Post-acute sequalae of COVID-19
From IDWiki
Background
- Also called post-acute sequalae of COVID-19 (PASC), post-acute COVID-19 syndrome (PACS), long, long-haul, or chronic COVID
Epidemiology
- Unfortunately, studies use a variety of definitions
- Affects somewhere around 40% of patients, depending on the definition
- More common in patients with risk factors for severe COVID-19 disease
- Less common in patients who have been vaccinated[1]
Pathophysiology
- Unclear
- Hypothesized to involve some combination of delayed resolution of inflammation, triggered autoimmunity, and persistent viral reservoir
Clinical Manifestations
- Fatigue, dyspnea, chest pain, brain fog
- More common after severe disease
- At 2 months, about 2/3 had symptoms, with 33 to 37% having cough or dyspnea and 13 to 23% has dysgeusia or anosmia12
- Those with persistent symptoms were more likely to be aged 40 to 60 years and have been hospitalized
- At 6 months, 75% had at least one symptom3
- Fatigue or weakness (63%)
- Difficulty sleeping (26%)
- Hair loss (22%)
- Dysgeusia or anosmia (10%)
- A minority have changes to pulmonary function tests (8%) or chest x-ray (18%)4
- May have persistent lymphopenia, elevated ferritin, or elevated D-dimer4
Diagnosis
- Definitions vary widely
WHO Clinical Case Definition
- History of probable or confirmed SARS-CoV-2 infection
- Onset usually within 3 months of infection
- Symptoms last for at least 2 months, without another explanation
- Fatigue, dyspnea, cognitive dysfunction, or others
- Symptoms may be new, following initial recovery, or persistent from initial illness
- Symptoms may fluctuate
Investigations
- Consider CBC/liver/renal, TSH, CRP, ferritin, ±BNP, ±cortisol
- Consider exercise tolerance tests
- If ongoing respiratory symptoms, consider CXR at 12 weeks
- If postural symptoms, get orthostatic vitals
- ↑ Azzolini E, Levi R, Sarti R, et al. Association Between BNT162b2 Vaccination and Long COVID After Infections Not Requiring Hospitalization in Health Care Workers. JAMA. 2022;328(7):676–678. doi:10.1001/jama.2022.11691
References
- ^ Vineet Chopra, Scott A. Flanders, Megan O'Malley, Anurag N. Malani, Hallie C. Prescott. Sixty-Day Outcomes Among Patients Hospitalized With COVID-19. Annals of Internal Medicine. 2020. doi:10.7326/m20-5661.
- ^ 10.1016/j.cmi.2020.09.052
- ^ Chaolin Huang, Lixue Huang, Yeming Wang, Xia Li, Lili Ren, Xiaoying Gu, Liang Kang, Li Guo, Min Liu, Xing Zhou, Jianfeng Luo, Zhenghui Huang, Shengjin Tu, Yue Zhao, Li Chen, Decui Xu, Yanping Li, Caihong Li, Lu Peng, Yong Li, Wuxiang Xie, Dan Cui, Lianhan Shang, Guohui Fan, Jiuyang Xu, Geng Wang, Ying Wang, Jingchuan Zhong, Chen Wang, Jianwei Wang, Dingyu Zhang, Bin Cao. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. The Lancet. 2021;397(10270):220-232. doi:10.1016/s0140-6736(20)32656-8.
- a b Oscar Moreno-Pérez, Esperanza Merino, Jose-Manuel Leon-Ramirez, Mariano Andres, Jose Manuel Ramos, Juan Arenas-Jiménez, Santos Asensio, Rosa Sanchez, Paloma Ruiz-Torregrosa, Irene Galan, Alexander Scholz, Antonio Amo, Pilar González-delaAleja, Vicente Boix, Joan Gil. Post-acute COVID-19 syndrome. Incidence and risk factors: A Mediterranean cohort study. Journal of Infection. 2021. doi:10.1016/j.jinf.2021.01.004.
