Long-Term Health Effects of COVID-19 Disability and Function Following SARS-CoV-2 Infection (2024) / Chapter Skim
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5 Chronic Conditions Similar to Long COVID
Pages 183-214

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From page 183...
... Additionally, Long COVID shares many features with other complex multisystem chronic conditions, including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and fibromyalgia (FM)
From page 184...
... . According to the IOM, ME/CFS is diagnosed when a patient meets the following criteria: a new-onset substantial activity impairment lasting at least 6 months, postexertional malaise, and unrefreshing sleep, in addition to cognitive impairment or orthostatic intolerance.
From page 185...
... A systematic review comparing clinical presentation and symptoms for ME/CFS and Long COVID found that only 3 of 21 Long COVID studies assessed patients who had had symptoms for at least 6 months (Wong and Weitzer, 2021)
From page 186...
... Functional Implications People with Long COVID, ME/CFS, and FM have decreased quality of life, including reduced physical and cognitive capacity, impairment in work performance, and reduced participation in society. In a study by Haider and colleagues (2023)
From page 187...
... Abbreviations: BP = bodily pain; CO = cognition; GA = getting along; GH = general health perceptions; HC = healthy control; LA1 = life activities 1; ME/CFS = myalgic encephalomyelitis/chronic fatigue syndrome; MH = general mental health; MO = mobility; PA = participation; PCC = post-COVID-19 condition; PF = physical functioning; RE = role limitations due to personal or emotional problems; RP = role limitations due to physical health problems; SC = self-care; SF = social functioning; SF-36v2 = 36-Item Short-Form Health Survey (version 2) ; VIT = vitality; WHODAS = 2.0 World Health Organization Disability Assessment Schedule (version 2)
From page 188...
... The significant overlap in clinical presentation between Long COVID and ME/CFS and FM raises the question of common mechanisms that could be involved in the pathogenesis of these conditions and offers the potential to use past clinical and biomedical research to accelerate the understanding of pathomechanisms specific to Long COVID. This section provides an overview of the potential overlapping pathomechanisms for which there is published evidence, summarized in Table 5-2.
From page 189...
... Long Postinfectious onset COVID ME/CFS FM Immune Innate immune exhaustion ✓ ✓ dysregulation Cytokine dysregulation ✓ ✓ Autoantibodies ✓ ✓ ✓ Neurological Neuroinflammation ✓ ✓ disturbances Reduced cerebral blood flow ✓ ✓ Impaired functional connectivity ✓ ✓ Abnormal brain metabolites ✓ ✓ ✓ Changes in brain region volumes ✓ ✓ Cardiovascular Orthostatic intolerance ✓ ✓ disturbances Endothelial dysfunction ✓ ✓ Coagulopathies ✓ Gastrointestinal Dysbiosis ✓ ✓ ✓ disturbances Gut–immune–brain axis ✓ ✓ Metabolic and Mitochondrial dysfunction ✓ ✓ mitochondrial Mitochondrial metabolite abnormalities ✓ ✓ dysfunction Down-regulation of the hypothalamic- ✓ ✓ ✓ pituitary-adrenal axis SOURCES: Augustin et al., 2021; Bakken et al., 2014; Bhargava and Hurley, 2023; Cao, 2020; Carruthers et al., 2011; Cervia et al., 2022; de Miranda et al., 2022; Demitrack et al., 1991; Farhadian et al., 2023; Garg et al., 2021b; Guasp et al., 2022; Jason et al., 2009; Komaroff and Lipkin, 2023; Lindell et al., 2000; NICE, 2020; Ram-Mohan et al., 2022; Raveendran et al., 2021; Srikanth et al., 2023; Su et al., 2022; Sukocheva et al., 2021; Tay et al., 2020; Urhan et al., 2022; Wessely, 1995; Yelin et al., 2022. Ojo-Amaize et al., 1994; Whiteside and Friberg, 1998)
From page 190...
... . Other neurological mechanisms include reduced cerebral blood flow (Barnden et al., 2016, 2019; Davis et al., 2023; Gay et al., 2015; Monje and Iwasaki, 2022; Shungu et al., 2012; Thapaliya et al., 2020, 2022; van Campen et al., 2022)
From page 191...
... . Metabolic Energy insufficiency increased reactive oxygen species (ROS)
From page 192...
... . Other epigenetic phenomena, like DNA methylation, that have been postulated as having impact in acute COVID infection may also have an impact in the pathophysiology of Long COVID or other postviral syndromes, and research is ongoing (Balnis et al., 2022)
From page 193...
... . Other symptom inventory questionnaires used to evaluate health effects of these chronic conditions include the 31-question Composite Autonomic Symptom Score (COMPASS 31)
From page 194...
... One study on established FM patients (median disease duration of 7.8 years at the beginning of the study) found that functional disability worsened over the 7-year study period, while pain, fatigue, sleep disturbances, anxiety, and depression remained unchanged (Wolfe et al., 1997)
From page 195...
... . TREATMENT AND MANAGEMENT The CDC "Post-COVID Conditions: Information for Healthcare Providers" page suggests symptom management approaches for Long COVID that have been helpful for disorders such as ME/CFS, FM, posttreatment Lyme disease, dysautonomia, and mast cell activation syndrome (CDC, 2024)
From page 196...
... A systematic review of nonpharmacological treatments in post-viral syndromes (including Long COVID) suggested interventions using Pilates exercises, resistance exercise, telerehabilitation, neuromodulation, and music therapy (Chandan et al., 2023)
From page 197...
... . Psychosocial Support Chronic conditions pose a significant burden with respect to psychological health.
From page 198...
... . Recently updated NICE guidelines for ME/CFS highlight that agents currently prescribed to treat cognitive impairment, fatigue, and sleep disturbances are of low quality and efficacy.
From page 199...
... The mechanism of action for these conditions remains unclear, and further investigation is needed. Current theories for potential shared mechanisms of action supported by published literature include immune dysregulation (including dysregulation of innate immune responses, cytokine dysregulation, or mast cell activation)
From page 200...
... The full recovery duration for Long COVID patients remains uncertain, but early diagnosis and treatment may help prevent progression to chronic conditions such as ME/CFS and FM. Currently there are no FDA approved drugs or evidence-based treatments for Long COVID, ME/CFS, or FM.
From page 201...
... 2014. Two age peaks in the incidence of chronic fatigue syndrome/myalgic encephalomyelitis: A population-based registry study from Norway 2008-2012.
From page 202...
... 2023. Myalgic encephalomyelitis/chronic fatigue syndrome is common in post-acute sequelae of SARS CoV-2 infection (PASC)
From page 203...
... 2019. A systematic review of cytokines in chronic fatigue syndrome/myalgic encephalomyelitis/ systemic exertion intolerance disease (CFS/ME/SEID)
From page 204...
... 2021. Are circulating fibroblast growth factor 21 and N-terminal prohormone of brain natriuretic peptide promising novel biomarkers in myalgic encephalomyelitis/chronic fatigue syndrome?
From page 205...
... 2021. Post-acute COVID-19 symptoms, a potential link with myalgic encephalomyelitis/chronic fatigue syndrome: A 6-month survey in a Mexican cohort.
From page 206...
... 2015a. Longitudinal analysis of immune abnormalities in varying severities of chronic fatigue syndrome/myalgic encephalomyelitis patients.
From page 207...
... 2020. A systematic review of mitochondrial abnormalities in myalgic encephalomyelitis/ chronic fatigue syndrome/systemic exertion intolerance disease.
From page 208...
... 2023. Autoimmune autonomic nervous system imbalance and conditions: Chronic fatigue syndrome, fibromyalgia, silicone breast implants, COVID and post-COVID syndrome, sick building syndrome, post-orthostatic tachycardia syndrome, autoimmune diseases and autoimmune/inflammatory syndrome induced by adjuvants.
From page 209...
... 2021. Recovery from chronic fatigue syndrome: A systematic review-heterogeneity of definition limits study comparison.
From page 210...
... 2016. Housebound versus nonhousebound patients with myalgic encephalomyelitis and chronic fatigue syndrome.
From page 211...
... 2015. Treatment of myalgic encephalomyelitis/chronic fatigue syndrome: A systematic review for a national institutes of health pathways to prevention workshop.
From page 212...
... 2020. A SWATH-MS analysis of myalgic encephalomyelitis/chronic fatigue syndrome peripheral blood mono nuclear cell proteomes reveals mitochondrial dysfunction.
From page 213...
... 2022. Orthostatic symptoms and reduc tions in cerebral blood flow in long-haul COVID-19 patients: Similarities with myalgic encephalomyelitis/chronic fatigue syndrome.
From page 214...
... 1998. Natural killer cells and natural killer cell activity in chronic fatigue syndrome.


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