Review: Muscle dysfunction in the long coronavirus disease 2019 syndrome: Pathogenesis and clinical approach, 2022, Costa Silva et al

Abstract

In long coronavirus disease 2019 (long COVID-19), involvement of the musculoskeletal system is characterised by the persistence or appearance of symptoms such as fatigue, muscle weakness, myalgia, and decline in physical and functional performance, even at 4 weeks after the onset of acute symptoms of COVID-19. Muscle injury biomarkers are altered during the acute phase of the disease. The cellular damage and hyperinflammatory state induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may contribute to the persistence of symptoms, hypoxaemia, mitochondrial damage, and dysregulation of the renin-angiotensin system. In addition, the occurrence of cerebrovascular diseases, involvement of the peripheral nervous system, and harmful effects of hospitalisation, such as the use of drugs, immobility, and weakness acquired in the intensive care unit, all aggravate muscle damage. Here, we review the multifactorial mechanisms of muscle tissue injury, aggravating conditions, and associated sequelae in long COVID-19.

Open access, https://onlinelibrary.wiley.com/doi/10.1002/rmv.2355

 

"3.3 Chronic fatigue syndrome

In many patients, the persistence of symptoms observed in long COVID-19 is centred on fatigue,16 accompanied by cognitive deficits, pain, and dyspnoea,8 and persist for several months after infection.15 These symptoms are similar to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a well-documented post-viral disease in the literature characterised by severe fatigue after exertion that does not improve with rest, lasting for periods longer than 6 months. It is believed that with the high incidence and prevalence of SARS-CoV-2 infections, a significant increase in ME/CFS cases may occur because of the post-viral fatigue, symptomatically identical to ME/CFS, observed in patients who recover from COVID-19.141 In infections by other coronaviruses such as SARS-CoV, the same reports of a post-viral syndrome include chronic fatigue, diffuse myalgia, depression, and sleep disturbances, which affect survivors for up to 4 years.4, 142 Perrin et al.143 suggested that patients with long COVID-19 may have a ‘post-COVID-19 syndrome’, similar to SARS."