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Holmes D, Colaneri M, Palomba E, Gori A. Exploring post-SEPSIS and post-COVID-19 syndromes: crossovers from pathophysiology to therapeutic approach. Front Med (Lausanne) 2024; 10:1280951. [PMID: 38249978 PMCID: PMC10797045 DOI: 10.3389/fmed.2023.1280951] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/07/2023] [Indexed: 01/23/2024] Open
Abstract
Sepsis, driven by several infections, including COVID-19, can lead to post-sepsis syndrome (PSS) and post-acute sequelae of COVID-19 (PASC). Both these conditions share clinical and pathophysiological similarities, as survivors face persistent multi-organ dysfunctions, including respiratory, cardiovascular, renal, and neurological issues. Moreover, dysregulated immune responses, immunosuppression, and hyperinflammation contribute to these conditions. The lack of clear definitions and diagnostic criteria hampers comprehensive treatment strategies, and a unified therapeutic approach is significantly needed. One potential target might be the renin-angiotensin system (RAS), which plays a significant role in immune modulation. In fact, RAS imbalance can exacerbate these responses. Potential interventions involving RAS include ACE inhibitors, ACE receptor blockers, and recombinant human ACE2 (rhACE2). To address the complexities of PSS and PASC, a multifaceted approach is required, considering shared immunological mechanisms and the role of RAS. Standardization, research funding, and clinical trials are essential for advancing treatment strategies for these conditions.
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Affiliation(s)
- Darcy Holmes
- Infectious Diseases Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marta Colaneri
- Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy
| | - Emanuele Palomba
- Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy
| | - Andrea Gori
- Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy
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Lynch ST, Dornbush R, Shahar S, Mansour R, Klepacz L, Primavera LH, Ferrando SJ. Change in Neuropsychological Test Performance Seen in a Longitudinal Study of Patients With Post-acute Sequelae of COVID-19: A 6-Month Follow-up Study. J Acad Consult Liaison Psychiatry 2024:S2667-2960(23)00856-X. [PMID: 38171454 DOI: 10.1016/j.jaclp.2023.12.005] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Post-acute sequelae of COVID-19 may include physical, psychiatric, and neurocognitive symptoms. Few studies of cognitive symptoms have been longitudinal, with many following participants briefly after infection and relying on subjective complaints, screening instruments, or computerized testing. This group previously reported diminished neuropsychological (NP) test performance in over half of 60 individuals tested in-person 7 months post-COVID-19, particularly those seeking care for cognitive complaints. The current study describes the initial and 6-month follow-up results of an expanded cohort of 75 participants. OBJECTIVE To measure longitudinal changes in neuropsychological test performance, as well as medical and psychiatric changes, post-COVID-19. METHODS Participants underwent NP, psychiatric, and medical assessments approximately 7 months after acute COVID-19 infection. Sixty-three (84%) returned approximately 6 months later for repeat evaluation. RESULTS At the initial visit, 29 (38.7%) met criteria for low NP performance, and 16 (21.3%) met criteria for extremely low NP performance. At 6-month follow-up, several NP domains that were significantly below normative values at the initial visit were no longer abnormal, with the exception of language. Only measures of delayed memory and fatigue showed significant improvements between the 2 time points. CONCLUSIONS A substantial proportion of individuals recovered from acute COVID-19 infection have persistent neuropsychiatric symptoms over 1 year after infection. While the overall sample in this study showed some improvement in NP test performance relative to norms, only fatigue and delayed memory improved significantly between times 1 and 2. No individual declined in NP test performance, though relatively few individuals made significant clinical improvement, indicating the need for serial neuropsychiatric assessment and treatment supports. Longitudinal follow-up of this cohort is in progress.
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Affiliation(s)
- Sean T Lynch
- Department of Psychiatry and Behavioral Sciences, School of Medicine, New York Medical College, Valhalla, NY; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY
| | - Rhea Dornbush
- Department of Psychiatry and Behavioral Sciences, School of Medicine, New York Medical College, Valhalla, NY; Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY
| | - Sivan Shahar
- Department of Psychiatry and Behavioral Sciences, School of Medicine, New York Medical College, Valhalla, NY; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY
| | - Rayah Mansour
- School of Public Health, New York Medical College, Valhalla, NY
| | - Lidia Klepacz
- Department of Psychiatry and Behavioral Sciences, School of Medicine, New York Medical College, Valhalla, NY; Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY
| | - Louis H Primavera
- School of Health Sciences, Touro College and University System, Valhalla, NY
| | - Stephen J Ferrando
- Department of Psychiatry and Behavioral Sciences, School of Medicine, New York Medical College, Valhalla, NY; Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY.
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Martínez-Ayala MC, Proaños NJ, Cala-Duran J, Lora-Mantilla AJ, Cáceres-Ramírez C, Villabona-Flórez SJ, Camacho-López PA. Factors associated with long COVID syndrome in a Colombian cohort. Front Med (Lausanne) 2023; 10:1325616. [PMID: 38188329 PMCID: PMC10767647 DOI: 10.3389/fmed.2023.1325616] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/04/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction After acute phase of SARS-CoV-2 infection, some patients persist with clinical symptoms, a phenomenon known as Long COVID syndrome. It is necessary to understand the factors associated with the persistence of these symptoms to develop individualized preventive approaches and effectively address this challenge. Objective To determine the factors associated with the persistence of symptoms six months after COVID-19 infection. Materials and methods A ambidirectional cohort, single-center study, that included individuals previously diagnosed with COVID-19 by real-time polymerase chain reaction (PCR) positive test, who were followed for a period of six months. Univariate, bivariate and a multivariate binomial regression model were performed to determine risk factors associated with the persistence of COVID-19 symptoms at the six months of follow-up. Results The prevalence of long COVID syndrome was 47%. Age demonstrated no significant association with Long COVID (RR 0.999 [95% CI 0.996-1.002]); however, female sex (RR 1.148 [95% CI 1.038-1.268]), requirement of mechanical ventilation (RR 1.278 [95% CI 1.050-1.555]), presence of Chronic Obstructive Pulmonary Disease (COPD) (RR 1.340 [95% CI 1.104-1.626]), Rheumatic Disease (RR 1.259 [95% CI 1.055-1.504]) and the Hospitalization Type: General Hospitalization (RR 1.247 [95% CI 1.090-1.427]) and ICU Hospitalization (RR 1.490 [95% CI 1.221-1.818]) were significantly associated with the persistence of symptoms at the six month of follow-up. Conclusion Female sex, presence of COPD, rheumatic disease, hospitalization type and requirement of mechanical ventilation during index infection were identified as significant risk factors for the diagnosis of Long COVID. These findings emphasize the importance of addressing Long COVID syndrome in terms of prevention and management, taking these risk factors into consideration.
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Affiliation(s)
- María Camila Martínez-Ayala
- School of Medicine, Universidad de La Sabana, Chía, Colombia
- Directorate of Research, Development and Technological Innovation, Ophthalmological Foundation of Santander (FOSCAL), Floridablanca, Colombia
| | | | - Julian Cala-Duran
- Directorate of Research, Development and Technological Innovation, Ophthalmological Foundation of Santander (FOSCAL), Floridablanca, Colombia
| | - Alvaro Jose Lora-Mantilla
- Directorate of Research, Development and Technological Innovation, Ophthalmological Foundation of Santander (FOSCAL), Floridablanca, Colombia
| | - Catalina Cáceres-Ramírez
- Directorate of Research, Development and Technological Innovation, Ophthalmological Foundation of Santander (FOSCAL), Floridablanca, Colombia
| | - Silvia Juliana Villabona-Flórez
- Directorate of Research, Development and Technological Innovation, Ophthalmological Foundation of Santander (FOSCAL), Floridablanca, Colombia
| | - Paul Anthony Camacho-López
- Directorate of Research, Development and Technological Innovation, Ophthalmological Foundation of Santander (FOSCAL), Floridablanca, Colombia
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Venugopal N, Armstrong PA, Wright TJ, Randolph KM, Batson RD, Yuen KCJ, Masel B, Sheffield-Moore M, Pyles RB, Urban RJ. Is there a role for growth hormone replacement in adults to control acute and post-acute COVID-19? Best Pract Res Clin Endocrinol Metab 2023; 37:101842. [PMID: 37996257 DOI: 10.1016/j.beem.2023.101842] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
The SARS-CoV-2 pandemic created a multitude of medical crossroads requiring real time adaptations of best practice covering preventative and interventional aspects of care. Among the many discoveries borne from efforts to address the myriad clinical presentations across multiple organ systems was a common impact on tissues with cells that express the ACE-2 receptor. The vast majority of acute infections began and often ended in the respiratory tract, but more recent evaluations have confirmed significant extrapulmonary manifestations including symptom clusters that extend beyond the acute phase of infection collectively referred to as "post-acute sequelae SARS-CoV-2 infection" (PASC) or more commonly as "long (-haul) COVID". Both acute SARS-CoV-2 infection and PASC are associated with gut microbiome dysbiosis and alterations in the gut-brain and HPA-axis in a subset of the infected. Mounting evidence suggests these extrapulmonary manifestations may ultimately lead to reduced growth hormone (GH) secretion as demonstrated following stimulation tests. Disrupted GH secretion could cause or exacerbate long lasting neuropsychological symptoms as seen in other similar manifesting conditions. Ongoing clinical research has shown promising improvement in PASC patients with fatigue and cognition complaints can be achieved via GH replacement therapy. GH stimulation testing should be considered in PASC workups and future research should delve deeper into the mechanistic effects of GH on acute COVID and PASC.
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Affiliation(s)
- Navneet Venugopal
- John Sealy School of Medicine, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA.
| | - Peyton A Armstrong
- John Sealy School of Medicine, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA.
| | - Traver J Wright
- Department of Internal Medicine, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA.
| | - Kathleen M Randolph
- Department of Internal Medicine, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA.
| | | | - Kevin C J Yuen
- Department of Neuroendocrinology, Barrow Pituitary Center and Barrow Neuroendocrinology Clinic, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA.
| | - Brent Masel
- Department of Neurology, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA; Centre for Neuro Skills, Bakersfield, CA 93313, USA.
| | - Melinda Sheffield-Moore
- Department of Internal Medicine, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA.
| | - Richard B Pyles
- Department of Pediatrics, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA.
| | - Randall J Urban
- Department of Internal Medicine, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA.
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Plummer AM, Matos YL, Lin HC, Ryman SG, Birg A, Quinn DK, Parada AN, Vakhtin AA. Gut-brain pathogenesis of post-acute COVID-19 neurocognitive symptoms. Front Neurosci 2023; 17:1232480. [PMID: 37841680 PMCID: PMC10568482 DOI: 10.3389/fnins.2023.1232480] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/31/2023] [Accepted: 09/01/2023] [Indexed: 10/17/2023] Open
Abstract
Approximately one third of non-hospitalized coronavirus disease of 2019 (COVID-19) patients report chronic symptoms after recovering from the acute stage of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Some of the most persistent and common complaints of this post-acute COVID-19 syndrome (PACS) are cognitive in nature, described subjectively as "brain fog" and also objectively measured as deficits in executive function, working memory, attention, and processing speed. The mechanisms of these chronic cognitive sequelae are currently not understood. SARS-CoV-2 inflicts damage to cerebral blood vessels and the intestinal wall by binding to angiotensin-converting enzyme 2 (ACE2) receptors and also by evoking production of high levels of systemic cytokines, compromising the brain's neurovascular unit, degrading the intestinal barrier, and potentially increasing the permeability of both to harmful substances. Such substances are hypothesized to be produced in the gut by pathogenic microbiota that, given the profound effects COVID-19 has on the gastrointestinal system, may fourish as a result of intestinal post-COVID-19 dysbiosis. COVID-19 may therefore create a scenario in which neurotoxic and neuroinflammatory substances readily proliferate from the gut lumen and encounter a weakened neurovascular unit, gaining access to the brain and subsequently producing cognitive deficits. Here, we review this proposed PACS pathogenesis along the gut-brain axis, while also identifying specific methodologies that are currently available to experimentally measure each individual component of the model.
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Affiliation(s)
- Allison M. Plummer
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Yvette L. Matos
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, United States
| | - Henry C. Lin
- Division of Gastroenterology and Hepatology, University of New Mexico, Albuquerque, NM, United States
- Section of Gastroenterology, New Mexico Veterans Affairs Health Care System, Albuquerque, NM, United States
| | - Sephira G. Ryman
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, United States
- Nene and Jamie Koch Comprehensive Movement Disorder Center, Department of Neurology, University of New Mexico, Albuquerque, NM, United States
| | - Aleksandr Birg
- Division of Gastroenterology and Hepatology, University of New Mexico, Albuquerque, NM, United States
- Section of Gastroenterology, New Mexico Veterans Affairs Health Care System, Albuquerque, NM, United States
| | - Davin K. Quinn
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Alisha N. Parada
- Division of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Andrei A. Vakhtin
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, United States
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Paradiso B, Limback C, Su T, Liao W, Mpotsaris A. Editorial: An update on neurological disorders post COVID-19 infection. Front Neurol 2023; 14:1229843. [PMID: 37521288 PMCID: PMC10374834 DOI: 10.3389/fneur.2023.1229843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/03/2023] [Indexed: 08/01/2023] Open
Affiliation(s)
- Beatrice Paradiso
- Department of Biomedical, Surgical and Dental Sciences, Faculty of Medicine and Surgery, Lino Rossi Research Center, University of Milan, Milan, Italy
- Anatomic Pathology Unit, Dolo Hospital Venice, Venice, Italy
| | - Clara Limback
- Department of Neuropathology and Ocular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Tao Su
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, The Second Affiliated Hospital, Institute of Neuroscience, Guangzhou Medical University, Guangzhou, China
| | - Weiping Liao
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, The Second Affiliated Hospital, Institute of Neuroscience, Guangzhou Medical University, Guangzhou, China
| | - Anastasios Mpotsaris
- München Hospital, Munich, Germany
- Faculty of Medicine, University Hospital Magdeburg, Magdeburg, Germany
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7
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Thompson M, Ferrando SJ, Dornbush R, Lynch S, Shahar S, Klepacz L, Smiley A. Impact of COVID-19 on employment: sociodemographic, medical, psychiatric and neuropsychological correlates. Front Rehabil Sci 2023; 4:1150734. [PMID: 37496702 PMCID: PMC10368129 DOI: 10.3389/fresc.2023.1150734] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/29/2023] [Indexed: 07/28/2023]
Abstract
Introduction Given the nature of the persistent physical and neuropsychiatric symptoms reported in the literature, among individuals after acute COVID illness; there is growing concern about the functional implications of the Post-Acute Sequelae of COVID-19 (PASC). We aim to evaluate associations of sociodemographic, medical, psychiatric and neuropsychological factors with employment status post COVID-19. Methods 59 participants were administered a neuropsychiatric assessment and queried about employment status and occupational difficulties months after quarantine. Two levels of comparison were conducted: (1) Those who took time off work (TTO) to those with no time off (NTO); (2) Those who reported occupational performance suffered (PS) to those who did not (PDNS). Results TTO vs. NTO exhibited extensive differences across medical, psychiatric and neurocognitive domains. PS vs. PDNS differed on subjective measures of physical and cognitive symptoms, but not on objective testing. Conclusion Individuals who took time off beyond COVID-19 quarantine experience persistent physical, psychiatric, subjective and objective neurocognitive burden. In contrast, occupational impairment appears to reflect subjective complaints, but not objective measures. Clinical implications are discussed.
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Affiliation(s)
- Madison Thompson
- School of Medicine, New York Medical College, Valhalla, NY, United States
| | - Stephen J. Ferrando
- School of Medicine, New York Medical College, Valhalla, NY, United States
- Department of Psychiatry, Westchester Medical Center Health Network, Valhalla, NY, United States
| | - Rhea Dornbush
- School of Medicine, New York Medical College, Valhalla, NY, United States
- Department of Psychiatry, Westchester Medical Center Health Network, Valhalla, NY, United States
| | - Sean Lynch
- School of Medicine, New York Medical College, Valhalla, NY, United States
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel,New York, NY, United States
| | - Sivan Shahar
- School of Medicine, New York Medical College, Valhalla, NY, United States
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY, United States
| | - Lidia Klepacz
- School of Medicine, New York Medical College, Valhalla, NY, United States
- Department of Psychiatry, Westchester Medical Center Health Network, Valhalla, NY, United States
| | - Abbas Smiley
- School of Medicine, New York Medical College, Valhalla, NY, United States
- Department of Surgery, Westchester Medical Center Health Network, Valhalla, NY, United States
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8
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Badenes Bonet D, Caguana Vélez OA, Duran Jordà X, Comas Serrano M, Posso Rivera M, Admetlló M, Herranz Blasco A, Cuadrado Godia E, Marco Navarro E, Martin Ezquerra G, Pineiro Aguin Z, Cumpli Gargallo MC, Gonzalez Garcia JG, Balcells Vilarnau E, Rodriguez Chiaradia D, Castells X, Gea J, Horcajada JP, Villar-García J. Treatment of COVID-19 during the Acute Phase in Hospitalized Patients Decreases Post-Acute Sequelae of COVID-19. J Clin Med 2023; 12:4158. [PMID: 37373850 DOI: 10.3390/jcm12124158] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/31/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The post-acute sequelae of SARS-CoV-2 (PASC) infection have caused a significant impact on our health system, but there is limited evidence of approved drugs focused on its prevention. Our objective was to identify risk factors that can determine the presence of PASC, with special attention to the treatment received in the acute phase, and to describe the profile of persistent symptoms in a multidisciplinary Post-Coronavirus Disease-19 (COVID-19) Unit. METHODS This one-year prospective observational study included patients following an acute COVID-19 infection, irrespective of whether they required hospital admission. A standardized symptom questionnaire and blood sampling were performed at the first follow-up visit, and demographic and clinical electronic data were collected. We compared subjects with PASC with those who had fully recovered. Multivariate logistic regression was performed to identify factors associated with PASC in hospitalized patients, and Kaplan-Meier curves were used to assess duration of symptoms according to disease severity and treatments received in the acute phase. RESULTS 1966 patients were evaluated; 1081 had mild disease, 542 moderate and 343 severe; around one third of the subjects had PASC, and were more frequently female, with obesity, asthma, and eosinophilia during acute COVID-19 disease. Patients who received treatment with dexamethasone and remdesivir during the course of the acute illness showed a lower median duration of symptoms, compared with those who received none of these treatments. CONCLUSION Treatment with dexamethasone and/or remdesivir may be useful to reduce the impact of PASC secondary to SARS-CoV-2 infection. In addition, we identified female gender, obesity, asthma, and disease severity as risk factors for having PASC.
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Affiliation(s)
- Diana Badenes Bonet
- Respiratory Medicine Department, Hospital del Mar, 08003 Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | - Oswaldo Antonio Caguana Vélez
- Respiratory Medicine Department, Hospital del Mar, 08003 Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | - Xavier Duran Jordà
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
- Assessoria Metodològica i Bioestadística (AMIB), 08003 Barcelona, Spain
| | - Merce Comas Serrano
- Epidemiology and Evaluation Department, Hospital del Mar, REDISSEC, RICAPPS, 08003 Barcelona, Spain
| | - Margarita Posso Rivera
- Epidemiology and Evaluation Department, Hospital del Mar, REDISSEC, RICAPPS, 08003 Barcelona, Spain
| | - Mireia Admetlló
- Respiratory Medicine Department, Hospital del Mar, 08003 Barcelona, Spain
| | | | | | - Ester Marco Navarro
- Physical Medicine and Rehabilitation Department, Hospital del Mar, 08003 Barcelona, Spain
| | | | - Zenaida Pineiro Aguin
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- Otorrinolaringology Department, Hospital del Mar, 08003 Barcelona, Spain
| | | | - Jose Gregorio Gonzalez Garcia
- Respiratory Medicine Department, Hospital del Mar, 08003 Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | - Eva Balcells Vilarnau
- Respiratory Medicine Department, Hospital del Mar, 08003 Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias, (CIBERES), Instituto de Salud Carlos III (ISCIII), 08003 Barcelona, Spain
| | - Diego Rodriguez Chiaradia
- Respiratory Medicine Department, Hospital del Mar, 08003 Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias, (CIBERES), Instituto de Salud Carlos III (ISCIII), 08003 Barcelona, Spain
| | - Xavier Castells
- Epidemiology and Evaluation Department, Hospital del Mar, REDISSEC, RICAPPS, 08003 Barcelona, Spain
| | - Joaquim Gea
- Respiratory Medicine Department, Hospital del Mar, 08003 Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias, (CIBERES), Instituto de Salud Carlos III (ISCIII), 08003 Barcelona, Spain
| | - Juan P Horcajada
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias, (CIBERES), Instituto de Salud Carlos III (ISCIII), 08003 Barcelona, Spain
- Infectious Diseases Department, Hospital del Mar, 08003 Barcelona, Spain
| | - Judit Villar-García
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
- Infectious Diseases Department, Hospital del Mar, 08003 Barcelona, Spain
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Bouhamdani N, Comeau D, Bourque C, Saulnier N. Encephalic nocardiosis after mild COVID-19: A case report. Front Neurol 2023; 14:1137024. [PMID: 36908618 PMCID: PMC9992866 DOI: 10.3389/fneur.2023.1137024] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/02/2023] [Indexed: 02/24/2023] Open
Abstract
The COVID-19 pandemic and the associated post-acute sequelae of COVID-19 (PASC) have led to the identification of a complex disease phenotype that is associated with important changes in the immune system. Herein, we describe a unique case of Nocardia farcinica cerebral abscess in an individual with sudden immunodeficiency several months after mild COVID-19. Intravenous Bactrim and Imipenem were prescribed for 6 weeks. After this, a 12-month course of Bactrim and Clavulin was prescribed to be taken orally, given the N. farcinica infection at the level of the central nervous system. This case report highlights the need for future research into the pathophysiology of COVID-19 and PASC immune dysregulation in convalescent individuals. It also draws attention to the need for timely consideration of opportunistic infections in patients with a history of COVID-19.
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Affiliation(s)
- Nadia Bouhamdani
- Vitalité Health Network, Dr. Georges-L.-Dumont University Hospital Center, Research Sector, Moncton, NB, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Formation Médicale du Nouveau-Brunswick, Université de Moncton, Moncton, NB, Canada
| | - Dominique Comeau
- Vitalité Health Network, Dr. Georges-L.-Dumont University Hospital Center, Research Sector, Moncton, NB, Canada
| | - Christine Bourque
- Vitalité Health Network, Dr. Georges-L.-Dumont University Hospital Center, Research Sector, Moncton, NB, Canada
| | - Nancy Saulnier
- Vitalité Health Network, Dr. Georges-L.-Dumont University Hospital Center, Research Sector, Moncton, NB, Canada
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Swank Z, Senussi Y, Manickas-Hill Z, Yu XG, Li JZ, Alter G, Walt DR. Persistent Circulating Severe Acute Respiratory Syndrome Coronavirus 2 Spike Is Associated With Post-acute Coronavirus Disease 2019 Sequelae. Clin Infect Dis 2023; 76:e487-e490. [PMID: 36052466 PMCID: PMC10169416 DOI: 10.1093/cid/ciac722] [Citation(s) in RCA: 147] [Impact Index Per Article: 147.0] [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: 07/05/2022] [Revised: 08/25/2022] [Accepted: 08/30/2022] [Indexed: 02/02/2023] Open
Abstract
The diagnosis of postacute sequelae of coronavirus disease 2019 (PASC) poses an ongoing medical challenge. To identify biomarkers associated with PASC we analyzed plasma samples collected from PASC and coronavirus disease 2019 patients to quantify viral antigens and inflammatory markers. We detect severe acute respiratory syndrome coronavirus 2 spike predominantly in PASC patients up to 12 months after diagnosis.
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Affiliation(s)
- Zoe Swank
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, Massachusetts, USA
| | - Yasmeen Senussi
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, Massachusetts, USA
| | | | - Xu G Yu
- Harvard Medical School, Boston, Massachusetts, USA
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jonathan Z Li
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Galit Alter
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David R Walt
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, Massachusetts, USA
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11
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Rutkowski S, Bogacz K, Rutkowska A, Szczegielniak J, Casaburi R. Inpatient post-COVID-19 rehabilitation program featuring virtual reality-Preliminary results of randomized controlled trial. Front Public Health 2023; 11:1121554. [PMID: 36815161 PMCID: PMC9939639 DOI: 10.3389/fpubh.2023.1121554] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 01/23/2023] [Indexed: 02/09/2023] Open
Abstract
Background Numerous recommendations from pulmonary scientific societies indicate the need to implement rehabilitation programs for patients after COVID-19. The aim of this study was to propose an innovative comprehensive intervention based on a hospital-based pulmonary rehabilitation program for individuals with post-acute sequelae of COVID-19. Methods It was decided to evaluate two forms of hospital rehabilitation: traditional and one provided through virtual reality. Preliminary results are based on a group of 32 patients (20 female and 12 male), of average age 57.8 (4.92) years in the period of 3-6 months after the initial infection. Primary outcomes included analysis of lung function, exercise performance and stress level. A 3-week, high-intensity, five-times per week pulmonary rehabilitation program was designed to compare the effectiveness of a traditional form with a VR-led, novel form of therapy. Results The analysis of the results showed a statistically significant improvement in both groups with regard to exercise performance expressed as 6MWT distance. Moreover, a statistically significant decrease in dyspnoea levels following the 6MWT was also noted in intergroup comparison, but the between-group comparison revealed non-statistically significant changes with low effect size. Regarding lung function, the analysis showed essentially normal lung function at baseline and a non-statistically significant improvement after the completion of the rehabilitation program. The analysis of the stress level showed a statistically significant improvement in both groups within the inter-group comparison, yet the between-group comparison of deltas values showed a non-significant difference with low effect size. Conclusion A 3-weeks inpatients pulmonary rehabilitation program led to improvement of the exercise performance of people with post-acute sequelae of COVID-19, but not lung function. Furthermore, the program was shown to reduce patients' stress levels. A comparison of the traditional form of rehabilitation to the novel form using VR, shows similar effectiveness in terms of exercise performance and stress levels.
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Affiliation(s)
- Sebastian Rutkowski
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland,*Correspondence: Sebastian Rutkowski ✉
| | - Katarzyna Bogacz
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland,Specialist Hospital of the Ministry of the Interior and Administration in Głuchołazy, Głuchołazy, Poland
| | - Anna Rutkowska
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland
| | - Jan Szczegielniak
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland,Specialist Hospital of the Ministry of the Interior and Administration in Głuchołazy, Głuchołazy, Poland
| | - Richard Casaburi
- Rehabilitation Clinical Trials Center, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, United States
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12
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Stromberg S, Baxter BA, Dooley G, LaVergne SM, Gallichotte E, Dutt T, Tipton M, Berry K, Haberman J, Natter N, Webb TL, McFann K, Henao-Tamayo M, Ebel G, Rao S, Dunn J, Ryan EP. Relationships between plasma fatty acids in adults with mild, moderate, or severe COVID-19 and the development of post-acute sequelae. Front Nutr 2022; 9:960409. [PMID: 36185653 PMCID: PMC9515579 DOI: 10.3389/fnut.2022.960409] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/02/2022] [Accepted: 08/09/2022] [Indexed: 11/17/2022] Open
Abstract
Background SARS-CoV-2 has infected millions across the globe. Many individuals are left with persistent symptoms, termed post-acute sequelae of COVID-19 (PASC), for months after infection. Hyperinflammation in the acute and convalescent stages has emerged as a risk factor for poor disease outcomes, and this may be exacerbated by dietary inadequacies. Specifically, fatty acids are powerful inflammatory mediators and may have a significant role in COVID-19 disease modulation. Objective The major objective of this project was to pilot an investigation of plasma fatty acid (PFA) levels in adults with COVID-19 and to evaluate associations with disease severity and PASC. Methods and procedures Plasma from adults with (N = 41) and without (N = 9) COVID-19 was analyzed by gas chromatography-mass spectrometry (GC-MS) to assess differences between the concentrations of 18 PFA during acute infection (≤14 days post-PCR + diagnosis) in adults with varying disease severity. Participants were grouped based on mild, moderate, and severe disease, alongside the presence of PASC, a condition identified in patients who were followed beyond acute-stage infection (N = 23). Results Significant differences in PFA profiles were observed between individuals who experienced moderate or severe disease compared to those with mild infection or no history of infection. Palmitic acid, a saturated fat, was elevated in adults with severe disease (p = 0.04), while behenic (p = 0.03) and lignoceric acid (p = 0.009) were lower in adults with moderate disease. Lower levels of the unsaturated fatty acids, γ-linolenic acid (GLA) (p = 0.03), linoleic (p = 0.03), and eicosapentaenoic acid (EPA) (p = 0.007), were observed in adults with moderate disease. Oleic acid distinguished adults with moderate disease from severe disease (p = 0.04), and this difference was independent of BMI. Early recovery-stage depletion of GLA (p = 0.02) and EPA (p = 0.0003) was associated with the development of PASC. Conclusion Pilot findings from this study support the significance of PFA profile alterations during COVID-19 infection and are molecular targets for follow-up attention in larger cohorts. Fatty acids are practical, affordable nutritional targets and may be beneficial for modifying the course of disease after a COVID-19 diagnosis. Moreover, these findings can be particularly important for overweight and obese adults with altered PFA profiles and at higher risk for PASC. Clinical trial registration [ClinicalTrials.gov], identifier [NCT04603677].
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Affiliation(s)
- Sophia Stromberg
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO, United States
| | - Bridget A. Baxter
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, United States
| | - Gregory Dooley
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, United States
| | - Stephanie M. LaVergne
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, United States
| | - Emily Gallichotte
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, United States
| | - Taru Dutt
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, United States
| | - Madison Tipton
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, United States
| | - Kailey Berry
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, United States
| | - Jared Haberman
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, United States
| | - Nicole Natter
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, United States
| | - Tracy L. Webb
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Kim McFann
- University of Colorado Health, Medical Center of the Rockies, Loveland, CO, United States
| | - Marcela Henao-Tamayo
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, United States
| | - Greg Ebel
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, United States
| | - Sangeeta Rao
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Julie Dunn
- University of Colorado Health, Medical Center of the Rockies, Loveland, CO, United States
| | - Elizabeth P. Ryan
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, United States
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13
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Noval Rivas M, Porritt RA, Cheng MH, Bahar I, Arditi M. Multisystem Inflammatory Syndrome in Children and Long COVID: The SARS-CoV-2 Viral Superantigen Hypothesis. Front Immunol 2022; 13:941009. [PMID: 35874696 PMCID: PMC9300823 DOI: 10.3389/fimmu.2022.941009] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/09/2022] [Indexed: 12/19/2022] Open
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a febrile pediatric inflammatory disease that may develop weeks after initial SARS-CoV-2 infection or exposure. MIS-C involves systemic hyperinflammation and multiorgan involvement, including severe cardiovascular, gastrointestinal (GI) and neurological symptoms. Some clinical attributes of MIS-C-such as persistent fever, rashes, conjunctivitis and oral mucosa changes (red fissured lips and strawberry tongue)-overlap with features of Kawasaki disease (KD). In addition, MIS-C shares striking clinical similarities with toxic shock syndrome (TSS), which is triggered by bacterial superantigens (SAgs). The remarkable similarities between MIS-C and TSS prompted a search for SAg-like structures in the SARS-CoV-2 virus and the discovery of a unique SAg-like motif highly similar to a Staphylococcal enterotoxin B (SEB) fragment in the SARS-CoV-2 spike 1 (S1) glycoprotein. Computational studies suggest that the SAg-like motif has a high affinity for binding T-cell receptors (TCRs) and MHC Class II proteins. Immunosequencing of peripheral blood samples from MIS-C patients revealed a profound expansion of TCR β variable gene 11-2 (TRBV11-2), which correlates with MIS-C severity and serum cytokine levels, consistent with a SAg-triggered immune response. Computational sequence analysis of SARS-CoV-2 spike further identified conserved neurotoxin-like motifs which may alter neuronal cell function and contribute to neurological symptoms in COVID-19 and MIS-C patients. Additionally, autoantibodies are detected during MIS-C, which may indicate development of post-SARS-CoV-2 autoreactive and autoimmune responses. Finally, prolonged persistence of SARS-CoV-2 RNA in the gut, increased gut permeability and elevated levels of circulating S1 have been observed in children with MIS-C. Accordingly, we hypothesize that continuous and prolonged exposure to the viral SAg-like and neurotoxin-like motifs in SARS-CoV-2 spike may promote autoimmunity leading to the development of post-acute COVID-19 syndromes, including MIS-C and long COVID, as well as the neurological complications resulting from SARS-CoV-2 infection.
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Affiliation(s)
- Magali Noval Rivas
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Guerin Children’s at Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Infectious and Immunologic Diseases Research Center (IIDRC) and Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Rebecca A. Porritt
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Guerin Children’s at Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Infectious and Immunologic Diseases Research Center (IIDRC) and Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Mary Hongying Cheng
- Department of Computational and Systems Biology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ivet Bahar
- Department of Computational and Systems Biology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Moshe Arditi
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Guerin Children’s at Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Infectious and Immunologic Diseases Research Center (IIDRC) and Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
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14
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Katsarou MS, Iasonidou E, Osarogue A, Kalafatis E, Stefanatou M, Pappa S, Gatzonis S, Verentzioti A, Gounopoulos P, Demponeras C, Konstantinidou E, Drakoulis N, Asimakos A, Antonoglou A, Mavronasou A, Spetsioti S, Kotanidou A, Katsaounou P. The Greek Collaborative Long COVID Study: Non-Hospitalized and Hospitalized Patients Share Similar Symptom Patterns. J Pers Med 2022; 12. [PMID: 35743774 DOI: 10.3390/jpm12060987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 06/14/2022] [Accepted: 06/14/2022] [Indexed: 12/20/2022] Open
Abstract
Long COVID-19 syndrome refers to persisting symptoms (>12 weeks) after the initial coronavirus infection and is estimated to affect 3% to 12% of people diagnosed with the disease globally. Aim: We conducted a collaborative study with the Long COVID patient organization in Greece, in order to estimate the characteristics, symptoms, and challenges these patients confront. Methods: Data were collected from 208 patients using unstructured qualitative free-text entries in an anonymized online questionnaire. Results: The majority of respondents (68.8%) were not hospitalized and reported lingering symptoms (66.8%) for more than six months. Eighteen different symptoms (fatigue, palpitations, shortness of breath, parosmia, etc.) were mentioned in both hospitalized and community patients. Awareness of Long COVID sequelae seems to be low even among medical doctors. Treatment options incorporating targeted rehabilitation programs are either not available or still not included inthe management plan of Long COVID patients. Conclusions: Patients infected with coronavirus with initial mild symptoms suffer from the same persistent symptoms as those who were hospitalized. Long COVID syndrome appears to be a multi-systemic entity and a multidisciplinary medical approach should be adopted in order to correctly diagnose and successfully manage these patients.
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15
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Nurek M, Rayner C, Freyer A, Taylor S, Järte L, MacDermott N, Delaney BC. Recommendations for the recognition, diagnosis, and management of long COVID: a Delphi study. Br J Gen Pract 2021; 71:e815-e825. [PMID: 34607799 PMCID: PMC8510689 DOI: 10.3399/bjgp.2021.0265] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/07/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND In the absence of research into therapies and care pathways for long COVID, guidance based on 'emerging experience' is needed. AIM To provide a rapid expert guide for GPs and long COVID clinical services. DESIGN AND SETTING A Delphi study was conducted with a panel of primary and secondary care doctors. METHOD Recommendations were generated relating to the investigation and management of long COVID. These were distributed online to a panel of UK doctors (any specialty) with an interest in, lived experience of, and/or experience treating long COVID. Over two rounds of Delphi testing, panellists indicated their agreement with each recommendation (using a five-point Likert scale) and provided comments. Recommendations eliciting a response of 'strongly agree', 'agree', or 'neither agree nor disagree' from 90% or more of responders were taken as showing consensus. RESULTS Thirty-three clinicians representing 14 specialties reached consensus on 35 recommendations. Chiefly, GPs should consider long COVID in the presence of a wide range of presenting features (not limited to fatigue and breathlessness) and exclude differential diagnoses where appropriate. Detailed history and examination with baseline investigations should be conducted in primary care. Indications for further investigation and specific therapies (for myocarditis, postural tachycardia syndrome, mast cell disorder) include hypoxia/desaturation, chest pain, palpitations, and histamine-related symptoms. Rehabilitation should be individualised, with careful activity pacing (to avoid relapse) and multidisciplinary support. CONCLUSION Long COVID clinics should operate as part of an integrated care system, with GPs playing a key role in the multidisciplinary team. Holistic care pathways, investigation of specific complications, management of potential symptom clusters, and tailored rehabilitation are needed.
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Affiliation(s)
- Martine Nurek
- Department of Surgery and Cancer, Imperial College London, London
| | - Clare Rayner
- Department of Acute Medicine, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham
| | - Anette Freyer
- Department of Acute Medicine, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham
| | - Sharon Taylor
- Central and North West London NHS Foundation Trust and honorary senior clinical lecturer, Imperial College School of Medicine, London
| | - Linn Järte
- Anaesthetics Department, Morriston Hospital, Swansea Bay University Health Board, Swansea
| | | | - Brendan C Delaney
- Department of Surgery and Cancer, Imperial College London, London, and principal in general practice, Albion Street Group Practice, London
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16
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McFann K, Baxter BA, LaVergne SM, Stromberg S, Berry K, Tipton M, Haberman J, Ladd J, Webb TL, Dunn JA, Ryan EP. Quality of Life (QoL) Is Reduced in Those with Severe COVID-19 Disease, Post-Acute Sequelae of COVID-19, and Hospitalization in United States Adults from Northern Colorado. Int J Environ Res Public Health 2021; 18:11048. [PMID: 34769566 DOI: 10.3390/ijerph182111048] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/01/2021] [Accepted: 10/10/2021] [Indexed: 12/24/2022]
Abstract
The longitudinal quality of life (QoL) of COVID-19 survivors, especially those with post-acute sequelae (PASC) is not well described. We evaluated QoL in our COVID-19 survivor cohort over 6 months using the RAND SF-36 survey. From July 2020–March 2021 we enrolled 110 adults from the United States with a positive SARS-CoV-2 nasopharyngeal polymerase chain reaction (PCR) into the Northern Colorado Coronavirus Biobank (NoCo-COBIO). Demographic data and symptom surveillance were collected from 62 adults. In total, 42% were hospitalized, and 58% were non-hospitalized. The Rand SF-36 consists of 36 questions and 8 scales, and questions are scored 0–100. A lower-scale score indicates a lower QoL. In conclusion, hospitalization, PASC, and disease severity were associated with significantly lower scores on the RAND SF-36 in Physical Functioning, Role Limitation due to Physical Health, Energy/Fatigue, Social Functioning, and General Health. Long-term monitoring of COVID-19 survivors is needed to fully understand the impact of the disease on QoL and could have implications for interventions to alleviate suffering during recovery.
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17
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Viszlayová D, Sojka M, Dobrodenková S, Szabó S, Bilec O, Turzová M, Ďurina J, Baloghová B, Borbély Z, Kršák M. SARS-CoV-2 RNA in the Cerebrospinal Fluid of a Patient with Long COVID. Ther Adv Infect Dis 2021; 8:20499361211048572. [PMID: 34659752 PMCID: PMC8511908 DOI: 10.1177/20499361211048572] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 07/21/2021] [Accepted: 09/02/2021] [Indexed: 01/07/2023] Open
Abstract
Over 10% of COVID-19 convalescents report post-COVID-19 complications, namely, ‘long
COVID’ or ‘post-COVID syndrome,’ including a number of neuro-psychiatric symptoms. The
pathophysiology of COVID-19 in the central nervous system is poorly understood but may
represent post-COVID injury, ongoing sterile maladaptive inflammation, or SARS-CoV-2
persistence. We describe a long COVID patient with SARS-CoV-2 RNA in the cerebrospinal
fluid, which seems important, specifically due to recent reports of gray matter volume
loss in COVID-19 patients. Further studies of SARS-CoV2 RNA, markers of inflammation, and
neuronal damage in the CSF of patients with long COVID would be useful and should address
whether the CNS can serve as a reservoir of SARS-CoV-2, clarify the pathway by which
COVID-19 contributes to CNS dysfunction, and how best to therapeutically address it.
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Affiliation(s)
- Daša Viszlayová
- Department of Neurology, Faculty Hospital Nové Zámky, Nové Zámky, Slovakia
| | - Martin Sojka
- Regional Public Health Authority in Komárno, Komárno, Slovakia
| | | | - Szabolcs Szabó
- Department of Neurology, Faculty Hospital Nové Zámky, Nové Zámky, Slovakia
| | - Ondrej Bilec
- Department of Neurology, Faculty Hospital Nové Zámky, Nové Zámky, Slovakia
| | - Mária Turzová
- Department of Neurology, Faculty Hospital Nové Zámky, Nové Zámky, Slovakia
| | - Juraj Ďurina
- Department of Internal medicine, Faculty Hospital Nové Zámky, Nové Zámky, Slovakia
| | - Barbara Baloghová
- Department of Internal medicine, Faculty Hospital Nové Zámky, Nové Zámky, Slovakia
| | - Zoltán Borbély
- Department of Internal medicine, Faculty Hospital Nové Zámky, Nové Zámky, Slovakia
| | - Martin Kršák
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, 12700 East 19th Avenue Box 168, Aurora, CO 80045, USA
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