Tag: long covid symptoms

Physical activity levels respiratory and peripheral muscle strength and pulmonary function in young post-COVID-19 patients : A cross-sectional study

Abstract:

Objective: Coronavirus disease 2019 (COVID-19) causes permanent problems, even mild severity. The long-term consequences of COVID-19 are still unknown. This study aimed to investigate physical activity levels, respiratory and peripheral muscle strength, and pulmonary function in the long term in young adult COVID-19 patients who recovered from mild disease.

Methods: This cross-sectional study was carried out at least 6 months after the COVID-19 diagnosis, 54 patients with COVID-19 (median age: 20 years) and 46 controls (median age: 21 years) were compared. Functional status (post-COVID-19 functional status scale), respiratory (maximum inspiratory and expiratory pressures (MIP, MEP)) and peripheral muscle strength (dynamometer), pulmonary function (Spirometry), dyspnea and fatigue (modified Borg scale), and physical activity levels (International Physical Activity Questionnaire) were evaluated.

Clinicaltrial number: NCT05381714.

Results: Patients with COVID-19 measured and percent predicted MIP and MEP were statistically decreased compared with the controls (p < 0.05). Shoulder abductors muscle strength (p < 0.001) and the number of individuals with low physical activity levels were significantly higher in patients compared with controls (p = 0.048). Pulmonary function, quadriceps muscle strength, exertional dyspnea, and fatigue scores were similar in groups (p > 0.05).

Conclusion: Respiratory and peripheral muscle strength and physical activity levels are adversely affected in patients with COVID-19, even though the patients were mildly affected in the long term. Also, symptoms such as dyspnea and fatigue may persist. Therefore, these parameters should be evaluated in the long term, even in young adults who are mildly affected by COVID-19.

Source: Güneş M, Yana M, Güçlü MB. Physical activity levels respiratory and peripheral muscle strength and pulmonary function in young post-COVID-19 patients : A cross-sectional study. Wien Klin Wochenschr. 2023 May;135(9-10):251-259. doi: 10.1007/s00508-023-02204-5. Epub 2023 Apr 28. PMID: 37115337; PMCID: PMC10141881. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10141881/ (Full text)

Trajectory of Gastrointestinal Symptoms in Previously Hospitalized COVID-19 Survivors: The Long COVID Experience Multicenter Study

Abstract:

This multicenter cohort study used Sankey plots and exponential bar plots to visualize the fluctuating evolution and the trajectory of gastrointestinal symptoms in previously hospitalized COVID-19 survivors during the first 18 months after acute SARS-CoV-2 infection. A total of 1266 previously hospitalized COVID-19 survivors were assessed at four points: hospital admission (T0), at 8.4 months (T1), at 13.2 months (T2), and at 18.3 months (T3) after hospitalization.
Participants were asked about their overall gastrointestinal symptoms and particularly diarrhea. Clinical and hospitalization data were collected from hospital medical records. The prevalence of overall gastrointestinal post-COVID symptomatology was 6.3% (n = 80) at T1, 3.99% (n = 50) at T2 and 2.39% (n = 32) at T3. The prevalence of diarrhea decreased from 10.69% (n = 135) at hospital admission (T0), to 2.55% (n = 32) at T1, to 1.04% (n = 14) at T2, and to 0.64% (n = 8) at T3. The Sankey plots revealed that just 20 (1.59%) and 4 (0.32%) patients exhibited overall gastrointestinal post-COVID symptoms or diarrhea, respectively, throughout the whole follow-up period.
The recovery fitted exponential curves revealed a decreasing prevalence trend, showing that diarrhea and gastrointestinal symptoms recover during the first two or three years after COVID-19 in previously hospitalized COVID-19 survivors. The regression models did not reveal any symptoms to be associated with the presence of gastrointestinal post-COVID symptomatology or post-COVID diarrhea at hospital admission or at T1. The use of Sankey plots revealed the fluctuating evolution of gastrointestinal post-COVID symptoms during the first two years after infection. In addition, exponential bar plots revealed the decreased prevalence of gastrointestinal post-COVID symptomatology during the first three years after infection.
Source: Fernández-de-las-Peñas C, Torres-Macho J, Guijarro C, Martín-Guerrero JD, Pellicer-Valero OJ, Plaza-Manzano G. Trajectory of Gastrointestinal Symptoms in Previously Hospitalized COVID-19 Survivors: The Long COVID Experience Multicenter Study. Viruses. 2023; 15(5):1134. https://doi.org/10.3390/v15051134 https://www.mdpi.com/1999-4915/15/5/1134 (Full text)

Corona With Lyme: A Long COVID Case Study

Abstract:

The longevity of the coronavirus disease 2019 (COVID-19) pandemic has necessitated continued discussion about the long-term impacts of SARS-CoV-2 infection. Many who develop an acute COVID-19 infection will later face a constellation of enduring symptoms of varying severity, otherwise known as long COVID. As the pandemic reaches its inevitable endemicity, the long COVID patient population will undoubtedly grow and require improved recognition and management. The case presented describes the three-year arc of a previously healthy 26-year-old female medical student from initial infection and induction of long COVID symptomology to near-total remission of the disease. In doing so, the course of this unique post-viral illness and the trials and errors of myriad treatment options will be chronologized, thereby contributing to the continued demand for understanding this mystifying disease.

Source: Thor DC, Suarez S. Corona With Lyme: A Long COVID Case Study. Cureus. 2023 Mar 24;15(3):e36624. doi: 10.7759/cureus.36624. PMID: 37155451; PMCID: PMC10122830. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10122830/ (Full text)

COVID-19: Post-recovery Manifestations

Abstract:

Background Post-COVID-19 syndrome, also known as long COVID, is a disorder that has many characteristics, one of which is chronic fatigue following acute infection with the SARS-CoV-2 virus.

Methodology We distributed a web-based survey among patients diagnosed with COVID-19 across the world and collected 190 responses regarding their demographics, histories, COVID-19 infection courses, and common symptoms.

Results We found that about 85.3% of the patients experienced some form of symptom following recovery from the infection. Among the reported symptoms, 59% of patients experienced fatigue or lethargy, 48.9% reported decreased stamina, 32.6% reported shortness of breath, 16.8% had a persistent cough, and 23.7% experienced anxiety following recovery from COVID-19.

Conclusions Reported symptoms closely resembled myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS); however, a deeper biochemical understanding of ME/CFS is required to confirm causation.

Source: Shaikh S, Siddiqi Z, Ukachukwu C, Mehkari Z, Khan S, Pamurthy K, Jahan F, Brown A. COVID-19: Post-recovery Manifestations. Cureus. 2023 Mar 29;15(3):e36886. doi: 10.7759/cureus.36886. PMID: 37128534; PMCID: PMC10147564. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10147564/ (Full text)

Long COVID: Where Are We in 2023?

Introduction:

The term “COVID Long-Hauler” or “Long-Haul COVID” was first created by patients within few months of the onset of the pandemic., The first publication of persistent symptoms following acute COVID-19 was from Italy in July 2020, where-in, 143 hospitalized patients with acute COVID-19 between April and May 2020, who eventually tested negative by polymerase chain reaction (PCR), were followed for two months as out-patient and 87.4% had at least one persistent symptom. The database study from the United States (U.S.) Department of Veterans Affairs (VA) was the first largest study to show that beyond a month of illness, there existed a higher risk for death and healthcare utilization because of a variety of incident respiratory, cardiovascular, neurological, musculoskeletal, gastrointestinal and metabolic disorders. Subsequently, multiple other observational studies have been published.– The systematic reviews that followed, were limited by the low quality of such studies, lack of standardized definition and representative biologic markers for the different organ systems involved as a part of this syndrome.

Source: Regunath H, Goldstein NM, Guntur VP. Long COVID: Where Are We in 2023? Mo Med. 2023 Mar-Apr;120(2):102-105. PMID: 37091941; PMCID: PMC10121126. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10121126/ (Full text)

Lung perfusion assessment in children with long-COVID: A pilot study

Abstract:

Background: There is increasing evidence that chronic endotheliopathy can play a role in patients with Post-Covid Condition (PCC, or Long Covid) by affecting peripheral vascularization. This pilot study aimed at assessing lung perfusion in children with Long-COVID with 99m Tc-MAA SPECT/CT.

Materials and methods: lung 99m Tc-MAA SPECT/CT was performed in children with Long-COVID and a pathological cardiopulmonary exercise testing (CPET). Intravenous injections were performed on patients in the supine position immediately before the planar scan according to the EANM guidelines for lung scintigraphy in children, followed by lung SPECT/CT acquisition. Reconstructed studies were visually analyzed.

Results: Clinical and biochemical data were collected during acute infection and follow-up in 14 children (6 females, mean age: 12.6 years) fulfilling Long-COVID diagnostic criteria and complaining of chronic fatigue and postexertional malaise after mild efforts, documented by CPET. Imaging results were compared with clinical scenarios during acute infection and follow-up. Six out of 14 (42.8%) children showed perfusion defects on 99m Tc-MAA SPECT/CT scan, without morphological alterations on coregistered CT.

Conclusions: This pilot investigation confirmed previous data suggesting that a small subgroup of children can develop lung perfusion defects after severe acute respiratory syndrome coronavirus 2 infection. Larger cohort studies are needed to confirm these preliminary results, providing also a better understanding of which children may deserve this test and how to manage those with lung perfusion defects.

Source: Pizzuto DA, Buonsenso D, Morello R, De Rose C, Valentini P, Fragano A, Baldi F, Di Giuda D. Lung perfusion assessment in children with long-COVID: A pilot study. Pediatr Pulmonol. 2023 Apr 25. doi: 10.1002/ppul.26432. Epub ahead of print. PMID: 37097045. https://onlinelibrary.wiley.com/doi/10.1002/ppul.26432 (Full text)

Long COVID and especially headache syndromes

Abstract:

Purpose of review: This is an expert overview on recent literature about the complex relationship between coronavirus disease 2019 (COVID-19) and headache.

Recent findings: Long COVID is a clinical syndrome characterized by the presence of persistent symptoms following the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Headache is one of the most common symptoms and is described most often as throbbing pain, associated with photo and phonofobia and worsening with physical exercise. In acute COVID-19, headache is usually described as moderate or severe, diffuse and oppressive although sometimes it has been described with a migraine-like phenotype, especially in patients with a previous history of migraine.

Headache intensity during acute phase seems to be the most important predictor of duration of headache over time. Some COVID-19 cases can be associated with cerebrovascular complications, and red flags of secondary headaches (e.g. new worsening or unresponsive headache, or new onset of neurological focal signs) should be urgently investigated with imaging. Treatment goals are the reduction of number and intensity of headache crises, and the prevention of chronic forms.

Summary: This review can help clinicians to approach patients with headache and infection from SARS-CoV-2, with particular attention to persistent headache in long COVID.

Source: Tana C, Giamberardino MA, Martelletti P. Long COVID and especially headache syndromes. Curr Opin Neurol. 2023 Jun 1;36(3):168-174. doi: 10.1097/WCO.0000000000001153. Epub 2023 Apr 4. PMID: 37078648. https://pubmed.ncbi.nlm.nih.gov/37078648/

Exaggerated blood pressure elevation in response to orthostatic challenge, a post-acute sequelae of SARS-CoV-2 infection (PASC) after hospitalization

Abstract:

Objective: Post-acute sequelae of SARS-COV-2 (PASC) are emerging as a major health challenge. Orthostatic intolerance secondary to autonomic failure has been found in PASC patients. This study investigated the effect of COVID-19 after recovery on blood pressure (BP) during the orthostatic challenge.

Research design and methods: Thirty-one out of 45 patients hospitalized due to COVID-19-related pneumonia that developed PASC and did not have hypertension at discharge were studied. They underwent a head-up tilt test (HUTT) at 10.8 ± 1.9 months from discharge. All met the PASC clinical criteria, and an alternative diagnosis did not explain the symptoms. This population was compared with 32 historical asymptomatic healthy controls.

Results: Exaggerated orthostatic blood pressure response (EOPR)/orthostatic hypertension (OHT) was detected in 8 out of 23 (34.7 %) patients, representing a significantly increased prevalence (7.67-fold increase p = 0.009) compared to 2 out of 32 (6.4 %) asymptomatic healthy controls matched by age, who underwent HUTT and were not infected with SARS-CoV-2.

Conclusions: This prospective evaluation in patients with PASC revealed abnormal blood pressure rise during the orthostatic challenge, suggesting of autonomic dysfunction in a third of the studied subjects. Our findings support the hypothesis that EOPR/OHT may be a phenotype of neurogenic hypertension. Hypertension in PASC patients may adversely affect the cardiovascular burden in the world.

Source: González-Hermosillo G JA, Galarza EJ, Fermín OV, González JMN, Tostado LMFÁ, Lozano MAE, Rabasa CR, Martínez Alvarado MDR. Exaggerated blood pressure elevation in response to orthostatic challenge, a post-acute sequelae of SARS-CoV-2 infection (PASC) after hospitalization. Auton Neurosci. 2023 Apr 21;247:103094. doi: 10.1016/j.autneu.2023.103094. Epub ahead of print. PMID: 37137186; PMCID: PMC10121145. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10121145/ (Full text)

Persistent post-COVID-19 dysosmia: Practices survey of members of the French National Union of Otorhinolaryngology-Head and Neck Surgery Specialists. CROSS analysis

Abstract:

Introduction: Persistent dysosmia more than 3 months after SARS-CoV-2 disease (COVID-19) is considered as long-COVID olfactory disease (LCOD). The primary objective of this study was to evaluate the diagnostic and therapeutic management of LCOD in the daily clinical practice of members of the National Union of Otorhinolaryngology-Head and Neck Surgery Specialists (Syndicat national des médecins spécialisés en ORL et chirurgie cervico-faciale) (SNORL). The secondary objective was to identify factors influencing management within the descriptive survey data.

Materials and methods: A questionnaire was designed (GoogleForm®) and e-mailed to all 715 SNORL members in January 2022.

Results: The response rate was 7.4% (n=53/715). In total, 94.3% of respondents (n=50) had managed LCOD cases, and 56% (n=28) used psychophysical olfactory tests. Specific olfactory medical therapy involved local corticosteroid nasal sprays in 49.1% of cases (n=26) and oral corticosteroids in 32.1% (n=17). Olfactory self-training was prescribed by 81.1% of respondents, with associated speech pathologist therapy in 15.1% (n=8) of cases. No predictive factors for specific management were identified.

Conclusion: Olfactometry is currently under-applied. Consistent with guidelines, non-drug therapy (olfactory training) is the first-line treatment for LCOD.

Source: Vandersteen C, Dubrulle C, Manera V, Castillo L, Payne M, Gros A. Persistent post-COVID-19 dysosmia: Practices survey of members of the French National Union of Otorhinolaryngology-Head and Neck Surgery Specialists. CROSS analysis. Eur Ann Otorhinolaryngol Head Neck Dis. 2023 Apr 7:S1879-7296(23)00052-2. doi: 10.1016/j.anorl.2023.04.002. Epub ahead of print. PMID: 37087365; PMCID: PMC10080269. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10080269/ (Full text)

Autonomic Dysfunction related to Post-Acute SARS-CoV-2 Syndrome

Introduction:

The SARS-CoV-2 virus, a member of the coronavirus family, has been responsible for the Coronavirus Disease-19 (COVID-19) pandemic with an acute phase causing pneumonia and pulmonary disorders, but it has been shown to extrapulmonary manifestations including cardiovascular and neurological diseases. Moreover, residual symptoms have been reported to persist past the acute phase. In a cross-sectional study of SARS-CoV-2 positive patients, at 48 days post-discharge the most common persistent symptoms were fatigue, difficulty breathing, and psychological distress.
 In a cohort study of 1,733 COVID-19 patients from Wuhan, China, patients reported persistence of fatigue, muscle weakness, sleeping difficulties, palpitations, anxiety, or depression at 6 months after initial onset.
 Numerous other studies now indicate the presence of persistent symptoms following COVID-19 infection, with over 200 symptoms reported. This syndrome has been coined as the Post-Acute SARS-CoV-2 Syndrome (PASC) and has been defined as the persistence of symptoms or development of new symptoms after the time of infection, which can include fatigue, brain fog, palpitations, and a plethora of other manifestations.
Source: Justin Haloot, DO, MS, MS, Ratna Bhavaraju-Sanka, MD, Jayasree Pillarisetti, MD Msc, Monica Verduzco-Gutierrez, MD. Autonomic Dysfunction related to Post-Acute SARS-CoV-2 Syndrome. Physical Medicine and Rehabiliation Clinics. Published: April 18, 2023. DOI:https://doi.org/10.1016/j.pmr.2023.04.003 (Full text)