Postviral Syndrome (post-acute Infection Syndrome PAIS) / Postvirale Fatigue incl. Long-Covid

Definition

After the actual pathogenic activity of a viral infection has subsided, a physical disorder with a broad spectrum of symptoms, including severe fatigue, concentration and memory disorders, but also disorders of various organs such as the lungs, muscles (myalgia), joints (arthralgia), dermatological, neurological symptoms and psychological problems. The syndrome has long been known from pathogens such as Ebstein-Barrr virus, cytomegalovirus, dengue virus, herpes simplex viruses, influenza viruses or enteroviruses, but basically the syndrome has been known for centuries, long before viruses were discovered, under various names such as post-influenza depression, encephalitis lethargica, influenza catalepsy, hysterical coma. These were classified as pyschic disorders out of ignorance, especially in severe cases with bedriddenness. Even three years after the Spanish flu epidemic, there was a famine because Tanzanian farmers were too exhausted to cultivate their fields. In the years after 1889, the PAIS of the Russian flu (also a coronavirus, similar in symptoms to SARS-Cov-19) was frequently diagnosed as „neurasthenia“. Many suffered from it for 3-5 years and the number of unhealed illnesses is also considerable. It has come into focus as a consequence of SARS-Cov-19 illnesses, as it occurs quite frequently as a „post-Covid“ or „long-Covid“ syndrome, even after mild or asymptomatic courses. Some estimates suggest that up to 80% of Covid-infected people develop a post-viral disorder that often lasts for weeks or months.

Post-viral syndrome lasting more than 12 weeks is present in an estimated 15% of all Covid sufferers; the Omikron variant has reduced this rate to an estimated 3%. Nevertheless, the sickness rate is a significant factor; in the USA alone, 1 million people were unemployed due to long Covid, which corresponds to a total financial loss of 2.6 trillion dollars (as of 10/2021).
In Germany, the average incapacity to work is 105 days, which is well above the average statistical sickness rate of 14.6 days per year.

According to the WHO, as of June 2023, one in thirty Europeans are affected by post-Covid. Even before the coronavirus pandemic, 300,000 people in Germany were affected by ME/CFS, according to the National Association of Statutory Health Insurance Physicians. The disorder is likely to be due to persistent immune activation or viral persistence, among other things. Terminologically, we speak of post-acute Covid symptoms 3-12 weeks after infection. Younger age seems to predispose to the disorder, with age the tendency to it decreases. Health disorders prior to the causative infection also appear to predispose to the disorder. The course of the symptoms can be slowly creeping, constant or even non-cyclical. New onset of symptoms during PAIS is also possible. Pathophysiologically, several possible mechanisms are discussed as causative:

Permanent organ damage such as myocardial damage, kidney damage, pulmonary fibrosis
Damage to sensory cells
Lasting disorders of the immune system, possibly with autoimmune reactions
Occurrence of various inflammations
psychic effects
Metabolic disorders
Neuroinflammation
Vascular dysregulation

In an Australian study of 90% of patients vaccinated against Covid-19, more than 20% still had health problems in the sense of post-viral syndrome after 12 weeks, and 4% had moderate to severely impaired fitness for everyday life. The frequency of post-viral syndrome after Covid-19 PCS is similar to that after influenza. It also shows that vaccination reduces the likelihood of post-viral syndrome in the case of Covid-19 by approx. 30%. Post-vac syndrome (post-vaccination syndrome) PVS, which is similar in symptoms, occurs much less frequently. It appears that the Omikron variant has a lower frequency of PCs. In the case of Ebstein-Barr virus EBV, the post-viral syndrome is often more pronounced with a long convalescence that has been known for a long time, but myalgic encephalitis/chronic fatique syndrome (ME/CFS) also occurs after EBV infections. According to studies, the risk of ME/CFS is increased after a varicella zoster or swine flu infection. Two thirds of patients with the autoimmunological nerve disease Guillain-Barre syndrome have previously had an infection with coronavirus, zotomegalovirus, Epstein-Barr virus, influenza, Zika virus or varicella-zoster, and encepahlitides with long-term symptoms have been described as early as the Spanish flu of 1918. A causal and successful therapy is not yet known, so that treatment is largely symptomatic. A detailed medical history is required. For example, the often very pronounced lack of exertion must be differentiated according to type or cause in order to derive an intervention, such as dyspnea, muscle weakness, general exhaustion, lack of mitochondrial function, lack of concentration. Well-dosed physical strain is conducive to healing, excessive strain can lead to deterioration.

Terminologically, a distinction has been proposed between long-Covid and post-Covid, in such a way that the former is understood as
is understood to be the symptoms after the four-week phase of the disease, and post-Covid is understood to be the symptoms that persist for at least 12 weeks or are new.

Cause

Viral infection

Predisposing

Younger to middle age

Diagnosis

MRI and PET scans can detect cerebral changes, including some of the brain’s metabolism
Pulmonary function test to clarify dyspnea
10-minute standing test, tilting table
Blood gases
ECG, echocardiography
X-ray, ultrasound, CT or MRI of the lungs

Symptoms

Arthralgias
Myalgias
cerebral and sensory disorders such as forgetfulness, concentration disorders, speech disorders, word-finding disorders, headaches, dizziness, tinnitus
Premature feeling of being overwhelmed by stimuli and demands
Brain-Fog
Cardiac arrhythmia, tachycardia, pectanginous complaints
Circulatory disorders
Dyspnea, cough, shortness of breath
Loss of sense of taste or smell (anosmia)
Gastrointestinal complaints
Swelling of the lymph nodes
Occurrence of non-pathogen-related fever
Insomnia
Night sweats
Hair loss
Dermatological symptoms: pruritus, efflorescence, swelling
Severely reduced resilience in some cases, tiredness, fatigue, which hardly improves even with rest and sleep; exercise intolerance (post-exertional malaise PEM or crash after overload, which can last for weeks to months)
Psychological symptoms such as anxiety disorders, depression, lack of drive, listlessness, despondency
Fatigue is described as physical, emotional and mental
Orthostasis dysregulation, POTS
Difficulty falling asleep and staying asleep, resulting in daytime tiredness, reduced immune performance and resilience. If compensatory sleep is then taken during the day, a disturbed wake-sleep rhythm often sets in
Unproductive or tenacious dry cough with respiratory pathogens
Eye symptoms, visual impairment, sensitivity to brightness, pain on movement of the eye, double vision, redness
Alopecia

Complications

Therapy

mostly symptomatic

yogabook

pathology: postviral syndrom incl. long-Covid