Long-COVID, including in the mechanisms of its cardiovascular manifestations. The aim of the study was to evaluate the effectiveness of a treatment with blockers of histamine receptors in Long-COVID patients who did not respond to other therapies.

Methods: Fourteen patients (F/M=9/5; 49.5±11.5 years) and 13 controls (F/M=8/5; 47.3±8.0 years) with Long-COVID symptoms attributed to MCA were evaluated. Patients were treated with fexofenadine (180 mg/day) and famotidine (40 mg/day). Fatigue, brain fog, abdominal disorders, and increased heart rate were evaluated in treated and untreated patients at baseline and 20 days later.

Results: Long-COVID symptoms disappeared completely in 29% of treated patients. There was significant improvement in each of the considered symptoms (improved or disappeared) in all treated patients, and the improvement grade was significantly greater in treated patients with respect to controls. No significant differences in the outcomes were observed in the controls.

Our data confirm that histamine receptors blockade may be an effective target to successfully treat long-COVID. Our finding supports the underlying role of MCA in the pathophysiology of Long-COVID.

Source: Fabrizio Salvucci, Roberto Codella, ADRIANA COPPOLA, Irene Zacchei, Gabriella Grassi, Maria L. Anti, Nicolita Nitisoara, Livio Luzi, and Carmine Gazzaruso. Antihistamines improve cardiovascular manifestations and other symptoms of Long-COVID attributed to Mast Cell Activation. Front. Cardiovasc. Med. Sec. General Cardiovascular Medicine. Volume 10 – 2023 | doi: 10.3389/fcvm.2023.1202696 https://www.frontiersin.org/articles/10.3389/fcvm.2023.1202696/abstract

Long COVID, the Brain, Nerves, and Cognitive Function

Abstract:

SARS-CoV-2, a single-stranded RNA coronavirus, causes an illness known as coronavirus disease 2019 (COVID-19). Long-term complications are an increasing issue in patients who have been infected with COVID-19 and may be a result of viral-associated systemic and central nervous system inflammation or may arise from a virus-induced hypercoagulable state. COVID-19 may incite changes in brain function with a wide range of lingering symptoms.
Patients often experience fatigue and may note brain fog, sensorimotor symptoms, and sleep disturbances. Prolonged neurological and neuropsychiatric symptoms are prevalent and can interfere substantially in everyday life, leading to a massive public health concern. The mechanistic pathways by which SARS-CoV-2 infection causes neurological sequelae are an important subject of ongoing research. Inflammation- induced blood-brain barrier permeability or viral neuro-invasion and direct nerve damage may be involved. Though the mechanisms are uncertain, the resulting symptoms have been documented from numerous patient reports and studies.
This review examines the constellation and spectrum of nervous system symptoms seen in long COVID and incorporates information on the prevalence of these symptoms, contributing factors, and typical course. Although treatment options are generally lacking, potential therapeutic approaches for alleviating symptoms and improving quality of life are explored.
Source: Reiss AB, Greene C, Dayaramani C, Rauchman SH, Stecker MM, De Leon J, Pinkhasov A. Long COVID, the Brain, Nerves, and Cognitive Function. Neurology International. 2023; 15(3):821-841. https://doi.org/10.3390/neurolint15030052 https://www.mdpi.com/2035-8377/15/3/52 (Full text)

Fatigue in Post-Acute Sequelae of Coronavirus Disease 2019

Abstract:

Fatigue from post-acute sequelae of coronavirus disease 2019 is a complex constellation of symptoms that could be driven by a wide spectrum of underlying etiologies. Despite this, there seems to be hope for treatment plans that focus on addressing possible etiologies and creating a path to improving quality of life and a paced return to activity.

Source: Abbott Z, Summers W, Niehaus W. Fatigue in Post-Acute Sequelae of Coronavirus Disease 2019. Phys Med Rehabil Clin N Am. 2023 Aug;34(3):607-621. doi: 10.1016/j.pmr.2023.04.006. Epub 2023 Apr 24. PMID: 37419535; PMCID: PMC10123359. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10123359/ (Full text)

Determinants of the Onset and Prognosis of the Post-COVID-19 Condition: A 2-Year Prospective Cohort Study

Abstract:

Background: At least 5-10% of subjects surviving COVID-19 develop the post-COVID-19 condition (PCC) or “Long COVID”. The clinical presentation of PCC is heterogeneous, its pathogenesis is being deciphered, and objective, validated biomarkers are lacking. It is unknown if PCC is a single entity or a heterogeneous syndrome with overlapping pathophysiological basis. In a large crossectional evaluation, the RECOVER study in the US identified four clusters of subjects with PCC according to their presenting symptoms. The long-term clinical implications of PCC remain unknown.

Methods: We conducted a 2-year prospective cohort study of subjects surviving COVID-19, including individuals fulfilling the WHO PCC definition and subjects with full clinical recovery. We systematically collected post-COVID-19 symptoms using prespecified questionnaires and performed additional diagnostic imaging tests when needed. Factors associated with PCC were identified and modeled using logistic regression. Unsupervised clustering analysis was used to group subjects with PCC according to their presenting symptoms. Factors associated with PCC recovery were modelled using a direct acyclic graph approach.

Findings: The study included 548 individuals, 341 with PCC, followed for a median of 23 months (IQR 16·5 – 23·5), and 207 subjects fully recovered. In the model with the best fit, subjects who were male and had tertiary studies were less likely to develop PCC, whereas a history of headache, or presence of tachycardia, fatigue, neurocognitive and neurosensitive complaints and dyspnea at COVID-19 diagnosis predicted the development of PCC. The cluster analysis revealed the presence of three symptom clusters with an additive number of symptoms. Only 26 subjects (7·6%) recovered from PCC during follow-up; almost all of them (n=24) belonged to the less symptomatic cluster A, dominated mainly by fatigue. Recovery from PCC was more likely in subjects who were male, required ICU admission, or had cardiovascular comorbidities, hyporexia and/or smell/taste alterations during acute COVID-19. Subjects presenting with muscle pain, impaired attention, dyspnea, or tachycardia, conversely, were less likely to recover from PCC.

Interpretation: Preexisting medical and socioeconomic factors, as well as acute COVID-19 symptoms, predict the development of and recovery from the PCC. Recovery is extremely rare during the first 2 years, posing a major challenge to healthcare systems.

Source: Mateu, Lourdes and Tebe, Cristian and Loste, Cora and Santos, José Ramón and Lladós, Gemma and López, Cristina and España-Cueto, Sergio and Toledo, Ruth and Font, Marta and Chamorro, Anna and Muñoz-López, Francisco and Nevot, Maria and Vallejo, Nuria and Teis, Albert and Puig, Jordi and Fumaz, Carmina Rodríguez and Muñoz-Moreno, José Antonio and Prats, Anna and Estany-Quera, Carla and Coll-Fernández, Roser and Herrero, Cristina and Casares, Patricia and Garcia, Anna and Paredes, Roger and Clotet, Bonaventura and Massanella, Marta, Determinants of the Onset and Prognosis of the Post-COVID-19 Condition: A 2-Year Prospective Cohort Study. Available at SSRN: https://ssrn.com/abstract=4505315 or http://dx.doi.org/10.2139/ssrn.4505315 (Full text available as PDF file)