Adolescent and Young Adult ME/CFS After Confirmed or Probable COVID-19.

Lindsay S Petracek,Richard L Violand,Renee L Swope,Neel R Patel,Rebecca F Vickers,Stacy J Suskauer,Peter C Rowe

doi:10.3389/fmed.2021.668944

Abstract

Introduction: Fatigue is a common acute symptom following SARS-CoV-2 infection (COVID-19). The presence of persistent fatigue and impaired daily physical and cognitive function has led to speculation that like SARS-CoV-1 infection, COVID-19 will be followed by myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).Methods and Results: We describe three adolescent and young adult patients who had confirmed or probable COVID-19 infections early on during the pandemic and were referred for evaluation to the Chronic Fatigue Clinic at the Johns Hopkins Children's Center. All patients reported orthostatic intolerance symptoms within the first 2 weeks of illness, and 10-min passive standing tests were consistent with postural tachycardia syndrome. After 6 months of illness, all three patients met criteria for ME/CFS. Clinical features of interest included strong histories of allergies in all three patients, two of whom had elevations in plasma histamine. Each demonstrated limitations in symptom-free range of motion of the limbs and spine and two presented with pathological Hoffman reflexes. These comorbid features have been reported in adolescents and young adults with ME/CFS.Conclusion: ME/CFS can be triggered by COVID-19 in adolescents and young adults. Further work is needed to determine the pathogenesis of ME/CFS after COVID-19 and optimal methods of treating these patients. Our preliminary study calls attention to several comorbid features that deserve further attention as potential targets for intervention. These include neuromuscular limitations that could be treated with manual forms of therapy, orthostatic intolerance and POTS for which there are multiple medications and non-pharmacologic therapies, treatable allergic and mast cell phenomena, and neurologic abnormalities that may require specific treatment. Larger studies will need to ascertain the prevalence of these abnormalities.

Highlights

Fatigue is a common acute symptom following SARS-CoV-2 infection (COVID-19)
Whether impaired production of antibodies is a risk-factor for prolonged symptoms after COVID-19 or is related to a sampling anomaly will need to be assessed in larger samples. Because these patients were referred to a specialist clinic at a tertiary care center, we cannot know whether the clinical features we observed will prove to be common across the general population of those with prolonged symptoms after COVID-19. Our evaluation of this sample of three patients suggests that myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) can be triggered by confirmed or probable COVID-19 in adolescents and young adults
Komaroff and Bateman [1] predict that over 10 million new cases of ME/CFS will be triggered by COVID-19 globally

Summary

Introduction

Fatigue is a common acute symptom following SARS-CoV-2 infection (COVID-19). The presence of persistent fatigue and impaired daily physical and cognitive function has led to speculation that like SARS-CoV-1 infection, COVID-19 will be followed by myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Orthostatic intolerance refers to a group of clinical conditions in which symptoms of fatigue, lightheadedness, difficulty concentrating, and others are aggravated by quiet upright posture and are ameliorated by recumbency [4]. There has been some uncertainty about whether orthostatic intolerance is an early and primary contributor to ME/CFS symptoms, or if it develops as a secondary phenomenon due to reduced activity or some other aspect of disease pathophysiology. This question can be difficult to resolve because the onset of ME/CFS can be insidious. Even when there has been an obvious post-infectious onset, the diagnosis of ME/CFS is made long after the acute illness, making the timing of symptom recall subject to bias

Methods

Results

Conclusion