Post-COVID Syndrome. A Case Series and Comprehensive Review

Abstract

The existence of a variety of symptoms with a duration beyond the acute phase of COVID-19, is referred to as post-COVID syndrome (PCS). We aimed to report a series of patients with PCS attending a Post-COVID Unit and offer a comprehensive review on the topic. Adult patients with previously confirmed SARS-CoV-2 infection were systematically assessed through a semi-structured and validated survey. Total IgG, IgA and IgM serum antibodies to SARS-CoV-2 were evaluated by an electrochemiluminescence immunoassay. A systematic review of the literature and meta‐analysis were conducted, following PRISMA guidelines. Univariate and multivariate methods were used to analyze data. Out of a total of 100 consecutive patients, 53 were women, the median of age was 49 years (IQR: 37.8 to 55.3), the median of post-COVID time after the first symptoms was 219 days (IQR: 143 to 258), and 65 patients were hospitalized during acute COVID-19. Musculoskeletal, digestive (i.e., diarrhea) and neurological symptoms including depression (by Zung scale) were the most frequent observed in PCS patients. A previous hospitalization was not associated with PCS manifestation. Arthralgia and diarrhea persisted in more than 40% of PCS patients. The median of anti-SARS-CoV-2 antibodies was 866.2 U/mL (IQR: 238.2 to 1681). Despite this variability, 98 patients were seropositive. Based on autonomic symptoms (by COMPASS 31) two clusters were obtained with different clinical characteristics. Levels of anti-SARS-CoV-2 antibodies were not different between clusters. A total of 40 articles (11,196 patients) were included in the meta‐analysis. Fatigue/muscle weakness, dyspnea, pain and discomfort, anxiety/depression and impaired concentration were presented in more than 20% of patients reported. In conclusion, PCS is mainly characterized by musculoskeletal, pulmonary, digestive and neurological involvement including depression. PCS is independent of severity of acute illness and humoral response. Long-term antibody responses to SARS-CoV-2 infection and a high inter-individual variability were confirmed. Future studies should evaluate the mechanisms by which SARS-CoV-2 may cause PCS and the best therapeutic options.

What Do We Need to Know About Musculoskeletal Manifestations of COVID-19?

“…Twenty literature reviews were identified2, 12-30 . Of the remaining studies, 31 presented original research 31-61 , 6 were case series 62-67 , 24 were case reports 68-91 , 1 provided a specialist’s opinion 92 , 4 were editorials 93-96 , and 2 were letters to the editor 97,98 .…”

“…Among patients with this syndrome, 77.3% reported musculoskeletal manifestations 39 . A case series stratified the manifestations into arthralgia (in 65% of those with long COVID), back pain (55%), weakness (46%), myalgia (42%), body pain (40%), fatigue (34%), and sarcopenia (28%) 64 . However, the frequency of symptoms varied across studies, with fatigue being present in up to 98% and arthralgia in up to 78; 16 .…”

“…Although there is no consensus across reviews and original research articles on the definition of post-COVID-19 syndrome, guidelines from the National Institute for Health and Care Excellence (NICE) define it as a group of signs and symptoms that are present for .12 weeks, developed during or after infection with SARS-CoV-2, and cannot be attributed to alternative diagnoses 101 . Musculoskeletal symptoms in this syndrome include fatigue, arthralgia, myalgia, new-onset back pain, muscle weakness, and poor physical performance 10,14,16,25,33,35,36,39,40,[43][44][45]49,[55][56][57]61,64 . Since COVID-19 is a relatively new disease, the literature lacks follow-up data to determine the natural history of post-COVID-19 syndrome and its management.…”

Protective role of ginseng in endometriosis during covid-19

“…For instance, Rg3 can significantly reduce the activity of NF-kB, elevate caspase-3 expression, and inhibit VEGF expression [ [52] , [53] , [54] , [55] , [56] ]. These effects of KRG may be beneficial to symptoms of post-COVID as well autoimmune problems, persistent chronic inflammation, and hormonal imbalance as a consequence of changes in the hypothalamic-pituitary-adrenal axis [ 7 , 57 ].…”

“…Causes of post-COVID syndrome are under study. Hypotheses including autoimmune problem, persisting chronic inflammation, and hormonal imbalance as a consequence of a change in the hypothalamic-pituitary-adrenal axis have been proposed [ 7 ]. To prevent the spread of the virus by contact, a stringent approach has been taken.…”