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Ikemizu Y, Oda Y, Hirose Y, Sasaki T, Iyo M. Cerebellar and Occipital Alterations in Brain Perfusion in a Patient With Post-acute COVID-19 Encephalopathy Misdiagnosed As Primary Psychotic Disorder. Cureus 2024; 16:e52953. [PMID: 38406081 PMCID: PMC10894069 DOI: 10.7759/cureus.52953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
We describe the case of an unvaccinated 21-year-old Japanese male who experienced psychotic symptoms attributed to encephalopathy, known as post-acute COVID-19 syndrome (PACS). One week after his discharge following the remission of a SARS-CoV-2 infection, he experienced hyperactive delirium and unexpected movements of his limbs. As COVID-19-associated encephalopathy was suspected as a cause of the psychotic symptoms, he was admitted to the Department of Neurology. He received antiviral and steroid pulse therapy, but his psychiatric symptoms did not improve completely. Consequently, he was admitted to our psychiatric ward with a diagnosis of a primary psychotic disorder. Although he did not take psychopharmacotherapy, he gradually achieved a remission of psychiatric symptoms. At three months post-SARS-CoV-2 infection, single-photon emission computed tomography (SPECT) revealed hypoperfusion in the bilateral cerebellar dentate nuclei and occipital lobes. However, no abnormal findings were observed on fluorine-18 fluoro-deoxy-glucose positron emission tomography (18F-FDG PET) at six months after the infection. This case indicates that (1) brain perfusion SPECT can be effective for detecting functional alterations in post-acute COVID-19-associated encephalopathy, and (2) it is necessary to carefully monitor patients' progress instead of quickly diagnosing a primary psychotic disorder.
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Affiliation(s)
- Yuki Ikemizu
- Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, JPN
- Research Center for Child Mental Development, Chiba University, Chiba, JPN
| | - Yasunori Oda
- Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Yuki Hirose
- Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Tsuyoshi Sasaki
- Department of Child Psychiatry, Chiba University Hospital, Chiba, JPN
| | - Masaomi Iyo
- Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, JPN
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Abstract
BACKGROUND Post-COVID-19 syndrome has emerged as a long-term complication in adults and children; its effect on adolescents' performance in school is not well studied. OBJECTIVES To study the physical/psychological impact of prolonged post-COVID-19 symptoms on school performance. METHODS This is a cross-sectional study using Google Forms, a web-based fully anonymized survey of children in grades 10-12. RESULTS The study included 54 students with a mean age of 16 years of whom 32 had COVID-19. Two were hospitalized and 10 had symptoms lasting more than four weeks. Commonly reported chronic symptoms were fatigue and cough. Seven students quit sports; eight had a decrease in their academic performance. Adolescents being infected more than once or not being fully vaccinated were more likely to develop prolonged symptoms and quit sports while academic performance in school was not affected. Three out of 10 (30%) students who had COVID-19 and responded to the questionnaire reported not seeking help. CONCLUSION Post-COVID-19 syndrome is associated with a decline in physical but not mental performance in school. Being infected more than once with SARS-CoV-2 seems to play an important role in the persistence of post-COVID-19 symptoms despite the fact that some adolescents are hesitant to seek medical or psychological care.
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Affiliation(s)
| | - May Skoury
- Nursing, Harrison Central School District, Harrison, USA
| | - Marc Y El Khoury
- Department of Medicine, Division of Infectious Diseases, New York Medical College, Valhalla, USA
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Chathoth AT, Anaswara N, Meethal AC, Vasudevan J, Gopal PV. Persisting and New Onset Symptomatology and Determinants of Functional Limitation of Post Acute COVID-19 Syndrome Cases- A Study from a Northern District of Kerala. Indian J Community Med 2023; 48:250-257. [PMID: 37323742 PMCID: PMC10263041 DOI: 10.4103/ijcm.ijcm_170_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 01/04/2023] [Indexed: 06/17/2023] Open
Abstract
Background COVID-19 disease has a wide range of persisting and new onset clinical manifestations even long after the acute phase. This study was conducted to identify the persisting and new onset symptomatology of post-COVID-19 syndrome patients from clinics in urban and peri-urban Kozhikode, South India, as well as to grade their functional limitation; assess the determinants and predictors. Material and Methods A cross-sectional study was conducted among 938 subjects attending the post-COVID clinics. Symptom profile, functional assessment, and limitation grading were done using the Post-COVID-19 Functional Status (PCFS) scale. Statistical analyses were done using the SPSS ver.20. Results Mean age was 41.50 ± 16.90 years. Fever, anosmia, dysgeusia, headache, and myalgia were the common acute COVID-19 symptoms (505,54%; 433,46.3%; 420,44.9%; 323,34.4%; 252,26.9%, respectively). Post-COVID-19, common persisting symptoms were myalgia (167,17.8%), fatigue (149,15.9%), dyspnea (113,12%), and headache (85,9.1%); the common new onset symptoms were shortness of breath and fatigue (228,24.3% and 220,23.4%, respectively). A total of 91 cases (9.7%) had post-COVID sleep disturbances; 16 (1.7%) had symptoms of anxiety and depressive thoughts. PCFS grading showed that 552 (63.8%) had negligible limitations (Grade I). Only one person had Grade IV limitation. Significant association (p < 0.05) was found between functional impairment grading by PCFS and age, gender, locality, type of family, duration of hospitalization, duration of unemployment following illness, source of infection, diabetes mellitus, and hypertension. Male gender, married status, CAD, and smoking had significant higher risks; urban locality and hospitalization decreased the risk. Conclusions SARS-CoV-2 cases have persistent and new onset symptoms and some degree of functional impairment post-COVID. Significant association was identified for various sociodemographic and clinical variables with the PCFS functional impairment grading.
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Affiliation(s)
- Anuradha Thalian Chathoth
- Department of Health Services, Government of Kerala, District Medical Office (Health), Kozhikode, Kerala, India
| | - Naveen Anaswara
- Department of Health Services, Government of Kerala, District Medical Office (Health), Kozhikode, Kerala, India
| | - Arjun Chathoth Meethal
- Department of Health Services, Government of Kerala, District Medical Office (Health), Kozhikode, Kerala, India
| | - Jayasree Vasudevan
- Department of Health Services, Government of Kerala, District Medical Office (Health), Kozhikode, Kerala, India
| | - Parvathi V. Gopal
- Department of Health Services, Government of Kerala, District Medical Office (Health), Kozhikode, Kerala, India
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Mejias A, Schuchard J, Rao S, Bennett TD, Jhaveri R, Thacker D, Bailey LC, Christakis DA, Pajor NM, Razzaghi H, Forrest CB, Lee GM. Leveraging serologic testing to identify children at risk for post-acute sequelae of SARS-CoV-2 infection: An EHR-based cohort study from the RECOVER program. J Pediatr 2023:S0022-3476(23)00117-8. [PMID: 36822507 PMCID: PMC9943558 DOI: 10.1016/j.jpeds.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 12/23/2022] [Accepted: 02/16/2023] [Indexed: 02/23/2023]
Abstract
Using an EHR-based algorithm we identified children with COVID-19 based exclusively on serologic testing from 3/2020 through 4/2022. The 2,714 serology-positive children were more likely to be inpatients (24% vs. 2%), have chronic conditions (37% vs 24%), or a MIS-C diagnosis (23% vs. <1%) than the 131,537 PCR-positive children. Identification of children who could have been asymptomatic or paucisymptomatic and not tested is critical to define the burden of PASC in children.
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Affiliation(s)
- Asuncion Mejias
- Division of Infectious Diseases, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, OH.
| | - Julia Schuchard
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Suchitra Rao
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Tellen D Bennett
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Ravi Jhaveri
- Division of Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Deepika Thacker
- Division of Cardiology, Nemours Children's Health, Wilmington, DE
| | - L Charles Bailey
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Dimitri A Christakis
- Center for Child Health, Behavior and Development, Seattle Children's Hospital, Seattle, WA
| | - Nathan M Pajor
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH
| | - Hanieh Razzaghi
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Christopher B Forrest
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Grace M Lee
- Department of Pediatrics (Infectious Diseases), Stanford University School of Medicine, Stanford, CA
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Borsi L. Trajectory of Functional Recovery from 6 to 12 Months in Persons Hospitalized for Severe SARS-CoV-2 Illness. Arch Phys Med Rehabil 2022. [PMCID: PMC9712932 DOI: 10.1016/j.apmr.2022.08.801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Research Objectives To identify distinct post-acute COVID-19 phenotypes among adults hospitalized for severe SARS-CoV-2 infection and describe multidimensional outcomes and trajectories at 6 and 12 months post-hospitalization. Design Prospective, longitudinal data collection in functional, physical, cognitive, and psychological domains at 3, 6, and 12 months post-hospitalization. Retrospective data collection from the acute care and post-acute care settings. Setting Acute care and post-acute telephone follow-up. Participants English- and Spanish- speaking adults, with decision-making capacity, admitted for inpatient rehabilitation following inpatient rehabilitation for acute COVID-19 related illness (N = 61). Interventions N/A. Main Outcome Measures Physical, cognitive, and psychological symptoms; self-reported employment status and assistance with ADLs. Results Median age 60.8 years; 59% male; 72.1% white; 72.1% non-Hispanic; 26.2% preferred assessment in Spanish. 83% required mechanical ventilation in acute care. Comorbidities were common. We found a high prevalence of persistent symptoms at 6- and 12- months across physical, cognitive, and emotional health outcome domains. Three post-acute phenotypes were identified at 6 months; a "minimally symptomatic" subgroup with minimal symptom endorsement across all domains relative to other subjects (22.95%, n = 14), a “predominantly physical symptoms” subgroup (47.54%, n = 29), and a “globally symptomatic” subgroup (29.51%, n = 18). A similar pattern for phenotypes emerges at 12-months, with 67.21% of subjects falling into the same phenotype at both time points. In the Predominantly Physical Symptom phenotype, 31.0% declined into the Globally Symptomatic Phenotype and 10.3% improved. In the Globally Symptomatic phenotype, 11.1% of participants transitioned to the Minimally Symptomatic phenotype and 16.7% to the Predominantly Physical Symptom phenotype. Compared to premorbid level of employment (50.8%), 24.6% of participants were employed at 12-months. Phenotype at 6-months was a significant predictor of employment at 12-months (B = 2.26, p = .05, OR = 9.6). Conclusions Persons with severe COVID-19 illness experience persistent functional limitations and reduced employment up to 12 months post-hospitalization. Distinct recovery subgroups were found suggesting the need for comprehensive assessment and tailored treatment for recovery. Author(s) Disclosures The authors declare no relevant conflicts of interest.
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Tabacof L, Tosto-Mancuso J, Wood J, Cortes M, Kontorovich A, McCarthy D, Rizk D, Rozanski G, Breyman E, Nasr L, Kellner C, Herrera JE, Putrino D. Post-acute COVID-19 Syndrome Negatively Impacts Physical Function, Cognitive Function, Health-Related Quality of Life, and Participation. Am J Phys Med Rehabil 2022; 101:48-52. [PMID: 34686631 PMCID: PMC8667685 DOI: 10.1097/phm.0000000000001910] [Citation(s) in RCA: 139] [Impact Index Per Article: 69.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE This report describes persistent symptoms associated with post-acute COVID-19 syndrome (PACS) and the impact of these symptoms on physical function, cognitive function, health-related quality of life, and participation. DESIGN This study used a cross-sectional observational study design. Patients attending Mount Sinai's post-acute COVID-19 syndrome clinic completed surveys containing patient-reported outcomes. RESULTS A total of 156 patients completed the survey, at a median (range) time of 351 days (82-457 days) after COVID-19 infection. All patients were prevaccination. The most common persistent symptoms reported were fatigue (n = 128, 82%), brain fog (n = 105, 67%), and headache (n = 94, 60%). The most common triggers of symptom exacerbation were physical exertion (n = 134, 86%), stress (n = 107, 69%), and dehydration (n = 77, 49%). Increased levels of fatigue (Fatigue Severity Scale) and dyspnea (Medical Research Council) were reported, alongside reductions in levels of regularly completed physical activity. Ninety-eight patients (63%) scored for at least mild cognitive impairment (Neuro-Qol), and the domain of the EuroQol: 5 dimension, 5 level most impacted was Self-care, Anxiety/Depression and Usual Activities. CONCLUSIONS Persistent symptoms associated with post-acute COVID-19 syndrome seem to impact physical and cognitive function, health-related quality of life, and participation in society. More research is needed to further clarify the relationship between COVID-19 infection and post-acute COVID-19 syndrome symptoms, the underlying mechanisms, and treatment options.
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Lopez-Leon S, Wegman-Ostrosky T, Perelman C, Sepulveda R, Rebolledo P, Cuapio A, Villapol S. More Than 50 Long-Term Effects of COVID-19: A Systematic Review and Meta-Analysis. Res Sq 2021:rs.3.rs-266574. [PMID: 33688642 PMCID: PMC7941645 DOI: 10.21203/rs.3.rs-266574/v1] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background. COVID-19, caused by SARS-CoV-2, can involve sequelae and other medical complications that last weeks to months after initial recovery, which has come to be called Long-COVID or COVID long-haulers. This systematic review and meta-analysis aims to identify studies assessing long-term effects of COVID-19 and estimates the prevalence of each symptom, sign, or laboratory parameter of patients at a post-COVID-19 stage. Methods . LitCOVID (PubMed and Medline) and Embase were searched by two independent researchers. All articles with original data for detecting long-term COVID-19 published before 1 st of January 2021 and with a minimum of 100 patients were included. For effects reported in two or more studies, meta-analyses using a random-effects model were performed using the MetaXL software to estimate the pooled prevalence with 95% CI. Heterogeneity was assessed using I 2 statistics. This systematic review followed Preferred Reporting Items for Systematic Reviewers and Meta-analysis (PRISMA) guidelines, although the study protocol was not registered. Results. A total of 18,251 publications were identified, of which 15 met the inclusion criteria. The prevalence of 55 long-term effects was estimated, 21 meta-analyses were performed, and 47,910 patients were included. The follow-up time ranged from 14 to 110 days post-viral infection. The age of the study participants ranged between 17 and 87 years. It was estimated that 80% (95% CI 65-92) of the patients that were infected with SARS-CoV-2 developed one or more long-term symptoms. The five most common symptoms were fatigue (58%), headache (44%), attention disorder (27%), hair loss (25%), and dyspnea (24%). All meta-analyses showed medium (n=2) to high heterogeneity (n=13). Conclusions . In order to have a better understanding, future studies need to stratify by sex, age, previous comorbidities, the severity of COVID-19 (ranging from asymptomatic to severe), and duration of each symptom. From the clinical perspective, multi-disciplinary teams are crucial to developing preventive measures, rehabilitation techniques, and clinical management strategies with whole-patient perspectives designed to address long COVID-19 care.
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Affiliation(s)
| | | | - Carol Perelman
- National Autonomous University of Mexico: Universidad Nacional Autonoma de Mexico
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