Most people who develop COVID-19 fully recover, but current evidence suggests approximately 10-20% of people experience a variety of mild and long term effects after they recover from their initial illness. These mild and long term effects are collectively known as "Long COVID" or post COVID-19 condition.
Post COVID-19 condition is defined as the illness that occurs in people who have a history of probable or confirmed SARS-CoV-2 infection; usually within three months from the onset of COVID-19, with symptoms and effects of post COVID-19 condition cannot be explained by an alternative diagnosis.
Post-COVID conditions may not affect everyone the same way. People with post-COVID conditions may experience health problems from different types and combinations of symptoms happening over different lengths of time. Most patients, symptoms slowly improve with time. However, for some people, post-COVID conditions may last months, and potentially years after COVID-19 illness.
People more likely to develop Long COVID;
- People who have experienced more severe COVID-19 illness, especially those who have hospitalized or needed intensive care
- People who had underlying health conditions prior to COVID-19
- People who did not get a COVID-19 vaccine
- People who experience multisystem inflammatory syndrome during or after COVID-19 illness
People who experience post-COVID conditions most commonly report;
General symptoms
- Tiredness or fatigue that interfere with daily life
- Symptoms that get worse after physical or mental effort ( known as post exertional malaise)
- Fever
Long term Respiratory effect of COVID-19
Major symptoms of post-acute covid-19 respiratory sequelae include the following
- Shortness of breath
- Dry cough
- Chest pain
- Age > 60 years
- Smokers
- Pre-existing respiratory diseases (eg: asthma, COPD, ILD)
- Patients requiring oxygen therapy at home
- Post Covid Diffuse Lung Disease : The lung parenchymal abnormalities that persist after the recovery from the acute COVID-19 illness may represent either a persistent inflammatory pathology or pulmonary fibrosis. An HRCT chest is helpful in characterizing the extent and type of abnormalities.
- Pulmonary embolism: Therapeutic anticoagulation should be administered.
- Pulmonary infections: Secondary bacterial pneumonia should be managed with oral/intravenous antibiotics.
- Cough should be treated according to the underlying cause.
- Symptoms of general ill-health: General measured should be followed by all patients including nutritious diet, regular exercise appropriate for the age and physical status, regular monitoring of important parameters (oxygen saturation).
Post-COVID Cardiovascular Symptoms
Cardiovascular symptoms are not only occur in symptomatic COVID-19 patients but have also been reported in asymptomatic patients. Up to 20-30% of hospitalized patients with sever COVID-19 have evidence of myocardial involvement manifested by;
- Elevated troponin levels
- Venous thrombo-embolism
- Heart failure
- Arrhythmias
- Profound fatigue
- Chest pain
- Dyspnea
- Palpitations
Post-COVID Gastrointestinal symptoms
Beside the common respiratory symptoms, some COVID-19 patients experience gastrointestinal symptoms such as
- ageusia
- lack of appetite
- nausea
- vomiting
- dyspepsia
- diarrhea
- abdominal pain and
- hepatitis.
Risk factors for developing post Covid GI and Liver manifestations
- Severe disease
- Older age
- Gut dysbiosis due to antivirals & antibiotic use
- Liver injury due to COVID-19, drugs or alternative medication intake
Post COVID-19 Renal symptoms
The common kidney related complications following COVID-19 are
- New onset Acute Kidney Injury (AKI)
- Rapid progression of pre-existing Chronic Kidney Disease
- Progression of CKD to end stage kidney disease (ESKD)
- New onset glomerular disease- Proteinuria, hematuria, renal dysfunction
- New onset hypertension or worsening of hypertension
- Fatigue and unexplained weakness
- Nocturia (frequent urination during night which disturb sleep)
- Increased froth in urine
- Swelling on leg
- Increase requirements of anti-hypertensives
- Complete blood count
- Routine Urine analysis
- Spot urine protein/creatinine ratio
- serum creatinine and blood urea
- serum Na & K
- 24-hour urine protein
- Ultrasound of kidneys
Common Post acute Covid-19 neurological symptoms;
- Fatigue
- Changes in concentration
- Impaired memory
- Persistent muscle weakness and myalgias
- Headaches
- Sleep disorders
- Dizziness
- Impairment in smell and taste
- CPK (those with muscle aches, myalgias and persistent weakness)
- Nerve conduction studies for patients with sensory motor complaints
- Brain MRI for patients with worsening and significant cognitive neuropsychiatric manifestations
- EEG for patients with status epilepticus
- Polysomnogram in patients with significant sleep dysfunction
Laboratory testing
At this time, no laboratory test can definitively distinguish post-COVID conditions from other etiologies, in part due to the heterogeneity of post-COVID conditions.
Laboratory testing should be guided by the patient history, physical examination and clinical findings.
Basic laboratory testing for post-COVID conditions
|
Category |
|
|
Blood count, electrolytes, and renal function |
|
|
Liver function |
|
|
Inflammatory markers |
|
|
Thyroid function |
|
|
Vitamin deficiencies |
|
Specialized laboratory testing for post-COVID conditions
|
Rheumatological
conditions |
Antinuclear
antibody, rheumatoid factor, Anti-cyclic citrullinated peptide, anti
cardiolipin, and creatinine phosphokinase |
|
Coagulation
disorders |
D-dimer,
fibrinogen |
|
Myocardial
injury |
Troponin |
|
Differentiate
symptoms of cardiac versus pulmonary origin |
B-type
natriuretic peptide |
No comments:
Post a Comment