Treatment of Long COVID or Post COVID syndrome: A Pharmacological approach.
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ABSTRACT:
SUBMITTER: Banerjee I
PROVIDER: S-EPMC9659683 | biostudies-literature | 2022 Sep
REPOSITORIES: biostudies-literature
Publications
Treatment of Long COVID or Post COVID syndrome: A Pharmacological approach.
Banerjee Indrajit I Robinson Jared J Sathian Brijesh B
Nepal journal of epidemiology 20220930 3
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Project description:Introduction Il est désormais admis que les « orteils COVID » sont associés à la pathogenèse du SARS-CoV-2. Les descriptions sont concordantes dans le monde entier, mais le suivi est peu décrit. Nous présentons 4 cas « d’orteils COVID » avec un suivi de plusieurs mois. Matériel et méthodes Entre février 2020 et avril 2021, 4 cas de plus de 3 mois ont été suivis rétrospectivement dans notre clinique dermatologique. Résultats Le premier patient était une femme de 19 ans sans antécédent médical. Deux mois après l’apparition des symptômes de la COVID-19, des lésions acrales de type engelures apparaissaient sur les orteils. Elle se plaignait de démangeaisons. Il n’y avait pas d’aggravation avec le froid. La sérologie SARS-CoV-2 était positive, et la recherche d’anticorps antinucléaires, de cryoglobuline, de cryofibrinogène, d’agglutinines froides était négative. Les engelures étaient encore visibles à 4 mois. Le deuxième patient était une femme de 18 ans en bonne santé. Deux semaines après l’apparition des signes de la COVID-19, des engelures asymptomatiques apparaissaient sur les orteils et les doigts. L’infection par le SARS-Cov-2 était confirmée par PCR nasopharyngée. En outre, on observait une éruption urticarienne transitoire et indolore du tronc, des genoux et des mains, exacerbée par la chaleur et disparaissant avec le froid. La biologie montrait des anticorps antinucléaires positifs avec une fluorescence nucléolaire, et un facteur rhumatoïde. Les engelures étaient encore visibles à 3 mois. Le troisième patient était une femme de 60 ans en bonne santé. Peu après les signes de la COVID-19 avec des symptômes typiques légers, apparaissaient des engelures indolores des orteils. Elle notait une exacerbation par la chaleur, mais pas d’aggravation par le froid. Un épisode de nécrose digitale fut observé et les engelures disparaissaient après cinq mois. Le 4e cas était une femme de 20 ans qui souffrait de symptômes compatibles avec la COVID-19. Cependant, aucune PCR nasopharyngée n’était réalisée et la sérologie était négative. Deux mois plus tard, des engelures et une érythromélalgie apparaissaient sur les orteils. Aucune autre cause n’était trouvée. Les symptômes persistaient après 10 mois, avec à certains endroits une évolution nécrotique superficielle. Discussion Notre petite série de cas montre une durée d’évolution des engelures de 3 à 10 mois. La symptomatologie varie de l’absence de douleur à l’incapacité fonctionnelle, avec parfois une évolution nécrotique. Nos données montrent une longue durée de ces symptômes. À ce jour, les « orteils COVID » n’ont pas été intégrés dans le concept de « long COVID » représentant les complications persistantes de la COVID-19 ; et aucun syndrome acral aigu pédiatrique n’a eu cette durée d’évolution. Nous suggérons de définir les orteils chroniques de la COVID-19 comme une entité distincte des formes aiguës survenant au cours de l’infection.
| S-EPMC8603690 | biostudies-literature
Project description:Fatigue is a dominant feature of both acute and convalescent coronavirus disease 2019 (COVID-19) (sometimes termed "long-COVID"), with up to 46% of patients reporting fatigue that lasts from weeks to months. The investigators of the international Collaborative on Fatigue Following Infection (COFFI) conducted a systematic review of post-COVID fatigue and a narrative review on fatigue after other infections, and made recommendations for clinical and research approaches to assessing fatigue after COVID-19. In the majority of COVID-19 cohort studies, persistent fatigue was reported by a significant minority of patients, ranging from 13% to 33% at 16-20 weeks post-symptom onset. Data from the prospective cohort studies in COFFI and others indicate that fatigue is also a prevalent outcome from many acute systemic infections, notably infectious mononucleosis, with a case rate for clinically significant Post-infective fatigue after exclusion of recognized medical and psychiatric causes, ranging from 10%-35% at 6 months. To better characterize post-COVID fatigue, the COFFI investigators recommend the following: application of validated screening questionnaires for case detection; standardized interviews encompassing fatigue, mood, and other symptoms; and investigative approaches to identify end-organ damage and mental health conditions.
| S-EPMC8496765 | biostudies-literature
Project description:BackgroundPost-viral syndromes (PVS), including Long COVID, are symptoms sustained from weeks to years following an acute viral infection. Non-pharmacological treatments for these symptoms are poorly understood. This review summarises the evidence for the effectiveness of non-pharmacological treatments for PVS.MethodsWe conducted a systematic review to evaluate the effectiveness of non-pharmacological interventions for PVS, as compared to either standard care, alternative non-pharmacological therapy, or placebo. The outcomes of interest were changes in symptoms, exercise capacity, quality of life (including mental health and wellbeing), and work capability. We searched five databases (Embase, MEDLINE, PsycINFO, CINAHL, MedRxiv) for randomised controlled trials (RCTs) published between 1 January 2001 to 29 October 2021. The relevant outcome data were extracted, the study quality was appraised using the Cochrane risk-of-bias tool, and the findings were synthesised narratively.FindingsOverall, five studies of five different interventions (Pilates, music therapy, telerehabilitation, resistance exercise, neuromodulation) met the inclusion criteria. Aside from music-based intervention, all other selected interventions demonstrated some support in the management of PVS in some patients.InterpretationIn this study, we observed a lack of robust evidence evaluating the non-pharmacological treatments for PVS, including Long COVID. Considering the prevalence of prolonged symptoms following acute viral infections, there is an urgent need for clinical trials evaluating the effectiveness and cost-effectiveness of non-pharmacological treatments for patients with PVS.RegistrationThe study protocol was registered with PROSPERO [CRD42021282074] in October 2021 and published in BMJ Open in 2022.
| S-EPMC9967466 | biostudies-literature
Project description:The postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC), also known as post-acute coronavirus disease 19 (COVID-19) or the long COVID syndrome (long COVID) is an emerging public health concern. A substantial proportion of individuals may remain symptomatic months after initial recovery. An updated review of published and ongoing trials focusing on managing long COVID will help identify gaps and address the unmet needs of patients suffering from this potentially debilitating syndrome. A comprehensive literature search was conducted on the international databases and clinical trial registries from inception to 31 July 2022. This review included 6 published trials and 54 trial registration records. There is significant heterogeneity in the characterization of long COVID and ascertainment of primary outcomes. Most of the trials are focused on individual symptoms of long COVID or isolated organ dysfunction, classified according to cardiovascular, respiratory and functional capacity, neurological and psychological, fatigue, and olfactory dysfunction. Most of the interventions are related to the mechanisms causing the individual symptoms. Although the six published trials showed significant improvement in the symptoms or organ dysfunction studied, these initial studies lack internal and external validity limiting the generalizability. This review provides an update of the pharmacological agents that could be used to treat long COVID. Further standardization of the diagnostic criteria, inclusion of participants with concomitant chronic cardiometabolic diseases and standardization of outcomes will be essential in future clinical trials.
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Project description:Long COVID or post-COVID-19 syndrome first gained widespread recognition among social support groups and later in scientific and medical communities. This illness is poorly understood as it affects COVID-19 survivors at all levels of disease severity, even younger adults, children, and those not hospitalized. While the precise definition of long COVID may be lacking, the most common symptoms reported in many studies are fatigue and dyspnoea that last for months after acute COVID-19. Other persistent symptoms may include cognitive and mental impairments, chest and joint pains, palpitations, myalgia, smell and taste dysfunctions, cough, headache, and gastrointestinal and cardiac issues. Presently, there is limited literature discussing the possible pathophysiology, risk factors, and treatments in long COVID, which the current review aims to address. In brief, long COVID may be driven by long-term tissue damage (e.g. lung, brain, and heart) and pathological inflammation (e.g. from viral persistence, immune dysregulation, and autoimmunity). The associated risk factors may include female sex, more than five early symptoms, early dyspnoea, prior psychiatric disorders, and specific biomarkers (e.g. D-dimer, CRP, and lymphocyte count), although more research is required to substantiate such risk factors. While preliminary evidence suggests that personalized rehabilitation training may help certain long COVID cases, therapeutic drugs repurposed from other similar conditions, such as myalgic encephalomyelitis or chronic fatigue syndrome, postural orthostatic tachycardia syndrome, and mast cell activation syndrome, also hold potential. In sum, this review hopes to provide the current understanding of what is known about long COVID.
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Project description:The devastating effects of the coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may not end when the acute illness has terminated. A subset of COVID-19 patients may have symptoms that persist for months. This condition has been described as 'long COVID'. From a historical perspective, it has been recognized that serious long-term neurological sequelae have been associated with RNA viruses such as influenza viruses and coronaviruses. A potential intervention for early post-COVID-19 neuropsychiatric impairment may be the commonly employed, readily available, reasonably priced macrolide antibiotic, azithromycin. We have observed a favourable clinical response with azithromycin in three patients with neurological symptoms associated with long COVID-19. We recommend considering formal clinical trials using azithromycin for patients with post-COVID-19 infection neurological changes including 'COVID fog' or the more severe neurological symptoms that may later develop.
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Project description:During 2020, increasing numbers of case reports, case series, and small observational studies reported long-term complications of coronavirus disease 2019 (COVID-19) in patients who had recovered from acute infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Long COVID has a prevalence of between 10-30% in patients with a recent history of SARS-CoV-2 infection. Pulmonary, hematologic, cardiovascular, neuropsychiatric, renal, endocrine, gastrointestinal and hepatobiliary, and dermatologic involvement, and chronic multisystem inflammatory syndrome in children (MIS-C) highlights the requirement for a multidisciplinary approach to the management of patients with long COVID. This Editorial aims to present the current status of long COVID, or post-COVID syndrome, and its global impact on health and the provision of health care.
| S-EPMC8194290 | biostudies-literature
Project description:In the recent pandemic disease, called COVID-19, the role of neurologists and neurobiologists represents a chance to study key features of brain infection and deepen neurological manifestations of COVID-19 and other coronavirus infections. In fact, many studies suggest brain damage during infection and persistent neurological symptoms after COVID-19 infection. Reverse transcription PCR test, antibody tests, Computed Tomography (CT) of the lung, and Magnetic Resonance (MR) of the brain of the patient were periodically performed during this case report for eight months after infection. The aim of this article is to describe the prolonged neurological clinical consequences related to COVID-19. We believe it is clinically clear that we can define a post-acute COVID-19 neurological syndrome. Therefore, in patients after a severe clinical condition of COVID-19, a deepening of persistent neurological signs is necessary.
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