Post-COVID Syndrome

A special issue of Viruses (ISSN 1999-4915). This special issue belongs to the section "SARS-CoV-2 and COVID-19".

Deadline for manuscript submissions: closed (31 December 2022) | Viewed by 49096

Special Issue Editors

National Academy of Medicine of Colombia, Bogotá, Colombia
Interests: translational medicine; autoimmunity; immunogenetics; rheumatic diseases; post-COVID syndrome
Institute of Transplantation Diagnostics and Cell Therapy, Division of Hemostasis, Hemotherapy, and Transfusion Medicine, Heinrich Heine University Medical Center, Düsseldorf, Germany
Interests: hemostasis and thrombosis; inherited and acquired platelet disorders; including platelet interactions with pathogens; thrombo-inflammation; antithrombotic treatment

Special Issue Information

Dear Colleagues,

Although most people with COVID-19 recover within weeks of illness, some patients experience post-COVID conditions. These post-COVID conditions may also be known as post-COVID-19 syndrome, long COVID, long-haul COVID, post-acute COVID-19, long-term effects of COVID, or chronic COVID.

Post-COVID syndrome (PCS), as a term, is preferred because it describes a set of signs and symptoms that are mutually related, and it includes signs and symptoms that appear after "recovery" (more than four weeks after acute illness).

The World Health Organization (WHO) released a consensus case definition for long COVID that is woefully vague. It defines a syndrome that: 1) occurs in those with a history or probable history of SARS-CoV-2 infection; 2) involves symptoms that occur or persist 3 months after infection; 3) has symptoms that last at least 2 months; and 4) cannot be explained by an alternative diagnosis.

According to the Centers for Disease Control and Prevention (CDC) "Post-COVID conditions are a wide range of new, returning, or ongoing health problems people can experience four or more weeks after first being infected with the virus that causes COVID-19. Even people who did not have COVID-19 symptoms in the days or weeks after they were infected can have post-COVID conditions. These conditions can present as different types and combinations of health problems for different lengths of time".

In this Special Issue of Viruses, we want to explore most of the topics related to PCS:

  • What is PCS and what is its natural history? How long does it last?
  • PCS in children
  • Differential diagnosis, e.g., deconditioning syndrome, myalgic encephalomyelitis/chronic fatigue syndrome
  • Who can experience PCS? Which are the risk factors?
  • Pathological mechanisms, e.g., viral persistence, endocrine dysregulation, endothelial dysfunction/endotheliopathy, autoimmune response, persistent inflammatory state, others.
  • Do vaccines protect against PCS?
  • Genetics
  • Therapeutic strategies

Prof. Dr. Juan-Manuel Anaya
Prof. Dr. Rüdiger E. Scharf
Guest Editors

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Keywords

  • post-COVID-19 syndrome
  • long COVID
  • long-haul COVID
  • post-acute COVID-19
  • chronic COVID
  • inflammation
  • autoimmunity
  • therapeutics
  • rehabilitation
  • vaccines

Published Papers (15 papers)

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Research

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18 pages, 2562 KiB  
Article
High Prevalence of Alternative Diagnoses in Children and Adolescents with Suspected Long COVID—A Single Center Cohort Study
by Sarah C. Goretzki, Maire Brasseler, Burcin Dogan, Tom Hühne, Daniel Bernard, Anne Schönecker, Mathis Steindor, Andrea Gangfuß, Adela Della Marina, Ursula Felderhoff-Müser, Christian Dohna-Schwake and Nora Bruns
Viruses 2023, 15(2), 579; https://0-doi-org.brum.beds.ac.uk/10.3390/v15020579 - 20 Feb 2023
Cited by 4 | Viewed by 1881
Abstract
Background: Long COVID (LC) is a diagnosis that requires exclusion of alternative somatic and mental diseases. The aim of this study was to examine the prevalence of differential diagnoses in suspected pediatric LC patients and assess whether adult LC symptom clusters are applicable [...] Read more.
Background: Long COVID (LC) is a diagnosis that requires exclusion of alternative somatic and mental diseases. The aim of this study was to examine the prevalence of differential diagnoses in suspected pediatric LC patients and assess whether adult LC symptom clusters are applicable to pediatric patients. Materials and Methods: Pediatric presentations at the Pediatric Infectious Diseases Department of the University Hospital Essen (Germany) were assessed retrospectively. The correlation of initial symptoms and final diagnoses (LC versus other diseases or unclarified) was assessed. The sensitivity, specificity, negative and positive predictive values of adult LC symptom clusters were calculated. Results: Of 110 patients, 32 (29%) suffered from LC, 52 (47%) were diagnosed with alternative somatic/mental diseases, and 26 (23%) remained unclarified. Combined neurological and respiratory clusters displayed a sensitivity of 0.97 (95% CI 0.91–1.00) and a negative predictive value of 0.97 (0.92–1.00) for LC. Discussion/Conclusions: The prevalence of alternative somatic and mental diseases in pediatric patients with suspected LC is high. The range of underlying diseases is wide, including chronic and potentially life-threatening conditions. Neurological and respiratory symptom clusters may help to identify patients that are unlikely to be suffering from LC. Full article
(This article belongs to the Special Issue Post-COVID Syndrome)
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13 pages, 663 KiB  
Article
Subjective and Objective Cognitive Impairments in Non-Hospitalized Persons 9 Months after SARS-CoV-2 Infection
by Inge Kirchberger, Daniela Peilstöcker, Tobias D. Warm, Jakob Linseisen, Alexander Hyhlik-Dürr, Christine Meisinger and Yvonne Goßlau
Viruses 2023, 15(1), 256; https://0-doi-org.brum.beds.ac.uk/10.3390/v15010256 - 16 Jan 2023
Cited by 7 | Viewed by 3274
Abstract
Studies on cognitive problems of persons with mild COVID-19 courses are still lacking. This study aimed to determine the frequency and associated factors of subjective and objective cognitive problems after COVID-19 in non-hospitalized persons. Study participants were examined at the University Hospital of [...] Read more.
Studies on cognitive problems of persons with mild COVID-19 courses are still lacking. This study aimed to determine the frequency and associated factors of subjective and objective cognitive problems after COVID-19 in non-hospitalized persons. Study participants were examined at the University Hospital of Augsburg from 04/11/2020 to 26/05/2021. The Wechsler Adult Intelligence Scale (WAIS) IV digit span, Stroop Color and Word Test (SCWT), Regensburger verbal fluency test (RWT) and, subjective ratings of memory and concentration were applied. Of the 372 participants (mean age 46.8 ± 15.2 years, 54.3% women, median time after infection 9.1 months), 24.9% reported concentration and 21.9% memory problems. Overall, 55.6% of the participants had at least a mild negative alteration in any cognitive test. The strongest impairments were found regarding memory functions (41.1% mild alterations, 6.2% distinct impairments) and verbal fluency (12.4% mild alterations, 5.4% distinct impairments). SCWT showed negative alterations in no more than 3.0% of the participants. Level of school education, age, and depressiveness emerged as significantly related to the cognitive tests. The number of complaints and depressiveness were significantly associated with subjective memory and concentration problems. It is important to identify mild cognitive impairment in non-hospitalized COVID-19 patients early to offer them effective interventions. Full article
(This article belongs to the Special Issue Post-COVID Syndrome)
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10 pages, 812 KiB  
Article
A Comprehensive Report of German Nationwide Inpatient Data on the Post-COVID-19 Syndrome Including Annual Direct Healthcare Costs
by Nike Walter, Markus Rupp, Siegmund Lang, Beate Leinberger, Volker Alt, Thilo Hinterberger and Thomas Loew
Viruses 2022, 14(12), 2600; https://0-doi-org.brum.beds.ac.uk/10.3390/v14122600 - 22 Nov 2022
Cited by 2 | Viewed by 1867
Abstract
Background: The aim of this study was to provide a comprehensive overview of German nationwide data including (i) the number of hospitalized Post-COVID Syndrome (PCS) cases including in-hospital mortality rates and intensive care unit treatments, (ii) the main common concomitant diagnoses associated with [...] Read more.
Background: The aim of this study was to provide a comprehensive overview of German nationwide data including (i) the number of hospitalized Post-COVID Syndrome (PCS) cases including in-hospital mortality rates and intensive care unit treatments, (ii) the main common concomitant diagnoses associated with PCS, (iii) the most frequently performed treatment procedures, and (iv) the annual direct healthcare costs. Methods: The incidence was calculated based on annual ICD-10 diagnosis codes “U09.9!, Post-COVID-19 condition”. Data on concomitant diagnoses, treatment procedures, treatment in an intensive care unit (ICU), in-hospital mortality, the proportion of G-DRGs, and cumulative costs were assessed based on the Institute for the Hospital Remuneration System (InEK) data for 2019. Results: A total of 29,808 PCS inpatients could be identified yielding a prevalence of 5.5%. In total, 1330 (4.5%) in-hospital deaths were recorded, and 5140 (17.2%) patients required ICU treatment. The majority of patients (18.6%) were aged 65–74 years. The most common concomitant diagnoses included pneumonia, critical illness polyneuropathy, dyspnea, chronic fatigue syndrome, and pulmonary embolisms. The most frequently performed procedures were computed tomography of the thorax with contrast medium, whole-body plethysmography, and the monitoring of respiration, heart, and circulation. The cost per case of the G-DRG codes that were analyzed ranged from € 620 ± 377 (E64D, Respiratory insufficiency, one day of occupancy) to € 113,801 ± 27,939 (A06B, Ventilation > 1799 h with complex OR procedure). Total cumulative direct healthcare costs of € 136,608,719 were calculated, resulting in mean costs of € 4583 per case. Conclusion: Post-COVID Syndrome is of major public health importance with substantial financial implications. The present article can support stakeholders in health care systems to foresee future needs and adapt their resource management. Consensus diagnostic criteria and rehabilitation guidelines are highly warranted. Full article
(This article belongs to the Special Issue Post-COVID Syndrome)
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10 pages, 266 KiB  
Article
Elevated Plasma D-Dimer Concentrations in Adults after an Outpatient-Treated COVID-19 Infection
by Christa Meisinger, Inge Kirchberger, Tobias D. Warm, Alexander Hyhlik-Dürr, Yvonne Goßlau and Jakob Linseisen
Viruses 2022, 14(11), 2441; https://0-doi-org.brum.beds.ac.uk/10.3390/v14112441 - 03 Nov 2022
Cited by 5 | Viewed by 2185
Abstract
Elevated D-dimer plasma concentrations are common in hospitalized COVID-19 patients and are often associated with a worse prognosis, but it is not yet clear whether this also applies to outpatient cases. The present cross-sectional study evaluated D-dimer levels and their association with clinical [...] Read more.
Elevated D-dimer plasma concentrations are common in hospitalized COVID-19 patients and are often associated with a worse prognosis, but it is not yet clear whether this also applies to outpatient cases. The present cross-sectional study evaluated D-dimer levels and their association with clinical parameters and inflammation biomarkers after a COVID-19 disease in individuals treated as outpatients. The study included 411 individuals (43.3% men) with an average age of 46.8 years (SD 15.2). Study participants who had acute COVID-19 disease at a median of 235 days (120; 323) ago were examined at the University Hospital Augsburg, Southern Germany, between 11/2020 and 05/2021. Plasma D-dimers were measured by a particle-enhanced immunoturbidimetric assay. Sixty-one subjects (15%) showed increased D-dimer concentrations (≥500 µg/L). Study participants with elevated D-dimer levels in comparison to subjects with levels in the reference range were significantly older, and more frequently reported a history of cardiovascular disease, hypertension, venous thromboembolism, and chronic venous insufficiency. In multivariable logistic regression analysis, CRP levels (OR 5.58 per mg/dL, 95% CI 1.77–17.60) and white blood cell count (OR 1.48 per nL, 95% CI 1.19–1.83) were significantly related to elevated D-dimers even after adjustment for multiple testing. However, acute or persistent symptoms were not significantly associated with increased D-dimers. Elevated D-dimer levels months after an acute COVID-19 disease seems to be associated with markers of inflammation. Further studies are needed to investigate the underlying pathophysiological mechanisms and consequences of prolonged D-dimer elevation in these patients. Full article
(This article belongs to the Special Issue Post-COVID Syndrome)
10 pages, 1265 KiB  
Article
Risk of Pulmonary Fibrosis and Persistent Symptoms Post-COVID-19 in a Cohort of Outpatient Health Workers
by Rosario Fernández-Plata, Anjarath-Lorena Higuera-Iglesias, Luz María Torres-Espíndola, Arnoldo Aquino-Gálvez, Rafael Velázquez Cruz, Ángel Camarena, Jaime Chávez Alderete, Javier Romo García, Noé Alvarado-Vásquez, David Martínez Briseño, Manuel Castillejos-López and Research Working Group
Viruses 2022, 14(9), 1843; https://0-doi-org.brum.beds.ac.uk/10.3390/v14091843 - 23 Aug 2022
Cited by 5 | Viewed by 1623
Abstract
Background: Infection by SARS-CoV-2 has been associated with multiple symptoms; however, still, little is known about persistent symptoms and their probable association with the risk of developing pulmonary fibrosis in patients post-COVID-19. Methods: A longitudinal prospective study on health workers infected by SARS-CoV-2 [...] Read more.
Background: Infection by SARS-CoV-2 has been associated with multiple symptoms; however, still, little is known about persistent symptoms and their probable association with the risk of developing pulmonary fibrosis in patients post-COVID-19. Methods: A longitudinal prospective study on health workers infected by SARS-CoV-2 was conducted. In this work, signs and symptoms were recorded of 149 health workers with a positive PCR test for SARS-CoV-2 at the beginning of the diagnosis, during the active infection, and during post-COVID-19 follow-up. The McNemar chi-square test was used to compare the proportions and percentages of symptoms between the baseline and each follow-up period. Results: The signs and symptoms after follow-up were cardiorespiratory, neurological, and inflammatory. Gastrointestinal symptoms were unusual at the disease onset, but unexpectedly, their frequency was higher in the post-infection stage. The multivariate analysis showed that pneumonia (HR 2.4, IC95%: 1.5–3.8, p < 0.001) and positive PCR tests still after four weeks (HR 5.3, IC95%: 2.3-12.3, p < 0.001) were factors associated with the diagnosis of post-COVID-19 pulmonary fibrosis in this study group. Conclusions: Our results showed that pneumonia and virus infection persistence were risk factors for developing pulmonary fibrosis post-COVID-19, after months of initial infection. Full article
(This article belongs to the Special Issue Post-COVID Syndrome)
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13 pages, 1645 KiB  
Article
Long-COVID Clinical Features and Risk Factors: A Retrospective Analysis of Patients from the STOP-COVID Registry of the PoLoCOV Study
by Michał Chudzik, Mateusz Babicki, Joanna Kapusta, Żaneta Kałuzińska-Kołat, Damian Kołat, Piotr Jankowski and Agnieszka Mastalerz-Migas
Viruses 2022, 14(8), 1755; https://0-doi-org.brum.beds.ac.uk/10.3390/v14081755 - 11 Aug 2022
Cited by 22 | Viewed by 3417
Abstract
Despite recovering from the acute phase of coronavirus disease (COVID-19), many patients report continuing symptoms that most commonly include fatigue, cough, neurologic problems, hair loss, headache, and musculoskeletal pain, a condition termed long-COVID syndrome. Neither its etiopathogenesis, nor its clinical presentation or risk [...] Read more.
Despite recovering from the acute phase of coronavirus disease (COVID-19), many patients report continuing symptoms that most commonly include fatigue, cough, neurologic problems, hair loss, headache, and musculoskeletal pain, a condition termed long-COVID syndrome. Neither its etiopathogenesis, nor its clinical presentation or risk factors are fully understood. Therefore, the purpose of this study was to retrospectively evaluate the most common symptoms of long-COVID among patients from the STOP COVID registry of the PoLoCOV study, and to search for risk factors for development of the syndrome. The registry includes patients who presented to the medical center for persistent clinical symptoms following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The analysis included data from initial presentation and at three-month follow-up. Of the 2218 patients, 1569 (70.7%) reported having at least one symptom classified as long-COVID syndrome three months after recovery from the initial SARS-CoV-2 infection. The most common symptoms included chronic fatigue (35.6%\), cough (23.0%), and a set of neurological symptoms referred to as brain fog (12.1%). Risk factors for developing long-COVID syndrome included female gender (odds ratio [OR]: 1.48, 95% confidence intervals [CI] [1.19–1.84]), severe COVID-19 (OR: 1.56, CI: 1.00–2.42), dyspnea (OR: 1.31, CI: 1.02–1.69), and chest pain (OR: 1.48, CI: 1.14–1.92). Long-COVID syndrome represents a significant clinical and social problem. The most common clinical manifestations are chronic fatigue, cough, and brain fog. Given the still-limited knowledge of long-COVID syndrome, further research and observation are needed to better understand the mechanisms and risk factors of the disease. Full article
(This article belongs to the Special Issue Post-COVID Syndrome)
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10 pages, 932 KiB  
Article
Long-Term Outcomes after Vaccine-Induced Thrombotic Thrombocytopenia
by Victoria Panagiota, Christiane Dobbelstein, Sonja Werwitzke, Arnold Ganser, Nina Cooper, Ulrich J. Sachs and Andreas Tiede
Viruses 2022, 14(8), 1702; https://0-doi-org.brum.beds.ac.uk/10.3390/v14081702 - 01 Aug 2022
Cited by 7 | Viewed by 2352
Abstract
Vaccine-induced thrombotic thrombocytopenia (VITT), or thrombosis with thrombocytopenia syndrome (TTS), is a rare but serious complication of adenovirus-based vaccines against severe respiratory syndrome coronavirus 2 (SARS-CoV-2). Observation of long-term outcomes is important to guide treatment of affected patients. This single-center consecutive cohort study [...] Read more.
Vaccine-induced thrombotic thrombocytopenia (VITT), or thrombosis with thrombocytopenia syndrome (TTS), is a rare but serious complication of adenovirus-based vaccines against severe respiratory syndrome coronavirus 2 (SARS-CoV-2). Observation of long-term outcomes is important to guide treatment of affected patients. This single-center consecutive cohort study included all patients diagnosed based on (1) vaccination 4 to 21 days before symptom onset, (2) signs or symptoms of venous or arterial thrombosis, (3) thrombocytopenia < 150/nL, (4) positive anti-platelet factor 4 (PF4) antibody, and (5) elevated D-Dimer > 4 times the upper limit of normal. Nine patients were enrolled. Acute management consisted of parenteral anticoagulants, corticosteroids, intravenous immunoglobulin (IVIG), and/or eculizumab. Eculizumab was successfully used in two patients with recurrent thromboembolic events after IVIG. Direct oral anticoagulants were given after hospital discharge. Median follow-up duration was 300 days (range 153 to 380). All patients survived the acute phase of the disease and were discharged from hospital. One patient died from long-term neurological sequelae of cerebral venous sinus thrombosis 335 days after diagnosis. Eight out of nine patients were alive at last follow-up, and seven had fully recovered. Anti-PF4 antibodies remained detectable for at least 12 weeks after diagnosis, and D-Dimer remained elevated in some patients despite oral anticoagulation. No recurrent thromboembolic events, other signs of VITT relapse, or bleeding complications occurred after discharge. In conclusion, VITT appears to be a highly prothrombotic condition. IVIG is not always successful, and eculizumab may be considered a rescue agent. Long-term management with direct oral anticoagulants appears to be safe and effective. Full article
(This article belongs to the Special Issue Post-COVID Syndrome)
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11 pages, 1005 KiB  
Article
The Self-Reported Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) and PainDETECT Questionnaires in COVID-19 Survivors with Post-COVID Pain
by César Fernández-de-las-Peñas, Juan Antonio Valera-Calero, Manuel Herrero-Montes, Pablo del-Valle-Loarte, Rafael Rodríguez-Rosado, Diego Ferrer-Pargada, Lars Arendt-Nielsen and Paula Parás-Bravo
Viruses 2022, 14(7), 1486; https://0-doi-org.brum.beds.ac.uk/10.3390/v14071486 - 07 Jul 2022
Cited by 10 | Viewed by 1999
Abstract
This study aimed to analyze correlations between Self-Report Leeds Assessment of Neuropathic Symptoms (S-LANSS) and PainDETECT with proxies of sensitization, pain-related, or psychological/cognitive variables in coronavirus disease, 2019 (COVID-19) survivors exhibiting post-COVID pain. Demographic, clinical, psychological, cognitive, sensitization-associated symptoms, and health-related quality of [...] Read more.
This study aimed to analyze correlations between Self-Report Leeds Assessment of Neuropathic Symptoms (S-LANSS) and PainDETECT with proxies of sensitization, pain-related, or psychological/cognitive variables in coronavirus disease, 2019 (COVID-19) survivors exhibiting post-COVID pain. Demographic, clinical, psychological, cognitive, sensitization-associated symptoms, and health-related quality of life were collected in 146 survivors with post-COVID pain. The PainDETECT and S-LANSS questionnaires were used for assessing neuropathic pain-related symptoms. Patients were assessed with a mean of 18.8 (SD 1.8) months after hospitalization. Both questionnaires were positively associated with pain intensity (p < 0.05), anxiety (PainDETECT p < 0.05; S-LANSS p < 0.01), sensitization-associated symptoms (p < 0.01), catastrophism (p < 0.01), and kinesiophobia (p < 0.01) and negatively associated with quality of life (PainDETECT p < 0.05; S-LANSS p < 0.01). Depressive levels were associated with S-LANSS (p < 0.05) but not with PainDETECT. The stepwise regression analyses revealed that 47.2% of S-LANSS was explained by PainDETECT (44.6%), post-COVID pain symptoms duration (1.7%), and weight (1.1%), whereas 51.2% of PainDETECT was explained by S-LANSS (44.6%), sensitization-associated symptoms (5.4%), and anxiety levels (1.2%). A good convergent association between S-LANSS and PainDETECT was found. Additionally, S-LANSS was associated with symptom duration and weight whereas PainDETECT was associated with sensitization-associated symptoms and anxiety levels, suggesting that the two questionnaires evaluate different aspects of the neuropathic pain spectrum in post-COVID pain patients. Full article
(This article belongs to the Special Issue Post-COVID Syndrome)
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14 pages, 934 KiB  
Article
Post-COVID-19 Impairment of the Senses of Smell, Taste, Hearing, and Balance
by Sonja Ludwig, Angela Schell, Michelle Berkemann, Frederic Jungbauer, Lena Zaubitzer, Lena Huber, Christian Warken, Valentin Held, Alexander Kusnik, Andreas Teufel, Matthias Ebert and Nicole Rotter
Viruses 2022, 14(5), 849; https://0-doi-org.brum.beds.ac.uk/10.3390/v14050849 - 20 Apr 2022
Cited by 15 | Viewed by 2705
Abstract
Background: Various symptoms have been associated with COVID-19, but little is known about the impacts of COVID-19 on the sensory system, risk factors, and the duration of symptoms. This study assesses olfactory, gustatory, hearing, and vestibular systems after COVID-19. Methods: This cross-sectional, single-center [...] Read more.
Background: Various symptoms have been associated with COVID-19, but little is known about the impacts of COVID-19 on the sensory system, risk factors, and the duration of symptoms. This study assesses olfactory, gustatory, hearing, and vestibular systems after COVID-19. Methods: This cross-sectional, single-center study involved 50 patients one to six months after COVID-19 and reports their patient records and the extent, onset, and duration of olfactory, gustatory, hearing, and balance disorders using questionnaires during and after COVID-19. Sensory symptoms were objectively studied using the following clinical tests after COVID-19 Sniffin’ Sticks, taste tests, tone/speech audiometry, and video head impulse test. Results: Post-COVID-19-patients were suffering from olfactory and gustatory impairment for up to six months. According to the Dizziness Handicap Inventory, balance disorders were less noticed: Overall, about 40% of the patients during COVID-19 and nearly all patients recovered within six months. After COVID-19, clinical tests revealed that 75% were suffering from hyposomnia/anosmia, and 20% of all patients reported mild hypogeusia for up to six months. Vestibular disorders and hearing impairment rarely/did not occur. Females were significantly more affected by sensory impairments than males. Conclusions: COVID-19 particularly caused olfactory and gustatory impairment; balance disorders were present too; vestibular and auditory symptoms were negligible. Full article
(This article belongs to the Special Issue Post-COVID Syndrome)
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Review

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17 pages, 1802 KiB  
Review
Post-COVID Syndrome in Adults—An Overview
by Rüdiger E. Scharf and Juan-Manuel Anaya
Viruses 2023, 15(3), 675; https://0-doi-org.brum.beds.ac.uk/10.3390/v15030675 - 04 Mar 2023
Cited by 12 | Viewed by 5037
Abstract
This article provides an overview of various aspects related to post-COVID syndrome. Apart from its prevalence, symptoms and sequelae, risk determinants, and psychosocial implications, the pathogenesis of post-COVID condition is discussed in more detail. A focus on thrombo-inflammation in SARS-CoV-2 infection, the role [...] Read more.
This article provides an overview of various aspects related to post-COVID syndrome. Apart from its prevalence, symptoms and sequelae, risk determinants, and psychosocial implications, the pathogenesis of post-COVID condition is discussed in more detail. A focus on thrombo-inflammation in SARS-CoV-2 infection, the role of neutrophil extracellular traps, and the prevalence of venous thromboembolism is made. Moreover, COVID-19 and post-COVID syndrome in immunocompromising conditions, and the impact of vaccination on the prevention and treatment of post-COVID symptoms are reviewed. Autoimmunity is a hallmark of post-COVID syndrome, and, therefore, is another focus of this article. Thus, misdirected cellular and humoral immune responses can enhance the risk of latent autoimmunity in post-COVID syndrome. Facing the high prevalence of COVID-19 cases worldwide, it can be assumed that autoimmune disorders will increase globally over the next few years. Recent advances in identifying genetically determined variants may open the avenue for a better understanding of the susceptibility to and severity of SARS-CoV-2 infection and post-COVID syndrome. Full article
(This article belongs to the Special Issue Post-COVID Syndrome)
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26 pages, 2852 KiB  
Review
Post-COVID-19 Syndrome Comprehensive Assessment: From Clinical Diagnosis to Imaging and Biochemical-Guided Diagnosis and Management
by Michael Zhipeng Yan, Ming Yang and Ching-Lung Lai
Viruses 2023, 15(2), 533; https://0-doi-org.brum.beds.ac.uk/10.3390/v15020533 - 14 Feb 2023
Cited by 6 | Viewed by 3970
Abstract
The COVID-19 outbreak was first reported in 2019, causing massive morbidity and mortality. The majority of the COVID-19 patients survived and developed Post-COVID-19 Syndrome (PC19S) of varying severity. Currently, the diagnosis of PC19S is achieved through history and symptomatology that cannot be explained [...] Read more.
The COVID-19 outbreak was first reported in 2019, causing massive morbidity and mortality. The majority of the COVID-19 patients survived and developed Post-COVID-19 Syndrome (PC19S) of varying severity. Currently, the diagnosis of PC19S is achieved through history and symptomatology that cannot be explained by an alternative diagnosis. However, the heavy reliance on subjective reporting is prone to reporting errors. Besides, there is no unified diagnostic assessment tool to classify the clinical severity of patients. This leads to significant difficulties when managing patients in terms of public resource utilization, clinical progression monitorization and rehabilitation plan formulation. This narrative review aims to review current evidence of diagnosis based on triple assessment: clinical symptomatology, biochemical analysis and imaging evidence. Further assessment tools can be developed based on triple assessment to monitor patient’s clinical progression, prognosis and intervals of monitoring. It also highlights the high-risk features of patients for closer and earlier monitoring. Rehabilitation programs and related clinical trials are evaluated; however, most of them focus on cardiorespiratory fitness and psychiatric presentations such as anxiety and depression. Further research is required to establish an objective and comprehensive assessment tool to facilitate clinical management and rehabilitation plans. Full article
(This article belongs to the Special Issue Post-COVID Syndrome)
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12 pages, 607 KiB  
Review
Unfavorable Outcome and Long-Term Sequelae in Cases with Severe COVID-19
by Andrea Fabbri, Antonio Voza, Alessandro Riccardi, Simone Vanni and Fabio De Iaco
Viruses 2023, 15(2), 485; https://0-doi-org.brum.beds.ac.uk/10.3390/v15020485 - 09 Feb 2023
Cited by 1 | Viewed by 1611
Abstract
Emerging evidence shows that individuals with COVID-19 who survive the acute phase of illness may experience lingering symptoms in the following months. There is no clear indication as to whether these symptoms persist for a short time before resolving or if they persist [...] Read more.
Emerging evidence shows that individuals with COVID-19 who survive the acute phase of illness may experience lingering symptoms in the following months. There is no clear indication as to whether these symptoms persist for a short time before resolving or if they persist for a long time. In this review, we will describe the symptoms that persist over time and possible predictors in the acute phase that indicate long-term persistence. Based on the literature available to date, fatigue/weakness, dyspnea, arthromyalgia, depression, anxiety, memory loss, slowing down, difficulty concentrating and insomnia are the most commonly reported persistent long-term symptoms. The extent and persistence of these in long-term follow-up is not clear as there are still no quality studies available. The evidence available today indicates that female subjects and those with a more severe initial disease are more likely to suffer permanent sequelae one year after the acute phase. To understand these complications, and to experiment with interventions and treatments for those at greater risk, we must first understand the physio-pathological mechanisms that sustain them. Full article
(This article belongs to the Special Issue Post-COVID Syndrome)
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15 pages, 1499 KiB  
Review
Cardiac Arrhythmias in Post-COVID Syndrome: Prevalence, Pathology, Diagnosis, and Treatment
by Aydin Huseynov, Ibrahim Akin, Daniel Duerschmied and Rüdiger E. Scharf
Viruses 2023, 15(2), 389; https://0-doi-org.brum.beds.ac.uk/10.3390/v15020389 - 29 Jan 2023
Cited by 17 | Viewed by 7713
Abstract
An increase in post-COVID patients with late sequelae of acute COVID-19 infection is emerging as an ongoing challenge for physicians and healthcare professionals. Since the beginning of the pandemic, it has rapidly become evident that the acute infection is not limited to the [...] Read more.
An increase in post-COVID patients with late sequelae of acute COVID-19 infection is emerging as an ongoing challenge for physicians and healthcare professionals. Since the beginning of the pandemic, it has rapidly become evident that the acute infection is not limited to the respiratory tract but that several organs, including the cardiovascular system, can be affected. Moreover, in a significant proportion of patients (ranging from about 10 to up to 50%) with former COVID-19, cardiopulmonary symptoms such as dyspnea, palpitations, restricted physical capacity, and cardiac arrhythmias can persist weeks and months after the acute SARS-CoV-2 infection. The spectrum of COVID-19-associated arrhythmias is rather wide, most likely due to various pathomechanisms. In this article, the prevalence of cardiac arrhythmias and underlying pathologies are reviewed, including direct myocardial injury and abnormal consequences with an impact on cardiac electric instability. The hyperinflammatory reaction of the host immune system is specifically considered. Moreover, several distinct rhythm disorders occurring in post-COVID patients are discussed with regard to their clinical management. Full article
(This article belongs to the Special Issue Post-COVID Syndrome)
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22 pages, 910 KiB  
Review
Pathogenic Connections in Post-COVID Conditions: What Do We Know in the Large Unknown? A Narrative Review
by Celina Silvia Stafie, Sorina Mihaela Solomon, Irina-Georgeta Sufaru, Maria Manaila, Ingrid Ioana Stafie, Gabriela Melinte, Bianca Simionescu and Letitia Leustean
Viruses 2022, 14(8), 1686; https://0-doi-org.brum.beds.ac.uk/10.3390/v14081686 - 30 Jul 2022
Cited by 4 | Viewed by 2927
Abstract
The coronavirus 2019 (COVID-19) disease has long-term effects, known as post-COVID conditions (PCC) or long-COVID. Post-COVID-19 syndrome is defined by signs and symptoms that occur during or after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection which persist for more than 12 weeks [...] Read more.
The coronavirus 2019 (COVID-19) disease has long-term effects, known as post-COVID conditions (PCC) or long-COVID. Post-COVID-19 syndrome is defined by signs and symptoms that occur during or after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection which persist for more than 12 weeks and cannot be supported by an alternative diagnosis. The cardiovascular damage caused by COVID-19 in the severe forms of the disease is induced by severe systemic inflammation, considered to be one of the causes of myocardial lesions, with increased levels of circulating cytokines and toxic response mediators. We have focused on conditions that can induce long-COVID-19, or multisystem inflammatory syndrome in adults or children (MIS-C/MIS-A), with an emphasis on endocrinological and metabolic disorders. Although described less frequently in children than in adults, long-COVID syndrome should not be confused with MIS-C, which is an acute condition characterized by multisystem involvement and paraclinical evidence of inflammation in a pediatric patient who tested positive for SARS-CoV-2. At the same time, we mention that the MIS-A symptoms remit within a few weeks, while the duration of long-COVID is measured in months. Long-COVID syndrome, along with its complications, MIS-A and MIS-C, represents an important challenge in the medical community. Underlying comorbidities can expose both COVID-19 adult and pediatric patients to a higher risk of negative outcomes not only during, but in the aftermath of the SARS-CoV-2 infection as well. Full article
(This article belongs to the Special Issue Post-COVID Syndrome)
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12 pages, 575 KiB  
Review
Cardiac Complications of COVID-19 in Low-Risk Patients
by Akash Srinivasan, Felyx Wong, Liam S. Couch and Brian X. Wang
Viruses 2022, 14(6), 1322; https://0-doi-org.brum.beds.ac.uk/10.3390/v14061322 - 17 Jun 2022
Cited by 8 | Viewed by 4347
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has resulted in over 6 million deaths and significant morbidity across the globe. Alongside common respiratory symptoms, COVID-19 is associated with a variety of cardiovascular complications in the acute and post-acute phases of infection. The suggested pathophysiological [...] Read more.
The coronavirus disease 2019 (COVID-19) pandemic has resulted in over 6 million deaths and significant morbidity across the globe. Alongside common respiratory symptoms, COVID-19 is associated with a variety of cardiovascular complications in the acute and post-acute phases of infection. The suggested pathophysiological mechanisms that underlie these complications include direct viral infection of the myocardium via the angiotensin-converting enzyme 2 (ACE2) protein and a cytokine release syndrome that results in indirect inflammatory damage to the heart. Patients with pre-existing cardiovascular disease and co-morbidities are generally more susceptible to the cardiac manifestations of COVID-19. However, studies have identified a variety of complications in low-risk individuals, including young adults and children. Myocarditis and paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS) are among the adverse events reported in the acute phase of infection. Furthermore, patients have reported cardiac symptoms persisting beyond the acute phase in post-COVID syndrome. This review summarises the acute and chronic cardiac consequences of COVID-19 in low-risk patients, explores the pathophysiology behind them, and discusses new predictive factors for poor outcomes. Full article
(This article belongs to the Special Issue Post-COVID Syndrome)
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