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LONG COVID-19 SYNDROME - Coggle Diagram
LONG COVID-19 SYNDROME
CYTOKINE STORM
- SARS-CoV-2 induces excessive and prolonged cytokine/chemokine responses in some infected individuals, known as the cytokine storm. Cytokine storm causes ARDS or multiple-organ dysfunction, which leads to physiological deterioration and death.
- In vitro cell experiments show that delayed release of cytokines and chemokines occurs in respiratory epithelial cells, dendritic cells (DCs), and macrophages at the early stage of SARS-CoV infection. Later, the cells secrete low levels of the antiviral factors interferons (IFNs) and high levels of proinflammatory cytokines (interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)) and chemokines (C-C motif chemokine ligand (CCL)-2, CCL-3, and CCL-5).
- THP-1 cells (a monocyte cell line), human peripheral blood monocyte-derived macrophages and DCs, and induces delayed but elevated levels of proinflammatory cytokines and chemokines.
CLINICAL MANIFESTATION
- There is a marked variation in the presentation of post-acute COVID-19 syndrome. Patients may present with non-specific symptoms such as fatigue, muscle aches and pains, poor sleep, cough, and breathlessness, to more specific organ-related symptoms, such as orthopnea, leg swelling, and exercise intolerance due to COVID-19 induced heart failure.
- Fatigue (53.1%), dyspnea (43.4%), joint pain (27.3%) and chest pain (21.7%) were the most commonly
reported symptoms.
PATHOGENESIS
The predominant pathophysiologic mechanisms of acute COVID-19 include the following
- Direct viral toxicity, endothelial damage
and microvascular injury; immune system dysregulation and stimulation of a hyperinflammatory state; hypercoagulability with resultant in situ thrombosis and macrothrombosis;and maladaptation of the angiotensin-converting enzyme 2 (ACE2) pathway.
Potential mechanisms contributing to the pathophysiology of post-acute COVID-19 include:
- virus-specific pathophysiologic
changes; immunologic aberrations and inflammatory damage in response to the acute infection and expected sequelae of
post-critical illness.
COMPLICATION & PROGNOSIS
- In the longer term, PTSD, depression and anxiety, and reduced quality of life were observed at one year after infection with SARS and MERS.
- n addition, a study found that up to 40% of patients who had SARS continued to experience fatigue and psychiatric illnesses for nearly 3.5 years after the acute infection.
- A meta-analysis of 28 follow-up studies found that six months after hospital discharge, approximately 25% of patients hospitalised with SARS and MERS had reduced lung function and exercise capacity.
- The prognosis of this new clinical entity is not known and is likely dependent on the severity of clinical symptoms, underlying comorbid conditions, and response to treatment. More clinical studies evaluating post-COVID-19 patients are required to understand the duration and the long-term effects of this new clinical entity.
DEFENITION, ETIOLOGY & RISK FACTOR
- There is no clear definition of post-acute COVID-19 syndrome. In general, it is an illness described among patients who have recovered from COVID-19 but still have ongoing symptoms or among those who continued to have symptoms for longer than normally expected (4-12 weeks).
- The etiology and the biological underpinnings of LCS are not clear yet. However, SARS-CoV-2 invades many tissues and has multi-organ and multi-system impacts.
- LCS has significant associations with sex (women), respiratory symptoms at the onset, and the severity of the illness (length of hospital stay), more than five early symptoms, and initial acute COVID-19 severity.
DIAGNOSIS APPROACH
ESSENTIAL CRITERIA (Evidence of preceding infection with SARS-CoV-2 within last 2–4 weeks)
Symptomatic
Confirmed
- Clinical features consistent with COVID-19, with positive throat swab RT-PCR
- Clinical features consistent with COVID-19, with negative throat swab RT- PCR, with positive antibody testing
Probable
- Clinical features consistent with COVID-19, with negative throat swab RT-PCR and antibody testing, with CT thorax or chest X ray consistent with COVID-19 in presence of contact with confirmed or suspected case of COVID-19 within 2 weeks of onset of symptoms
- Clinical features consistent with COVID-19, with negative throat swab RT-PCR, antibody testing and negative CT thorax and chest X ray in presence of contact with confirmed or suspected case of COVID-19 within 2 weeks of onset of symptoms.
Possible
- Clinical features consistent with COVID-19, with negative throat swab RT-PCR and antibody testing, with CT thorax or chest X ray consistent with COVID-19 in the absence of contact with confirmed or suspected case of COVID-19 within 2 weeks of onset of symptoms, in the setting of community transmission.
- Clinical features consistent with COVID-19, with negative throat swab RT-PCR, antibody testing and negative CT thorax and chest X ray in the absence of contact with confirmed or suspected case of COVID-19 within 2 weeks of onset of symptoms, in the setting of community transmission
Asymptomatic
Confirmed
- Either positive throat swab RT-PCR or positive antibody testing or both
Probable
- Negative throat swab RT-PCR and antibody testing with CT thorax, chest X ray consistent with COVID-19 in presence of contact with confirmed or suspected case of COVID-19
Possible
- Negative throat swab RT-PCR, antibody testing and negative CT thorax and chest X ray in presence of contact with confirmed or suspected case of COVID-19
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TREATMENT
- Patients should be educated about self-monitoring at home with FDA-approved devices that include a pulse oximeter, blood pressure, and blood glucose monitors.
- Patients should be encouraged to consume a healthy balanced diet, maintain proper sleep hygiene, limit alcohol use and quit smoking.
- Simple analgesia with acetaminophen as needed should be considered
- If tolerated, a structured exercise program consisting of aerobic and resistance components must be advised, provided they are no other contraindications.
PREVENTION
- The best way to prevent post-COVID conditions is to prevent COVID-19 illness. For people who are eligible, getting vaccinated against COVID-19 as soon as you can is the best way to prevent getting COVID-19 and can also help protect those around you.
EPIDEMIOLOGY
- COVID-19 appears to be associated with long-term effects that are common and diverse, with 57% of patients having at least one long-COVID
- The incidence of each feature was: abnormal breathing (18.71% in the 1- to 180-day period; 7.94% in the 90- to180-day period), fatigue/malaise (12.82%; 5.87%), chest/throat pain (12.60%; 5.71%), headache (8.67%; 4.63%), other pain (11.60%; 7.19%), abdominal symptoms (15.58%; 8.29%), myalgia (3.24%; 1.54%), cognitive symptoms (7.88%; 3.95%), and anxiety/depression (22.82%; 15.49%).