Post-Acute COVID-19 Symptoms, a Potential Link with [ME/CFS]: A 6-Month Survey in a Mexican Cohort, 2021, González-Hermosillo et al

[Andy]

Abstract

The aim of this study was to describe the clinical evolution during 6 months of follow-up of adults recovered from COVID-19. We tried to determine how many met the definition of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). A total of 130 patients (51.0 ± 14 years, 34.6% female) were enrolled. Symptoms were common, participants reported a median number of 9 (IQR 5–14) symptoms. Fatigue was the most common symptom (61/130; 46.9%). Patients with fatigue were older 53.9 ± 13.5 years compared with 48.5 ± 13.3 years in those without fatigue (p = 0.02) and had a longer length of hospital stay, 17 ± 14 days vs. 13 ± 10 days (p = 0.04). There was no difference in other comorbidities between patients with fatigue and those without it, and no association between COVID-19 severity and fatigue. After multivariate adjustment of all baseline clinical features, only age 40 to 50 years old was positively associated with fatigue, OR 2.5 (95% CI 1.05–6.05) p = 0.03. In our survey, only 17 (13%) patients met the Institute of Medicine’s criteria for “systemic exertion intolerance disease,” the new name of ME/CFS. In conclusion, in some patients, the features of post-acute COVID-19 syndrome overlap with the clinical features of ME/CFS.

Open access, https://www.mdpi.com/2076-3425/11/6/760/htm

 

[Ariel]

Glad there is a discussion of the effect of different diagnostic criteria on their findings in section 3, where they specify percentages for different case definitions of ME/CFS.

 

[Louie41]

I find it almost impossible to read large blocks of text link this. Could the text be broken up? @Andy

I appreciate all the time you take to find and post articles, and I almost faint when confronting those with large blocks of text.

 

[Hoopoe]

13% is close to what has been found in other infectious illnesses.

 

[Dolphin]

Glad there is a discussion of the effect of different diagnostic criteria on their findings in section 3, where they specify percentages for different case definitions of ME/CFS.

There is a large discrepancy in the prevalence of ME/CFS as a result of using different definitions. The more specific the exclusion criteria in the definition, the smaller the number of patients diagnosed with ME/CFS.

Based on the original criteria of ME/CFS proposed by the Centers for Disease Control and Prevention (CDC) Fukuda definition of 1994 [13], the only mandatory feature of ME/CFS is unexplained chronic fatigue, which must be accompanied by at least four out of eight minor symptoms related to neurological, cognitive, sleep, autonomic, gastrointestinal, and genitourinary disturbances, plus pain. In our survey, 23 (17.6%) patients met this case definition criteria.

The Canadian clinical case definition [14] specifies that post exertional malaise (a vague feeling of discomfort or fatigue) must occur with a loss of physical or mental stamina, muscle, or cognitive fatigability. In addition, there need to be two or more neurological/cognitive manifestations, (unrefreshing sleep or poor sleep quality), as well as a significant degree of arthralgia and/or myalgia. Finally, there needs to be at least one symptom from two of the following categories: autonomic manifestations (neurally mediated hypotension, postural orthostatic tachycardia, lightheadedness, palpitations with or without arrhythmias), neuroendocrine manifestations (recurrent feelings of feverishness and cold extremities), and immune manifestations (recurrent sore throats). Therefore, in our cohort, 20 (15.3%) patients met these criteria.

Compared with the International Consensus Criteria of 2011 [15], where a patient has to report at least eight (one mandatory: post-exertional neuroimmune exhaustion, and seven variable symptoms) to meet the diagnosis of ME, while autonomic, sensory and cognitive dysfunctions are not compulsory; 25 (19.2%) of our patients met the diagnosis criteria.

The Institute of Medicine [16], recently proposed a new case definition that included the following 4 symptoms: substantial reduction or impairment in the ability to engage in pre-illness levels of occupational, educational, social, or personal activities; post-exertional malaise, unrefreshing sleep; and at least one of the two following symptoms: cognitive impairment or orthostatic intolerance. According to this definition, the presence of other illnesses should not preclude patients from receiving a diagnosis of ME/CFS (SEID) except in the event that all the symptoms can be accounted for by these other illnesses. Following the SEID case definition in our cohort, only 17 (13%) patients met the criteria for ME/CFS.

 

[Andy]

From the above detail, I think we can safely assume they are applying the definitions incorrectly somehow.