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Cegolon L, Mauro M, Sansone D, Tassinari A, Gobba FM, Modenese A, Casolari L, Liviero F, Pavanello S, Scapellato ML, Taus F, Carta A, Spiteri G, Monaco MGL, Porru S, Larese Filon F. A Multi-Center Study Investigating Long COVID-19 in Healthcare Workers from North-Eastern Italy: Prevalence, Risk Factors and the Impact of Pre-Existing Humoral Immunity-ORCHESTRA Project. Vaccines (Basel) 2023; 11:1769. [PMID: 38140174 PMCID: PMC10747427 DOI: 10.3390/vaccines11121769] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Introduction: The impact of long-COVID-19 syndrome is rather variable, since it is influenced by several residual confounders. This study aimed to investigate the prevalence of long COVID-19 in healthcare workers (HCWs) from four university hospitals in north-eastern Italy: Trieste, Padua, Verona, and Modena-Reggio Emilia. Methods: During the period June 2022-August 2022, HCWs were surveyed for past COVID-19 infections, medical history, and any acute as well as post-COVID-19 symptoms. The prevalence of long COVID-19 was estimated at 30-60 days or 61+ days since first negative swab following first and second COVID-19 episode. Furthermore, the risk of long COVID-19 was investigated by multivariable logistic regression. Results were expressed as the adjusted odds ratio (aOR) with a 95% confidence interval (95%CI). Results: 5432 HCWs returned a usable questionnaire: 2401 were infected with SARS-CoV-2 at least once, 230 were infected at least twice, and 8 were infected three times. The prevalence of long COVID-19 after a primary COVID-19 infection was 24.0% at 30-60 days versus 16.3% at 61+ days, and 10.5% against 5.5% after the second SARS-CoV-2 event. The most frequent symptoms after a first COVID-19 event were asthenia (30.3%), followed by myalgia (13.7%), cough (12.4%), dyspnea (10.2%), concentration deficit (8.1%), headache (7.3%), and anosmia (6.5%), in decreasing order of prevalence. The risk of long COVID-19 at 30-60 days was significantly higher in HCWs hospitalized for COVID-19 (aOR = 3.34; 95%CI: 1.62; 6.89), those infected with SARS-CoV-2 during the early pandemic waves-namely the Wuhan (aOR = 2.16; 95%CI: 1.14; 4.09) or Alpha (aOR= 2.05; 95%CI: 1.25; 3.38) transmission periods-and progressively increasing with viral shedding time (VST), especially 15+ days (aOR = 3.20; 95%CI: 2.07; 4.94). Further determinants of long COVID-19 at 30-60 days since primary COVID-19 event were female sex (aOR = 1.91; 95%CI: 1.30; 2.80), age >40 years, abnormal BMI, or administrative services (reference category). In contrast, HCWs vaccinated with two doses before their primary infection (aOR = 0.57; 95%CI: 0.34; 0.94), undergraduate students, or postgraduate medical trainees were less likely to experience long COVID-19 at 30-60 days. Apart from pandemic waves, the main determinants of long COVID-19 at 30-60 days were confirmed at 61+ days. Conclusions: The risk of long COVID-19 following primary infection increased with the severity of acute disease and VST, especially during the initial pandemic waves, when more virulent viral strains were circulating, and susceptibility to SARS-CoV-2 was higher since most HCWs had not been infected yet, COVID-19 vaccines were still not available, and/or vaccination coverage was still building up. The risk of long COVID-19 therefore decreased inversely with humoral immunity at the individual level. Nevertheless, the prevalence of long COVID-19 was remarkably lower after SARS-CoV-2 reinfections regardless of vaccination status, suggesting that hybrid humoral immunity did not increase protection against the syndrome compared to immunity mounted by either natural infection or vaccination separately. Since the risk of long COVID-19 is currently low with Omicron and patients who developed the syndrome following SARS-CoV-2 infection in the early pandemic waves tend to return to a state of full health with time, a cost-effective approach to screen post-COVID-19 symptoms during the Omicron time could be restricted to vulnerable individuals developing severe disease and/or with prolonged VST.
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Affiliation(s)
- Luca Cegolon
- Occupational Medicine Unit, Department of Medical, Surgical & Health Sciences, University of Trieste, 34129 Trieste, Italy; (M.M.); (D.S.); (A.T.); (F.L.F.)
- Occupational Medicine Unit, University Health Agency Giuliano-Isontina (ASUGI), 34129 Trieste, Italy
| | - Marcella Mauro
- Occupational Medicine Unit, Department of Medical, Surgical & Health Sciences, University of Trieste, 34129 Trieste, Italy; (M.M.); (D.S.); (A.T.); (F.L.F.)
- Occupational Medicine Unit, University Health Agency Giuliano-Isontina (ASUGI), 34129 Trieste, Italy
| | - Donatella Sansone
- Occupational Medicine Unit, Department of Medical, Surgical & Health Sciences, University of Trieste, 34129 Trieste, Italy; (M.M.); (D.S.); (A.T.); (F.L.F.)
| | - Alice Tassinari
- Occupational Medicine Unit, Department of Medical, Surgical & Health Sciences, University of Trieste, 34129 Trieste, Italy; (M.M.); (D.S.); (A.T.); (F.L.F.)
| | - Fabrizio Maria Gobba
- Department of Biomedical, Metabolic and Neurological Sciences, University of Modena and Reggio-Emilia, 41125 Modena, Italy; (F.M.G.); (A.M.)
| | - Alberto Modenese
- Department of Biomedical, Metabolic and Neurological Sciences, University of Modena and Reggio-Emilia, 41125 Modena, Italy; (F.M.G.); (A.M.)
| | - Loretta Casolari
- Health Surveillance Service, Modena University Hospital, 41125 Modena, Italy;
| | - Filippo Liviero
- Occupational Medicine Unit, Padua University Hospital, 35128 Padua, Italy; (F.L.); (S.P.)
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35128 Padua, Italy
| | - Sofia Pavanello
- Occupational Medicine Unit, Padua University Hospital, 35128 Padua, Italy; (F.L.); (S.P.)
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35128 Padua, Italy
| | - Maria Luisa Scapellato
- Occupational Medicine Unit, Padua University Hospital, 35128 Padua, Italy; (F.L.); (S.P.)
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35128 Padua, Italy
| | - Francesco Taus
- Department of Diagnostics and Public Health, Section of Medical Statistics, University of Verona, 37134 Verona, Italy;
| | - Angela Carta
- Occupational Medicine Unit, Verona University Hospital, 37134 Verona, Italy; (A.C.); (G.S.); (M.G.L.M.); (S.P.)
- Department of Diagnostics and Public Health, Section of Occupational Medicine, University of Verona, 37134 Verona, Italy
| | - Gianluca Spiteri
- Occupational Medicine Unit, Verona University Hospital, 37134 Verona, Italy; (A.C.); (G.S.); (M.G.L.M.); (S.P.)
| | - Maria Grazia Lourdes Monaco
- Occupational Medicine Unit, Verona University Hospital, 37134 Verona, Italy; (A.C.); (G.S.); (M.G.L.M.); (S.P.)
| | - Stefano Porru
- Occupational Medicine Unit, Verona University Hospital, 37134 Verona, Italy; (A.C.); (G.S.); (M.G.L.M.); (S.P.)
- Department of Diagnostics and Public Health, Section of Occupational Medicine, University of Verona, 37134 Verona, Italy
| | - Francesca Larese Filon
- Occupational Medicine Unit, Department of Medical, Surgical & Health Sciences, University of Trieste, 34129 Trieste, Italy; (M.M.); (D.S.); (A.T.); (F.L.F.)
- Occupational Medicine Unit, University Health Agency Giuliano-Isontina (ASUGI), 34129 Trieste, Italy
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Madison AA, Renna M, Andridge R, Peng J, Shrout MR, Sheridan J, Lustberg M, Ramaswamy B, Wesolowski R, Williams NO, Noonan AM, Reinbolt RE, Stover DG, Cherian MA, Malarkey WB, Kiecolt-Glaser JK. Conflicts hurt: social stress predicts elevated pain and sadness after mild inflammatory increases. Pain 2023; 164:1985-1994. [PMID: 36943254 PMCID: PMC10440304 DOI: 10.1097/j.pain.0000000000002894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 02/07/2023] [Indexed: 03/23/2023]
Abstract
ABSTRACT Individuals respond differently to inflammation. Pain, sadness, and fatigue are common correlates of inflammation among breast cancer survivors. Stress may predict response intensity. This study tested whether breast cancer survivors with greater exposure to acute or chronic social or nonsocial stress had larger increases in pain, sadness, and fatigue during an acute inflammatory response. In total, 156 postmenopausal breast cancer survivors (ages 36-78 years, stage I-IIIA, 1-9 years posttreatment) were randomized to either a typhoid vaccine/saline placebo or the placebo/vaccine sequence, which they received at 2 separate visits at least 1 month apart. Survivors had their blood drawn every 90 minutes for the next 8 hours postinjection to assess levels of interleukin-6 and interleukin-1 receptor antagonist (IL-1Ra). Shortly after each blood draw, they rated their current levels of pain, sadness, and fatigue. Women also completed the Test of Negative Social Exchange to assess chronic social stress and the Trier Inventory of Chronic Stressors screen to index chronic general stress. At each visit, a trained experimenter administered the Daily Inventory of Stressful Events to assess social and nonsocial stress exposure within the past 24 hours. After statistical adjustment for relevant demographic and behavioral covariates, the most consistent results were that survivors who reported more chronic social stress reported more pain and sadness in response to IL-1Ra increases. Frequent and ongoing social stress may sensitize the nervous system to the effects of inflammation, with potential implications for chronic pain and depression risk among breast cancer survivors.
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Affiliation(s)
- Annelise A Madison
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, United States
- Department of Psychology, The Ohio State University, Columbus, OH, United States
| | - Megan Renna
- School of Psychology, University of Southern Mississippi, Hattiesburg, MS, United States
| | - Rebecca Andridge
- Division of Biostatistics, The Ohio State University, Columbus, OH, United States
| | - Juan Peng
- Division of Biostatistics, The Ohio State University, Columbus, OH, United States
| | - M Rosie Shrout
- College of Health and Human Sciences, Purdue University, West Lafayette, IN, United States
| | - John Sheridan
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, United States
- Division of Biosciences, The Ohio State University College of Dentistry, Columbus, OH, United States
| | | | - Bhuvaneswari Ramaswamy
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Robert Wesolowski
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Nicole O Williams
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Anne M Noonan
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Raquel E Reinbolt
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Daniel G Stover
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Mathew A Cherian
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, United States
| | - William B Malarkey
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Janice K Kiecolt-Glaser
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, United States
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, United States
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Al-Hadrawi DS, Al-Rubaye HT, Almulla AF, Al-Hakeim HK, Maes M. Lowered oxygen saturation and increased body temperature in acute COVID-19 largely predict chronic fatigue syndrome and affective symptoms due to Long COVID: A precision nomothetic approach. Acta Neuropsychiatr 2023; 35:76-87. [PMID: 36134517 DOI: 10.1017/neu.2022.21] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Long coronavirus disease 2019 (LC) is a chronic sequel of acute COVID-19. The exact pathophysiology of the affective, chronic fatigue and physiosomatic symptoms (labelled as "physio-affective phenome") of LC has remained elusive. OBJECTIVE The current study aims to delineate the effects of oxygen saturation (SpO2) and body temperature during the acute phase on the physio-affective phenome of LC. METHOD We recruited 120 LC patients and 36 controls. For all participants, we assessed the lowest SpO2 and peak body temperature during acute COVID-19, and the Hamilton Depression and Anxiety Rating Scale (HAMD/HAMA) and Fibro Fatigue (FF) scales 3-4 months later. RESULTS Lowered SpO2 and increased body temperature during the acute phase and female sex predict 60.7% of the variance in the physio-affective phenome of LC. Using unsupervised learning techniques, we were able to delineate a new endophenotype class, which comprises around 26.7% of the LC patients and is characterised by very low SpO2 and very high body temperature, and depression, anxiety, chronic fatigue, and autonomic and gastro-intestinal symptoms scores. Single latent vectors could be extracted from both biomarkers, depression, anxiety and FF symptoms or from both biomarkers, insomnia, chronic fatigue, gastro-intestinal and autonomic symptoms. CONCLUSION The newly constructed endophenotype class and pathway phenotypes indicate that the physio-affective phenome of LC is at least in part the consequence of the pathophysiology of acute COVID-19, namely the combined effects of lowered SpO2, increased body temperature and the associated immune-inflammatory processes and lung lesions.
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Sandler CX, Cvejic E, Valencia BM, Li H, Hickie IB, Lloyd AR. Predictors of Chronic Fatigue Syndrome and Mood Disturbance After Acute Infection. Front Neurol 2022; 13:935442. [PMID: 35959390 PMCID: PMC9359311 DOI: 10.3389/fneur.2022.935442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
Prospective cohort studies following individuals from acute infections have documented a prevalent post-infective fatigue state meeting diagnostic criteria for chronic fatigue syndrome (CFS) – that is, a post-infective fatigue syndrome (PIFS). The Dubbo Infection Outcomes Study (DIOS) was a prospective cohort following individuals from acute infection with Epstein-Barr virus (EBV), Ross River virus (RRV), or Q fever through to assessment of caseness for CFS designated by physician and psychiatrist assessments at 6 months. Previous studies in DIOS have revealed that functional genetic polymorphisms in both immunological (pro- and anti-inflammatory cytokines) and neurological (the purinergic receptor, P2X7) genes are associated with both the severity of the acute infection and subsequent prolonged illness. Principal components analysis was applied to self-report data from DIOS to describe the severity and course of both the overall illness and concurrent mood disturbance. Associations between demographics and acute infection characteristics, with prolonged illness course as well as the PIFS outcome were examined using multivariable statistics. Genetic haplotype-driven functional variations in the neuropeptide Y (NPY) gene previously shown to be associated with brain responses to stress, and to trait anxiety were also examined as predictors. The sample included 484 subjects (51% female, median age 32, IQR 19–44), of whom 90 (19%) met diagnostic criteria for CFS at 6 months. Participants with greater overall illness severity and concurrent mood disturbance in the acute illness had a more prolonged illness severity (HR = 0.39, 95% CI: 0.34–0.46, p < 0.001) and mood disturbance (HR = 0.36, 95% CI: 0.30–0.42, p < 0.001), respectively. Baseline illness severity and RRV infection were associated with delayed recovery. Female gender and mood disturbance in the acute illness were associated with prolonged mood disturbance. Logistic regression showed that the odds of an individual being diagnosed with PIFS increased with greater baseline illness severity (OR = 2.24, 95% CI: 1.71–2.94, p < 0.001). There was no association between the NPY haplotypes with overall illness severity or mood disturbance either during the acute illness phase or with prolonged illness (p > 0.05). Severe acute infective illnesses predicted prolonged illness, prolonged mood disturbance and PIFS. These factors may facilitate early intervention to manage both PIFS and mood disturbances.
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Affiliation(s)
- Carolina X. Sandler
- Laboratory Viral Immunology Systems Program, Kirby Institute, The University of New South Wales (UNSW Sydney), Sydney, NSW, Australia
- Sport and Exercise Science, School of Health Science, Western Sydney University, Sydney, NSW, Australia
- Menzies Health Institute Queensland, Griffith University Brisbane, Queensland, QLD, Australia
| | - Erin Cvejic
- The University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney, NSW, Australia
| | - Braulio M. Valencia
- Laboratory Viral Immunology Systems Program, Kirby Institute, The University of New South Wales (UNSW Sydney), Sydney, NSW, Australia
| | - Hui Li
- Laboratory Viral Immunology Systems Program, Kirby Institute, The University of New South Wales (UNSW Sydney), Sydney, NSW, Australia
| | - Ian B. Hickie
- The University of Sydney, Brain and Mind Centre, Sydney, NSW, Australia
| | - Andrew R. Lloyd
- Laboratory Viral Immunology Systems Program, Kirby Institute, The University of New South Wales (UNSW Sydney), Sydney, NSW, Australia
- *Correspondence: Andrew R. Lloyd
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Lasselin J. Back to the future of psychoneuroimmunology: Studying inflammation-induced sickness behavior. Brain Behav Immun Health 2021; 18:100379. [PMID: 34761246 PMCID: PMC8566772 DOI: 10.1016/j.bbih.2021.100379] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 12/16/2022] Open
Abstract
What do we know about sickness behavior? In this article, I guide you through some of the complexity of sickness behavior occurring after an immune challenge. I highlight the many features of behavioral and affective changes induced during experimental endotoxemia in humans, and describe how little we know about many of these features. I argue that we need to dismantle the components of inflammation-induced sickness behavior, and study each component in detail. I also point out the large inter-individual differences in inflammation-induced behavioral and affective changes, and the fact that psychosocial factors likely interact with inflammation to shape inflammation-induced sickness behavior. PNI clearly lacks investigations of the vulnerability and resilient factors underlying the inter-individual variability in sickness behavior. Throughout the article, I base my argument on my published articles, and provide concrete examples from my experience and the data that I have collected over the past 10 years. Given the relevance of inflammation-induced sickness behavior for inflammation-associated depression and for how people react to infections, I encourage current and future psychoneuroimmunologists to return towards basic science of sickness behavior. Inflammation-related sickness behavior is relevant for inflammation-associated depression The many features of sickness behavior should be investigated in detail There are large inter-individual variability in sickness behavior Vulnerability and resilient factors predicting sickness responses are little known I call for a return towards basic science of sickness behavior.
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Affiliation(s)
- Julie Lasselin
- Stress Research Institute, Department of Psychology, Stockholm University, SE-106 91, Stockholm, Sweden.,Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Osher Center for Integrative Medicine, ME Neuroradiologi, Karolinska Universitetssjukhuset, Stockholm, Sweden
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Sandler CX, Wyller VBB, Moss-Morris R, Buchwald D, Crawley E, Hautvast J, Katz BZ, Knoop H, Little P, Taylor R, Wensaas KA, Lloyd AR. Long COVID and Post-infective Fatigue Syndrome: A Review. Open Forum Infect Dis 2021; 8:ofab440. [PMID: 34631916 PMCID: PMC8496765 DOI: 10.1093/ofid/ofab440] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/22/2021] [Indexed: 11/14/2022] Open
Abstract
Fatigue is a dominant feature of both acute and convalescent coronavirus disease 2019 (COVID-19) (sometimes termed "long-COVID"), with up to 46% of patients reporting fatigue that lasts from weeks to months. The investigators of the international Collaborative on Fatigue Following Infection (COFFI) conducted a systematic review of post-COVID fatigue and a narrative review on fatigue after other infections, and made recommendations for clinical and research approaches to assessing fatigue after COVID-19. In the majority of COVID-19 cohort studies, persistent fatigue was reported by a significant minority of patients, ranging from 13% to 33% at 16-20 weeks post-symptom onset. Data from the prospective cohort studies in COFFI and others indicate that fatigue is also a prevalent outcome from many acute systemic infections, notably infectious mononucleosis, with a case rate for clinically significant Post-infective fatigue after exclusion of recognized medical and psychiatric causes, ranging from 10%-35% at 6 months. To better characterize post-COVID fatigue, the COFFI investigators recommend the following: application of validated screening questionnaires for case detection; standardized interviews encompassing fatigue, mood, and other symptoms; and investigative approaches to identify end-organ damage and mental health conditions.
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Affiliation(s)
| | - Vegard B B Wyller
- Department of Pediatrics and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Blindern, Oslo, Norway
| | - Rona Moss-Morris
- Health Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, Washington, USA
| | - Esther Crawley
- Bristol Medical School, University of Bristol. Bristol. Centre for Academic Child Health, Bristol, United Kingdom
| | - Jeannine Hautvast
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Nijmegen, Netherlands
| | - Ben Z Katz
- Northwestern University Feinberg School of Medicine, Chicago, Department of Pediatrics, Chicago, Illinois, USA
- Ann & Robert H Lurie Children’s Hospital of Chicago, Division of Infectious Diseases, Chicago, Illinois, USA
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Paul Little
- Primary Care Research Centre, Primary Care Public Health and Medical Education Unit, Faculty of Medicine, University of Southampton, United Kingdom
| | - Renee Taylor
- College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Knut-Arne Wensaas
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - Andrew R Lloyd
- The Kirby Institute, UNSW Sydney, New South Wales, Australia
- Correspondence: Andrew Lloyd, MBBS, PhD, FRACP, FAHMS, Level 5, Wallace Wurth Building, Kirby Institute, UNSW Sydney, NSW 2052, Australia ()
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O'Neal AJ, Hanson MR. The Enterovirus Theory of Disease Etiology in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Critical Review. Front Med (Lausanne) 2021; 8:688486. [PMID: 34222292 PMCID: PMC8253308 DOI: 10.3389/fmed.2021.688486] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/26/2021] [Indexed: 02/06/2023] Open
Abstract
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a complex, multi-system disease whose etiological basis has not been established. Enteroviruses (EVs) as a cause of ME/CFS have sometimes been proposed, as they are known agents of acute respiratory and gastrointestinal infections that may persist in secondary infection sites, including the central nervous system, muscle, and heart. To date, the body of research that has investigated enterovirus infections in relation to ME/CFS supports an increased prevalence of chronic or persistent enteroviral infections in ME/CFS patient cohorts than in healthy individuals. Nevertheless, inconsistent results have fueled a decline in related studies over the past two decades. This review covers the aspects of ME/CFS pathophysiology that are consistent with a chronic enterovirus infection and critically reviews methodologies and approaches used in past EV-related ME/CFS studies. We describe the prior sample types that were interrogated, the methods used and the limitations to the approaches that were chosen. We conclude that there is considerable evidence that prior outbreaks of ME/CFS were caused by one or more enterovirus groups. Furthermore, we find that the methods used in prior studies were inadequate to rule out the presence of chronic enteroviral infections in individuals with ME/CFS. Given the possibility that such infections could be contributing to morbidity and preventing recovery, further studies of appropriate biological samples with the latest molecular methods are urgently needed.
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Affiliation(s)
- Adam J O'Neal
- Department of Molecular Biology and Genetics, Cornell University, Ithaca, NY, United States
| | - Maureen R Hanson
- Department of Molecular Biology and Genetics, Cornell University, Ithaca, NY, United States
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Valencia BM, Cvejic E, Vollmer-Conna U, Hickie IB, Wakefield D, Li H, Pedergnana V, Rodrigo C, Lloyd AR. The severity of the pathogen-induced acute sickness response is affected by polymorphisms in genes of the NLRP3 inflammasome pathway. Brain Behav Immun 2021; 93:186-193. [PMID: 33434563 PMCID: PMC7794598 DOI: 10.1016/j.bbi.2021.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/18/2020] [Accepted: 01/06/2021] [Indexed: 12/27/2022] Open
Abstract
The acute sickness response (ASR) is a stereotyped set of symptoms including fatigue, pain, and disturbed mood, which are present in most acute infections. The immunological mechanisms of the ASR are conserved, with variations in severity determined partly by the pathogen, but also by polymorphisms in host genes. The ASR was characterised in three different serologically-confirmed acute infections in Caucasians (n = 484) across four symptom domains or endophenotypes (termed 'Fatigue', 'Musculoskeletal pain', 'Mood disturbance', and 'Acute sickness'). Correlations were sought with functional single nucleotide polymorphisms in the NLRP3 inflammasone pathway and severity of the endophenotypes. Individuals with severe Fatigue, Musculoskeletal pain, or Mood endophenotypes were more likely to have prior episodes of significant fatigue (11.4 vs. 3.8%, p = 0.07), pain (14.3 vs. 1.2%, p = 0.001), or Mood disturbance (13 vs 1%, p=0.001), suggesting trait characteristics. The high functioning allele of the rs35829419 SNP in NLRP3 was more common in those with severe Fatigue (OR = 13.3, 95% CI: 1.7-104), particularly in a dominant inheritance pattern (OR = 13.4, 95% CI: 1.8-586.3). In a multivariable analysis assuming dominant inheritance, both rs35829419 and the rs4848306 SNP in Interleukin(IL)-1β, were independently associated with severe Fatigue (OR = 29.6, 95% CI: 2.6-330.9 and OR = 13, 95% CI: 2.7-61.8, respectively). The severity of fatigue in acute infection is influenced by genetic polymorphisms in NLRP3 and IL-1β.
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Affiliation(s)
- Braulio M. Valencia
- Kirby Institute, The University of New South Wales, Sydney (UNSW Sydney), Wallace Wurth Building, High St, Kensington, NSW 2052, Australia
| | - Erin Cvejic
- The University of Sydney, School of Public Health, Faculty of Medicine and Health, Edward Ford Building (A27), Fisher Rd, NSW 2006, Australia,Department of Human Behaviour, School of Psychiatry, UNSW Sydney, Kensington, NSW 2052, Australia
| | - Ute Vollmer-Conna
- Department of Human Behaviour, School of Psychiatry, UNSW Sydney, Kensington, NSW 2052, Australia
| | - Ian B. Hickie
- Brain and Mind Centre, The University of Sydney, 94 Mallett St, Camperdown, NSW 2050, Australia
| | - Denis Wakefield
- School of Medical Sciences, UNSW Sydney, Wallace Wurth Building, High St, Kensington, NSW 2052, Australia
| | - Hui Li
- Kirby Institute, The University of New South Wales, Sydney (UNSW Sydney), Wallace Wurth Building, High St, Kensington, NSW 2052, Australia
| | - Vincent Pedergnana
- Laboratoire MIVEGEC, Institut de recherche pour le développement, 39 Avenue Charles Flahault, 34090 Montpellier, France
| | - Chaturaka Rodrigo
- Kirby Institute, The University of New South Wales, Sydney (UNSW Sydney), Wallace Wurth Building, High St, Kensington, NSW 2052, Australia,School of Medical Sciences, UNSW Sydney, Wallace Wurth Building, High St, Kensington, NSW 2052, Australia
| | - Andrew R. Lloyd
- Kirby Institute, The University of New South Wales, Sydney (UNSW Sydney), Wallace Wurth Building, High St, Kensington, NSW 2052, Australia,Corresponding author at: Viral Immunology Systems Program, Kirby Institute, UNSW Sydney, 2052, Australia
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Shattuck EC, Perrotte JK, Daniels CL, Xu X, Sunil TS. The Contribution of Sociocultural Factors in Shaping Self-Reported Sickness Behavior. Front Behav Neurosci 2020; 14:4. [PMID: 32038193 PMCID: PMC6992553 DOI: 10.3389/fnbeh.2020.00004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/09/2020] [Indexed: 12/11/2022] Open
Abstract
Sickness behavior is an evolutionarily conserved phenomenon found across a diverse range of animals involving a change in motivational priorities to theoretically maximize energetic investment in immune function and recovery. Typical components of sickness behavior include reduced sociability and activity, changes in diet, and depressed affect. Importantly, however, sickness behavior appears to be subject to other demands of life history in animal models, including reproduction and offspring survival. Thus, "feeling sick" is often context dependent with possible effects on morbidity and mortality. While humans may not always face the same life history trade-offs, sociocultural norms and values may similarly shape sickness behavior by establishing internalized parameters for "socially appropriate sickness." We explore the role of these factors in shaping sickness behavior by surveying a national U.S. sample (n = 1,259). Self-reported and recalled sickness behavior was measured using the SicknessQ instrument, which has previously been validated against experimentally induced sickness behavior. After post-stratification weighting and correction for Type I error, generalized linear models showed that sickness behavior is significantly affected by various factors across sex and racial/ethnic groupings. Income below the national mean (b = 1.85, adj. p = 0.025), stoic endurance of pain and discomfort (b = 1.61, adj. p < 0.001), and depressive symptomology (b = 0.53, adj. p < 0.001) were each associated with greater sickness behavior scores. Familism (b = 1.59, adj. p = 0.008) was positively associated with sickness behavior in men, but not women. Endurance of pain and discomfort was associated with greater sickness behavior in Whites only (b = 1.94, adj. p = 0.002), while familism approached significance in African Americans only (b = 1.86, adj. p = 0.057). These findings may reflect different social contexts of sickness across demographic groups, which may in turn have important implications for pathogen transmission and recovery times, potentially contributing to health disparities.
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Affiliation(s)
- Eric C. Shattuck
- Institute for Health Disparities Research, College of Liberal and Fine Arts, The University of Texas at San Antonio, San Antonio, TX, United States
| | - Jessica K. Perrotte
- Department of Psychology, Texas State University, San Marcos, TX, United States
| | - Colton L. Daniels
- Department of Sociology, College of Liberal and Fine Arts, The University of Texas at San Antonio, San Antonio, TX, United States
| | - Xiaohe Xu
- Department of Sociology, College of Liberal and Fine Arts, The University of Texas at San Antonio, San Antonio, TX, United States
- School of Public Administration, Sichuan University, Chengdu, China
| | - Thankam S. Sunil
- Institute for Health Disparities Research, College of Liberal and Fine Arts, The University of Texas at San Antonio, San Antonio, TX, United States
- Department of Sociology, College of Liberal and Fine Arts, The University of Texas at San Antonio, San Antonio, TX, United States
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