Consequences of COVID-19 and nervous and lung complications
COVID-19 causes sequelae in some patients who have different organ systems, probably due to several mechanisms.
Scarring lung changes may be left after severe pneumonia. Neurological organ complications are rare and are mainly associated with severe diseases.
Follow-up symptoms can be expected to impose a significant burden on healthcare in the coming years, and the need for treatment must be prepared.
Although there are no individual therapies that have been shown to be effective, long-term symptomatic patients are likely to benefit from multidisciplinary support, rehabilitation, follow-up, ongoing treatment regimens, and symptomatic therapies.
The majority of COVID-19 patients recover from an acute respiratory infection in less than two weeks, but some have a longer duration of symptoms. In the United Kingdom, the scientific company ZOE has developed an application to collect data on the symptoms of people with the disease. It states that 10% of patients with microbiologically confirmed COVID-19 have a symptom of more than 3 weeks.
In the United States, in telephone interviews, one-third said their health had not returned to normal within 2 to 3 weeks of a positive test result; the proportion of influenza patients is known to be 10%.
Prolonged symptoms have been termed post-acute COVID-19 when symptoms have persisted for more than 3 weeks and long COVID-19 when symptoms have persisted for more than 12 weeks.
There is no exact definition of the symptom. Persistent symptoms after severe viral pneumonia and intensive care or neurological complications may be different from those seen after mild or no respiratory symptoms.
COVID-19 infection is also associated with an increased risk of thrombosis, and the physical symptoms of pulmonary embolism or other venous thrombosis are unique. We are talking about several aftereffects with different etiologies and symptoms.
Interpretations are further complicated by the fact that prior COVID-19 test positivity has not been considered a necessary criterion for the prolonged symptoms. In COVID-19 infection, a nucleic acid detection test may not always be able to detect infection if it is located in the lower respiratory tract or if there are no respiratory symptoms and the antibody test is not always positive. Also, not everyone got the test in the early stages of the epidemic.
Patients with prolonged sequelae have called for careful health care research and tailored treatment, rather than being ignored and left to recover alone.
This has been justified e.g. that visceral changes could be detected in more than half of patients with mild symptoms by magnetic resonance imaging (7) and, for example, infected British doctors have reported myocarditis, pericarditis, hepatitis, thyroiditis, renal failure and allergy symptoms associated with the infection.
In a systematic review covering 39 studies and 68,361 patients with laboratory-confirmed mild to severe symptomatic COVID-19, the incidence of acute neurological symptoms was 21%. The most common were headache (5.4%), muscle damage (5.1%), psychiatric disorders (4.6%), loss of consciousness (2.8%), olfactory or taste disturbances (2.3%), acute cerebrovascular accident. (1,4%) and dizziness (1.3%).
Rare were symptoms of a cerebral nerve (0. 6%), root and nerve plexus dysfunction (0. 4%), and epilepsy (0.7%).
Central nervous system symptoms are known to occur in the acute phase in more than one-third of hospitalized COVID-19 patients and nearly half of those with severe symptoms. The most common central nervous system symptom associated with a serious disease is delirium, which is present in up to 40%. The greatest risk is in elderly patients with a history of cognitive impairment.
Neurological complications can be divided into four main groups: 1) encephalopathies 2) inflammatory central nervous system syndromes, 3) peripheral nervous system diseases, and 4) cerebral infarctions. In severely ill patients, acute phase encephalopathy may be associated not only with neurocognitive disease, but also with psychosis or mood disorders based on patient data collected from the UK portal CoroNerve.
Neuropsychiatric symptoms may also be due to psychological stress due to life-threatening illness and pandemic socio-economic stressors.
Acute encephalitis, or encephalitis, have been described only in isolated cases, either as part of other symptoms or as an immunological complication triggered by infection. Guillain-Barré syndrome and nerve pain (0.8% in mild and 4.5% in severe infection) or muscle pain (4.8% and 19.3%) have been described as patient cases or series and correlate with the severity of the initial disease.
Fortunately, cerebrovascular disorders are rare and are more common in severely ill patients than in mild cases. Acute cerebral infarction occurred in 1.3% of severely ill patients, and 63% of them required intensive or supervised treatment. Hospital-related mortality was quite high, 23%.
Neurological complications usually appear already during the acute phase of the disease
Cerebral dysfunction is thought to be due to coagulation and endothelial dysfunction and microthrombotic mechanisms in cerebral infarction and to immunological mechanisms associated with cytokine storm.
Immune-mediated mechanisms are thought to be involved in brain and peripheral nervous system disorder. In a series of pediatric patients with COVID-19, symptoms and findings of central and peripheral nervous system (encephalopathy, dysphagia, ataxia, and muscle weakness with reflective dysfunction) have been reported in children with multiple myeloma.
Neurological symptoms have also been suspected to be direct central nervous system viral invasion, but there is no consensus on the evidence. Magnetic resonance imaging of individual patients has shown that the virus has entered the area of the olfactory coil.
Neurological complications and associated dysfunction usually occur as early as the acute phase of the disease, although there may be a short delay in symptoms by the immunological mechanism.
A British study evaluated patients ’symptoms approximately one and a half months after discharge. Follow-up symptoms such as weakness or fatigue, dyspnoea and symptoms of a stress reaction were quite common and occurred more frequently in ICU patients than in inpatients.
A Chinese study evaluated the recovery of 55 patients with COVID-19 pneumonia three months after discharge. After three months, 71% had lung imaging findings. In a thin section of the lungs, half of the patients had findings in 1–3 lung segments and a quarter on both sides of the lungs. Frosted glass changes and the so-called crazy paving, changes (intralobular septic thickening) were mainly corrected, but interstitial thickening remained as a sign of possible fibrosis.
Many have described the symptom as strange and previously inexperienced.
Because COVID-19 infection is associated with an increased susceptibility to obstruction, the possibility of pulmonary embolism should also be borne in mind if the patient complains of exertional dyspnea, rapid heartbeat, or hypoxemia as a consequence of the infection. In a French study, pulmonary embolism was reported in up to 20% of patients in the early stages of a pandemic.
However, susceptibility to thrombosis is greatest in the acute phase of the disease, and prophylactic anticoagulant medication is part of the treatment, especially in hospitalized patients. HUS also recommends low-molecular-weight heparin for 10 to 30 days in outpatient settings for generalized patients over 60 years of age and over 40 years of age, as well as for anyone with risk factors for obstruction.
Other prolonged symptoms
Many have described the symptom as strange and previously inexperienced. Prolonged symptoms may include fatigue, dyspnoea, cough, and taste and smell disturbances, but also headache, muscle aches, warmth, tinnitus, rash, abdominal symptoms, and palpitations and palpitations.
Traumatic stress response is common after COVID-19, in up to 96% of patients. New psychiatric diagnoses, especially anxiety disorders, have been found to be twice as common as for example after influenza.
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