4.6 Review

Pathophysiology and mechanism of long COVID: a comprehensive review

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Summary: The COVID-19 pandemic has caused unprecedented morbidity, mortality, and disruption, with a new syndrome known as 'long COVID' emerging among survivors. This syndrome, characterized by debilitating symptoms like breathlessness and palpitations, may be related to autonomic nervous system disruption post-infection. Physicians should recognize and support individuals with 'long COVID' symptoms, with a focus on managing the underlying impaired autonomic physiology.

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Yuanyuan Qin et al.

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Eric Y. Wang et al.

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Ani Nalbandian et al.

Summary: SARS-CoV-2 is responsible for the COVID-19 pandemic, causing global healthcare crises. Recovery from COVID-19 may lead to persistent symptoms and long-term complications, prompting the need for multidisciplinary care and follow-up for survivors.

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Pierpaolo Trimboli et al.

Summary: This systematic review provides insights into potential thyroid consequences in COVID-19 patients, including thyrotoxicosis, low-T3 syndrome, and subacute thyroiditis. It concludes that having a thyroid disease does not increase the risk of SARS-CoV-2 infection, and that thyroid patients do not require a specific COVID-19-adapted follow-up. However, factors like critical illness and medication may affect thyroid laboratory tests.

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COVID-19-related anosmia is associated with viral persistence and inflammation in human olfactory epithelium and brain infection in hamsters

Guilherme Dias de Melo et al.

Summary: Recent investigations have shown that olfactory and taste dysfunction are common in mildly symptomatic COVID-19 patients. Research on the olfactory neuroepithelium revealed that SARS-CoV-2 infection can cause local inflammation and lead to acute loss of smell, which may account for prolonged symptoms of COVID-19 such as anosmia.

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Bruno Silva Andrade et al.

Summary: The global COVID-19 pandemic has led to millions of infections, creating a long-term care burden for survivors. It is crucial to study both short-term and long-term effects, as they impact various human systems.

VIRUSES-BASEL (2021)

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Convalescent COVID-19 patients are susceptible to endothelial dysfunction due to persistent immune activation

Florence W. J. Chioh et al.

Summary: The impact of COVID-19 on vascular health of recovered patients is significant, with elevated levels of circulating endothelial cells indicating vascular injury. The presence of proinflammatory and activated T lymphocyte-associated cytokines suggests cytokine-driven endothelial dysfunction. Effector T cells were more frequent in COVID-19 convalescents, pointing to a possible cytotoxic effector cell targeting of activated endothelial cells.
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Woo-Jung Song et al.

Summary: Cough is a common symptom of COVID-19 and can persist for weeks or even months after infection, leading to long-term effects known as post-COVID syndrome. Researchers hypothesize that neurotropic pathways may be responsible for cough hypersensitivity state after SARS-CoV-2 infection, and neuroinflammatory events in the brain could contribute to the development of post-COVID syndrome. There are gaps in understanding the mechanisms of acute and chronic COVID-19 associated cough and post-COVID syndrome, but potential ways to reduce the impact of COVID-19 by controlling cough are being considered.

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Summary: There is limited understanding of the risk factors, histopathology, and pathophysiology of post-COVID-19 pulmonary fibrosis. Serial clinical screening for pulmonary fibrosis is recommended after COVID-19, and further research is needed to determine the risk factors and appropriate management of post-COVID-19 pulmonary fibrosis.

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Summary: The study found that SARS-CoV-2 may enter the human body through infecting taste papillae cells, affecting taste receptor stem cell activity and causing taste impairment. Some patients still had not fully recovered, with disrupted taste stem cells.

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Alberto Perez-Gomez et al.

Summary: SARS-CoV-2 infection causes abnormal immune response, affecting the quantity and function of dendritic cells, with some markers remaining altered during acute phase and follow-up.

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Alex G. Richter et al.

Summary: The study revealed a higher frequency of autoantibodies associated with SARS-CoV-2 infection in COVID-19 patients, even detectable months post-infection. COVID-19 patients displayed a more restricted pattern of autoantibodies, including skin, skeletal muscle, and cardiac antibodies.

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Antibody Response to SARS-CoV-2 is Associated with Long-term Clinical Outcome in Patients with COVID-19: a Longitudinal Study

Javier Garcia-Abellan et al.

Summary: Long-COVID is associated with weak anti-SARS-CoV-2 antibody response, severity of illness, and female gender. Late clinical events and persistent symptoms in the medium and long term occur in a significant proportion of patients hospitalized for COVID-19.

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Development of ACE2 autoantibodies after SARS-CoV-2 infection

John M. Arthur et al.

Summary: Many patients with a history of SARS-CoV-2 infection have developed specific antibodies against ACE2, which may decrease the activity of soluble ACE2 in plasma and increase levels of Ang II, potentially triggering symptoms of PASC.

PLOS ONE (2021)

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Harry Crook et al.

Summary: The long-term effects of covid-19 can affect multiple systems in the body, leading to persistent symptoms that impact patients of varying severity. These symptoms include fatigue, dyspnea, and cognitive impairment, among others. Studies discuss risk factors for acute and long covid, as well as potential therapeutic options.

BMJ-BRITISH MEDICAL JOURNAL (2021)

Review Infectious Diseases

Long COVID or post-COVID-19 syndrome: putative pathophysiology, risk factors, and treatments

Shin Jie Yong

Summary: Long COVID or post-COVID-19 syndrome is a poorly understood condition that affects survivors with symptoms like fatigue, dyspnoea, cognitive impairments, and more. The pathophysiology, risk factors, and treatments are still lacking in literature, but potential treatments may include rehabilitation training and repurposed drugs from similar conditions. Further research is needed to substantiate risk factors and treatment options.

INFECTIOUS DISEASES (2021)

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Immunofibrotic drivers of impaired lung function in postacute sequelae of SARS-CoV-2 infection

Hyung J. Chun et al.

Summary: This study found that biological factors related to neutrophil activation, fibrosis signaling, and alveolar repair may be novel therapeutic or prognostic targets for individuals recovering from COVID-19 with persistent respiratory symptoms.

JCI INSIGHT (2021)

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Potential for increased prevalence of neuropathic pain after the COVID-19 pandemic

Nadine Attal et al.

Summary: COVID-19 commonly presents with respiratory symptoms, but pain is also a common symptom, some of which may be neuropathic. Various viral infections like herpes zoster and HIV can cause neurological complications including neuropathic pain, and COVID-19 can also lead to neurological complications that may result in chronic neuropathic pain. Longitudinal cohort studies are needed to evaluate the exact risk of neuropathic pain after COVID-19.

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COVID-19 symptoms over time: comparing long-haulers to ME/CFS

Leonard A. Jason et al.

Summary: Symptoms among long-hauler COVID-19 patients tend to decrease over time, with an intensification of neurocognitive symptoms, while compared to ME/CFS, COVID-19 long-haulers initially have more severe symptoms in immune and orthostatic domains but show less severe symptoms over time, except in the orthostatic domain.

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Article Medicine, Research & Experimental

Alterations in T and B cell function persist in convalescent COVID-19 patients

Halima A. Shuwa et al.

Summary: The study describes the phenotypic and functional characteristics of B and T cells in hospitalized COVID-19 patients during acute disease and at 3-6 months of convalescence. The alterations in B cell subsets observed in acute COVID-19 patients were largely recovered in convalescent patients, while T cells from convalescent patients displayed continued alterations. Different subgroups of convalescent patients were identified based on distinct lymphocyte phenotypes, with one subgroup associated with poorer clinical outcomes.
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Long COVID and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)-A Systemic Review and Comparison of Clinical Presentation and Symptomatology

Timothy L. Wong et al.

Summary: Early studies on long COVID symptoms show significant overlaps with ME/CFS, highlighting the need for monitoring and treatment. Further research into the similarities and differences between long COVID and ME/CFS is warranted.

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Functional autoantibodies against G-protein coupled receptors in patients with persistent Long-COVID-19 symptoms

Gerd Wallukat et al.

Summary: Within a sample of long-term COVID-19 recovered patients, various GPCR-fAABs autoantibodies were detected, with some antibodies causing positive chronotropic effects on cardiac cells while affecting the nervous and cardiovascular systems significantly.

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Neuropsychiatric and Cognitive Sequelae of COVID-19

Sanjay Kumar et al.

Summary: COVID-19 may have long-term mental health effects on patients, necessitating global recognition and planning to address mental health issues. Research indicates that patients may develop neurological symptoms and the virus could potentially cause damage to the nervous system, leading to long-term neuropsychiatric sequelae.

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Medium-term effects of SARS-CoV-2 infection on multiple vital organs, exercise capacity, cognition, quality of life and mental health, post-hospital discharge

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Summary: The study found that COVID-19 patients discharged from the hospital still experience breathlessness, fatigue, cognitive impairment, and mental health issues. MRI revealed abnormalities in multiple organs, which were linked to inflammation and severity of acute illness.

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Vasculitis changes in COVID-19 survivors with persistent symptoms: an [18F]FDG-PET/CT study

Martina Sollini et al.

Summary: The study included 10 COVID-19 recovered patients with persistent symptoms, showing increased [F-18]FDG uptake in bone marrow and blood vessels. Compared to controls, the recovered patients had higher [F-18]FDG uptake ratios, indicating that SARS-CoV-2 may induce vascular inflammation leading to persisting symptoms.

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Long-term sequelae following previous coronavirus epidemics

Oliver O'Sullivan

Summary: Both survivors of SARS and MERS faced chronic problems, which could provide insights for the medical planning for survivors of COVID-19, particularly focusing on cardiopulmonary sequelae, fatigue, and psychological burden.

CLINICAL MEDICINE (2021)

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SARS CoV-2 related microvascular damage and symptoms during and after COVID-19: Consequences of capillary transit-time changes, tissue hypoxia and inflammation

Leif Ostergaard

Summary: COVID-19 infection can cause symptoms in multiple organs, including low blood oxygen levels, muscle pain, fatigue, and mood changes. Capillary damage and inflammation may play a role in these symptoms.

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Multiorgan impairment in low-risk individuals with post-COVID-19 syndrome: a prospective, community-based study

Andrea Dennis et al.

Summary: A study conducted in two UK community centers found that 70% of individuals with persistent symptoms following recovery from SARS-CoV-2 infection had impairment in one or more organs 4 months after initial COVID-19 symptoms. Common symptoms included fatigue, muscle aches, breathlessness, and headaches.

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Pain: A potential new label of COVID-19

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HEADACHE (2020)

Letter Medicine, General & Internal

Postmortem Examination of Patients With COVID-19

Tina Schaller et al.

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (2020)

Article Orthopedics

Musculoskeletal Consequences of COVID-19

Nathaniel P. Disser et al.

JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME (2020)

Letter Medicine, General & Internal

Endothelial cell infection and endotheliitis in COVID-19

Zsuzsanna Varga et al.

LANCET (2020)

Article Medicine, General & Internal

Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19

Maximilian Ackermann et al.

NEW ENGLAND JOURNAL OF MEDICINE (2020)

Letter Endocrinology & Metabolism

COVID-19, ketoacidosis and new-onset diabetes: Are there possible cause and effect relationships among them?

Sandro Gentile et al.

DIABETES OBESITY & METABOLISM (2020)

Review Cardiac & Cardiovascular Systems

COVID-19 cardiac injury: Implications for long-term surveillance and outcomes in survivors

Raul D. Mitrani et al.

HEART RHYTHM (2020)

Article Cardiac & Cardiovascular Systems

Association of Cardiac Infection With SARS-CoV-2 in Confirmed COVID-19 Autopsy Cases

Diana Lindner et al.

JAMA CARDIOLOGY (2020)

Article Biochemistry & Molecular Biology

The Immunology of Multisystem Inflammatory Syndrome in Children with COVID-19

Camila Rosat Consiglio et al.

Review Biochemistry & Molecular Biology

Effects of COVID-19 on the Nervous System

Costantino Iadecola et al.

Article Biochemistry & Molecular Biology

Clinical and immunological assessment of asymptomatic SARS-CoV-2 infections

Quan-Xin Long et al.

NATURE MEDICINE (2020)

Editorial Material Rheumatology

Autoimmune and inflammatory diseases following COVID-19

Caroline Galeotti et al.

NATURE REVIEWS RHEUMATOLOGY (2020)

Editorial Material Clinical Neurology

Immediate and long-term consequences of COVID-19 infections for the development of neurological disease

Michael T. Heneka et al.

ALZHEIMERS RESEARCH & THERAPY (2020)

Editorial Material Medicine, General & Internal

Management of post-acute covid-19 in primary care

Trisha Greenhalgh et al.

BMJ-BRITISH MEDICAL JOURNAL (2020)

Review Cardiac & Cardiovascular Systems

Vascular Manifestations of COVID-19 - Thromboembolism and Microvascular Dysfunction

Kirsty A. Roberts et al.

FRONTIERS IN CARDIOVASCULAR MEDICINE (2020)

Editorial Material Biochemistry & Molecular Biology

Deleterious Outcomes in Long-Hauler COVID-19: The Effects of SARS-CoV-2 on the CNS in Chronic COVID Syndrome

Abdul Mannan Baig

ACS CHEMICAL NEUROSCIENCE (2020)

Article Neurosciences

Post-COVID-19 Fatigue: Potential Contributing Factors

Thorsten Rudroff et al.

BRAIN SCIENCES (2020)

Article Pharmacology & Pharmacy

Stabilizing mast cells by commonly used drugs: a novel therapeutic target to relieve post-COVID syndrome?

Itsuro Kazama

DRUG DISCOVERIES AND THERAPEUTICS (2020)

Article Infectious Diseases

Covid-19 hyperinflammation and post-Covid-19 illness may be rooted in mast cell activation syndrome

Lawrence B. Afrin et al.

INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES (2020)

Article Medicine, Research & Experimental

Post-viral fatigue and COVID-19: lessons from past epidemics

Mohammed F. Islam et al.

FATIGUE-BIOMEDICINE HEALTH AND BEHAVIOR (2020)

Review Respiratory System

Pulmonary Fibrosis in COVID-19 Survivors: Predictive Factors and Risk Reduction Strategies

Ademola S. Ojo et al.

PULMONARY MEDICINE (2020)

Article Medicine, General & Internal

Cerebral Micro-Structural Changes in COVID-19 Patients - An MRI-based 3-month Follow-up Study

Yiping Lu et al.

ECLINICALMEDICINE (2020)

Review Psychiatry

Psychiatric face of COVID-19

Luca Steardo et al.

TRANSLATIONAL PSYCHIATRY (2020)

Review Immunology

Short- and potential long-term adverse health outcomes of COVID-19: a rapid review

T. Y. M. Leung et al.

EMERGING MICROBES & INFECTIONS (2020)