COVID-19 and post-infectious myalgic encephalomyelitis/chronic fatigue syndrome: a narrative review

Abstract

Coronavirus disease 2019 (COVID-19) is a viral infection which can cause a variety of respiratory, gastrointestinal, and vascular symptoms. The acute illness phase generally lasts no more than 2–3 weeks. However, there is increasing evidence that a proportion of COVID-19 patients experience a prolonged convalescence and continue to have symptoms lasting several months after the initial infection. A variety of chronic symptoms have been reported including fatigue, dyspnea, myalgia, exercise intolerance, sleep disturbances, difficulty concentrating, anxiety, fever, headache, malaise, and vertigo. These symptoms are similar to those seen in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a chronic multi-system illness characterized by profound fatigue, sleep disturbances, neurocognitive changes, orthostatic intolerance, and post-exertional malaise. ME/CFS symptoms are exacerbated by exercise or stress and occur in the absence of any significant clinical or laboratory findings. The pathology of ME/CFS is not known: it is thought to be multifactorial, resulting from the dysregulation of multiple systems in response to a particular trigger. Although not exclusively considered a post-infectious entity, ME/CFS has been associated with several infectious agents including Epstein–Barr Virus, Q fever, influenza, and other coronaviruses. There are important similarities between post-acute COVID-19 symptoms and ME/CFS. However, there is currently insufficient evidence to establish COVID-19 as an infectious trigger for ME/CFS. Further research is required to determine the natural history of this condition, as well as to define risk factors, prevalence, and possible interventional strategies.

A Randomized Controlled Trial of the Efficacy of Systemic Enzymes and Probiotics in the Resolution of Post-COVID Fatigue

“…There are no specific biomarkers, and diagnosis is typically based on symptoms. In fact, a subset of patients suffering from COVID-19 satisfied the diagnostic criteria of CFS/ME [ 7 ] In addition, major post-acute COVID-19 symptoms resemble post-infectious ME/CFS [ 8 ]. The changes in neurotransmitter levels, inflammation, psychological disorders, stress levels, and cognitive dysfunction are thought to be contributing factors in fatigue [ 2 ].…”

Increased risk of chronic fatigue and hair loss following COVID-19 in individuals with hypohidrotic ectodermal dysplasia

“…Although the deficient development of various eccrine glands in HED patients entails recurrent respiratory infections, atrophic rhinitis, and keratoconjunctivitis sicca [6,16], neither the course of COVID- observed concerning postinfectious fatigue, a chronic illness with constitutional and neurocognitive symptoms persisting long after clearance of the initial infection [17]. Chronic fatigue is a multifactorial and poorly understood consequence of a variety of predominantly viral infections.…”

“…Chronic fatigue is a multifactorial and poorly understood consequence of a variety of predominantly viral infections. Coxiella burnetii, Epstein-Barr virus, influenza virus, and other infectious agents have been hypothesized to cause persistent dysregulation of inflammatory response and metabolic pathways, most likely related to a miscommunication in cytokine networks [17,18]. There is an increasing number of individuals who suffer from post-acute COVID-19, an even more complex disease entity characterized by persistent symptoms and/or delayed or long-term complications beyond 4 weeks from the onset of symptoms [19,20], including anosmia, muscular weakness, cognitive and sleep disturbances, chest pain, palpitations, and hair loss.…”

Understanding the Post COVID-19 Condition (Long COVID) and the Expected Burden for Ontario

“…A review of the neurologic impact of COVID-19 identified two major categories: 1) acute and rarely occurring severe consequences such as Guillain-Barré syndrome or encephalitis, and 2) chronic, highly variable, and often time-varying symptoms which overlap with conditions such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). 15 Symptoms such as dyspnea, myalgia (muscle pain), exercise intolerance and sleep disturbances that are commonly reported in the post COVID-19 condition have some similarities to symptom complexes noted in ME/CFS. 15 Fatigue is one of the most commonly reported cognitive symptoms by individuals with the post COVID-19 condition, and was reported by 40% of individuals post infection with influenza or coronaviruses such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).…”

“…15 Symptoms such as dyspnea, myalgia (muscle pain), exercise intolerance and sleep disturbances that are commonly reported in the post COVID-19 condition have some similarities to symptom complexes noted in ME/CFS. 15 Fatigue is one of the most commonly reported cognitive symptoms by individuals with the post COVID-19 condition, and was reported by 40% of individuals post infection with influenza or coronaviruses such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). 16 Persistent post-viral fatigue beyond 6 months was noted post SARS infection in approximately one quarter of patients.…”