CONSEQUENCES OF THE CORONAVIRUS INFECTION: THE POST-COVID SYNDROME AND MENTAL MANIFESTATIONS. LITERATURE REVIEW
Introduction. The pathogenetic aspects of the inflammatory syndrome and complications after coronavirus infection have different development mechanisms. Patients who have had COVID-19, after recovery, experience fatigue, shortness of breath, central nervous system dysfunction and other extrapulmonary symptoms. The article describes the features of the course of various clinical disorders after suffering from COVID-19. In addition, some mechanisms for the development of long-term consequences are discussed.
Aim. Conduct an analysis of the literature data on the pathogenesis, clinical manifestations and development of various manifestations of post-Covid syndrome, including cognitive impairment.
Search strategy: Full-text publications in English and Russian that are devoted to the problem of COVID-19 were included in this review. The search for sources was carried out in the following databases: PubMed, The Cochrane Library, Scopus, Elsevier, and E-library; by keywords, (COVID-19, coronavirus infection, SARS-CoV-2, post-acute Covid syndrome, cognitive impairment) from 2019 to 2022. According to the topic of study, 712 publications have been reviewed, 81 of which met the selection criteria and were included in this review.
Results. Numerous publications show that the range of clinical symptoms of post-Covid syndrome is wide. Research has identified the following mental consequences after a coronavirus infection: anxiety, memory and attention impairment, depression smell disorder, insomnia, debuts of known mental disorders. The global medical community has been introduced the concept of “long Сovid”, which combines subacute COVID-19 and post-Сovid syndrome. Thus, a more detailed study of this problem is relevant with the search for algorithms for providing effective medical care for coronavirus infection and post-COVID disorders.
Indira K. Zhumabekova1*, https://orcid.org/0000-0001-9285-887X
Vilen B. Molotov-Luchanskiy2, https://orcid.org/0000-0001-8473-4375
Larisa L. Macievskaya2
1 NCJSC «Astana Medical University», Astana, Republic of Kazakhstan;
2 NCJSC «Karaganda Medical University», Karaganda, Republic of Kazakhstan.
1. Ackermann M., Verleden S.E., Kuehnel M., Haverich A., Welte T., Laenger F. et al. Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19 // N Engl J Med. 2020, Jul 9; 383 (2): 120-128 doi: 10.1056/NEJMoa2015432
2. Ahmad I., Rathore F.A. Neurological manifestations and complications of COVID-19: A literatu-re review // J Clin Neurosci. 2020. 77:8–12. doi: 10.1016/j. jocn.2020.05.017
3. Akiyama M., Zeisbrich M., Ibrahim N., Ohtsuki S., Berry, G.J., Hwang P.H., et al. Neutrophil extracellular traps induce tissue-invasive monocytes in granulomatosis with polyangiitis // Front Immunol. 13 Noverber 2019: 10:2617 DOI: 103389/fimmu201902617.
4. Alemanno F., Houdayer E., Parma A., Spina A., Del Forno A., Scatolini A. et al. COVID-19 Cognitive Deficits after Respiratory Assistance in the Subacute Phase: A COVID-Rehabilitation Unit Experience // PLoS One. 2021.16(2):e0246590. doi: 10.1371/journal.pone.0246590.
5. Belli S., Balbi B. et al. Low physical functioning and impaired performance of activities of daily life in COVID‐19 patients who survived the hospitalization // Eur Respir J. 2020. 56(4):2002096. doi: 10.1183/13993003.02096-2020
6. Bi Q., Wu Y., Mei S. et al. Epidemiology and transmission of COVID-19 in 391 cases and 1286 of their close contacts in Shenzhen, China: a retrospective cohort study // Lancet Infect Dis. 2020: S1473-3099(20)30287-5. doi: 10.1016/S1473- 3099(20)30287-5
7. Carfi A., Bernabei R., Landi F. Persistent symptoms in patients after acute COVID- 19 // JAMA. 2020. 324:603–605.
8. Chen N., Zhou M., Dong X., Qu J., Gong F., Han Y. et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study // The Lancet. 2020. 30 January DOI: https://doi.org/101016/S0140-6736(20)30211-7 (Accessed: 15.02.2020)
9. Colizzi M., Bortoletto R., Silvestri M., Mondin F. Medically unexplained symptoms in the times of Covid-19 pandemic: A case-report // Brain Behav Immun Health. 2020. 5:100073. doi: 10.1016/ j.bbih.2020.100073.
10. Coolen T., Lolli V., Sadeghi N., Rovai A., Trotta N., Taccone F.S. et al. Early Postmortem Brain MRI Findings in COVID-19 Non-Survivors // Neurology. 2020. 95(14):e2016–e2027. doi: 10.1212/WNL.0000000000010116.
11. Dalakas M.C. Guillain-Barré syndrome: The first documented COVID - 19-triggered autoimmune neurologic disease: More to come with myositis in the offing // Neurol Neuroimmunol Neuroinflamm. 2020. 7(5):e781. doi: 10.1212/NXI.0000000000000781.
12. De Lorenzo R., Conte C., Lanzani C., Benedetti F., et al. Residual Clinical Damage after COVID-19: A Retrospective and Prospective Observational Cohort Study // PLoS One. 2020. 15(10):e0239570. doi: 10.1371/journal.pone.0239570.
13. Du Toit A. Outbreak of a novel coronavirus // Nat Rev Microbiol. 2020. 18 (3): 123.
14. Fan B.E., Lim K.G.E., Chong V.C.L., Chan S.S.W., Ong K.H., et al. COVID-19 and mycoplasma pneumoniae coinfection // Am J Hematol. 2020. 95(6):723-724.
15. Foldes D., Hinton R., Arami S., Bain B.J. Plasmacytoid lymphocytes in SARS-CoV-2 infection (Covid-19) // Am J Hematol. 2020, 95(7):861-862.
16. Fotuhi M., Mian A., Meysami S., Raji C.A. Neurobiology of COVID-19 // J Alzheimer’s Dis. 2020. 76:3–19. doi: 10.3233/JAD-200581.
17. García L.F. Immune Response, Inflammation, and the Clinical Spectrum of COVID-19, Front. Immunol. 2020. 11, 1441. https://doi.org/10.3389/fimmu.2020.01441 (Accessed: 16.06.2020)
18. Goërtz Y.M.J., Van Herck M., Delbressine J.M., Vaes A.W., Meys R., Machado F.V.C. et al. Persistent Symptoms 3 Months after a SARS-CoV-2 Infection: the PostCOVID-19 Syndrome? // ERJ Open Res. 2020. 6(4):00542. doi: 10.1183/ 23120541.00542-2020.
19. Guan W.J., Ni Z.Y., Hu Y. et al. Clinical characteristics of coronavirus disease 2019 in China // N Engl J Med. 2020. 382(18):1708–1720. doi: 10.1056/NEJMoa2002032
20. Han H., Yang L., Liu R., Liu F., Wu K.L., Li J., Liu X.H., Zhu C.L. Prominent changes in blood coagulation of patients with SARS-CoV-2 infection // Clin Chem Lab Med. 2020. 10.1515/cclm-2020-0188
21. Hannah E., Davisa L., Assafa G.S., McCorkella L., Weia H., Lowa R.J., Re'ema Yo., Redfielda S., Austina Ja.P., Akrami A. Characterizing long COVID in an international cohort: 7 months of symptoms and their impact // E Clinical Medicine. 2021. July 14, 3:00
22. Helms J., Kremer S., Merdji H., Schenck M., Severac F., Clere-Jehl R. et al. Delirium and encephalopathy in severe COVID-19: a cohort analysis of ICU patients // Crit Care. 2020 24:491. doi: 10.1186/s13054-020-03200-1
23. Heneka M.T., Golenbock D., Latz E., Morgan D., Brown R. Immediate and Long-Term Consequences of COVID-19 Infections for the Development of Neurological Disease // Alzheimers Res Ther. 2020. 12(1):69. doi: 10.1186/ s13195-020-00640-3.
24. Holmes E.A., O’Connor R.C., Perry V.H., Tracey I., Wessely S., Arseneault L., et al. Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science // Lancet Psychiatry. 2020 7:547–60. doi: 10.1016/S2215-0366(20)30168-1.
25. Huang C., Huang L., Wang Y., Li X., Ren L., Gu X., Kang L., Guo L., Liu M. et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study // The Lancet. 2021. 397 (10270), 220–232.
26. Jose R., Manuel A., COVID-19 Cytokine Storm: The Interplay Between Inflammation and Coagulation // The Lancet. Respiratory medicine. 2020. 45:85-89.
27. Josefs T, Barrett T.J., Brown E.J., Quezada A., Wu X., Voisin M., et al. Neutrophil Extracellular Traps (NETs) promote macrophage inflammation and impair atherosclerosis resolution in mice with diabetes // JCI Insight. 2020 Apr 9; 5(7)
28. Knopp P., Miles A., Webb T.E., Mcloughlin B.C., Mannan I., Raja N., et al. Presenting features of COVID-19 in older people: relationships with frailty, inflammation and mortality // Eur Geriatr Med. 2020. 11:1089–94. doi: 10.1007/s41999-020-00373-4
29. Kucharski J.A., Russell W.T., Diamond C. et al. Early dynamics of transmission and control of COVID-19: a mathematical modelling study // Lancet Infect Dis. 2020: 20(5):553–558. doi: 10.1016/ S1473-3099(20)30144-4.
30. Lu R., Zhao X., Li J., Niu P. et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding // Lancet. 2020. 395 (10 224): 565–74.
31. Matschke J., Lütgehetmann M., Hagel C., Sperhake J.P., Schröder A.S., Edler C. et al. Neuropathology of Patients with COVID-19 in Germany: A Post-Mortem Case Series // Lancet Neurol. 2020. 19(11):919–929. doi: 10.1016/S1474-4422(20)30308-2.
32. McAloon C.G., Collins B.A., Hunt K.H. et al. The incubation period of COVID-19 - A rapid systematic review and meta-analysis of observational research // MedRxiv and bioRxiv. 2020. doi:10.1101/ 2020.04.24.20073957
33. Mehta P., McAuley D.F., Brown M., Sanchez E., Tattersall R.S., Manson J.J., et al. COVID-19: consider cytokine storm syndromes and immunosuppression // Lancet. 2020 Mar 28; 395 (10229):1033-1034
34. Mitra A., Dwyre D.M., Schivo M., Thompson G.R., Cohen S.H., Ku N. et al. Leukoerythroblastic reaction in a patient with COVID-19 infection // Am J Hematol. 2020, 25;10.1002/ajh.2579.
35. Mao L., Jin H., Wang M., et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China // JAMA Neurol. 2020. 77(6):1–9. doi: 10.1001/jamaneurol.2020.1127.
36. Mohabbat A.B., Mohabbat N.M., Wight E.C. Fibromyalgia and chronic fatigue syndrome in the age of COVID-19 // Mayo Clin Proc Innov Qual Outcomes. 2020. 4(6):764–766. doi: 10.1016/j.mayocpiqo.2020.08.002.
37. Mohr A., Dannerbeck L., Lange T.J. et al. Cardiopulmonary exercise pattern in patients with persistent dyspnoea after recovery from COVID-19 // Respir Med. 2021. 16(1):732. doi: 10.4081/mrm.2021.732
38. Moriguchi T., Harii N., Goto J., Harada D., Sugawara H., Takamino J. et al. A first case of meningitis/encephalitis associated with SARS‐Coronavirus‐2 // Int J Infect Dis IJID Off Publ Int Soc Infect Dis. 2020. 94: 55–58. doi:10.1016/j.ijid.2020.03.062
39. Motaghinejad M., Gholami M. Possible neurological and mental outcomes of COVID-19 infection: a hypothetical role of ACE-2\Mas\BDNF signaling pathway // Int J Prev Med. 2020. 11:84. doi: 10.4103/ijpvm.IJPVM_114_20.
40. Mousavizadeha L. Genotype and phenotype of COVID-19: their roles in pathogenesis // J Microbiol Immunol Infect. 2020. Apr 9. URL: https://doi.org/10.1016/j.jmii.2020.03.022. (Accessed: 09.04.2020)
41. Ong X.W., Tan K., Chia Y.P., et al. Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) from a symptomatic patient // JAMA. 2020. 323 (16):1610–1612. doi:10.1001/jama.2020.3227
42. Oxley T.J., Mocco J., Majidi S., Kellner C.P., Shoirah H., Singh I.P. et al. Large Vessel Stroke as a Presenting Feature of Covid-19 in the Young // N Engl J. Med. 2020. 382(20):e60. doi: 10.1056/NEJMc2009787.
43. Pendlebury S.T., Rothwell P.M. Incidence and Prevalence of Dementia Associated with Transient Ischaemic Attack and Stroke: Analysis of the Population-Based Oxford Vascular Study // Lancet Neurol. 2019. 18(3):248–258. doi: 10.1016/S1474-4422(18)30442-3.
44. Pietro D.A., Comini L., Gazzi L., Luisa A., Vitacca M. Neuropsychological Pattern in a Series of Post-Acute COVID-19 Patients in a Rehabilitation Unit: Retrospective Analysis and Correlation with Functional Outcomes // Public Health 2021, 18, 5917. https://doi.org/10.3390/ijerph18115917 (Accessed: 31.05.2021)
45. Pinna P., Grewal P., Hall J.P. et al. Neurological manifestations and COVID-19: experiences from a tertiary care center at the Frontline // J Neurol Sci. 2020. 415:116969. doi: 10.1016/j.jns.2020.116969
46. Pleasure S.J., Green A.J., Josephson S.A. The Spectrum of Neurologic Disease in the Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic Infection: Neurologists Move to the Frontlines // JAMA Neurol. 2020. 77(6):679–680. doi: 10.1001/jamaneurol.2020.1065
47. Poduri R., Joshi G., Jagadeesh G. Drugs targeting various stages of the SARSCoV-2 life cycle: exploring promising drugs for the treatment of Covid-19 // Cell Signal. 2020. 74:109721. doi: 10.1016/j.cellsig.2020.109721.
48. Poncet-Megemont L., Paris P., Tronchere A. et al. High prevalence of headaches during COVID-19 infection: a retrospective cohort study // Headache. 2020. 60(10):2578–2582. doi: 10.1111/head.13923.
49. Potey P.M., Rossi A.G., Lucas C.D., and Dorward D.A. Neutrophils in the initiation and resolution of acute pulmonary inflammation: understanding biological function and therapeutic potential // J Pathol. 2019. 247(5):672-8.
50. Poyiadji N., Shahin G., Noujaim D., Stone M., Patel S., Griffith B. COVID‐19‐associated Acute Hemorrhagic Necrotizing Encephalopathy: CT and MRI Features // Radiology. 2020. 201187.doi:10.1148/radiol.2020201187
51. Rogers J.P., Chesney E., Oliver D., et al. Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic // Lancet Psychiatry. 2020. 7(7):611–627. doi: 10.1016/S2215-0366(20)30203-0
52. Román G.C., Spencer P.S., Reis J. et al. The neurology of COVID-19 revisited: a proposal from the environmental neurology specialty group of the world federation of neurology to implement international neurological registries // J Neurol Sci. 2020. 414:116884. doi: 10.1016/j.jns.2020.116884
53. Rudd J.M., Pulavendran S., Ashar H.K., Ritchey J.W., Snider T.A., Malayer J.R., et al. Neutrophils Induce a Novel Chemokine Receptors Repertoire During Influenza Pneumonia // Front Cell Infect Microbiol. 2019. 9:108
54. Sellner J., Taba P., Öztürk S., Helbok R. The need for neurologists in the care of COVID-19 patients // Eur J Neurol. 2020. 10.1111/ene.14257. doi: 10.1111/ene.14257.
55. Shai B., Fish J.E. Neuropsychological consequences of Covid-19 // Neuropsychological Rehabilitation 2020. October DOI:10.1080/09602011.2020.1808483
56. Sigfrid L., Cevik M., Jesudason E., Lim W.S., Rello J., Amuasi J. et al. What Is the Recovery Rate and Risk of Long-Term Consequences Following a Diagnosis of COVID-19? A Harmonised, Global Longitudinal Observational Study Protocol // BMJ Open. 2021. 11(3):e043887. doi: 10.1136/bmjopen-2020-04388.
57. Solomon I.H., Normandin E., Bhattacharyya S., Mukerji S.S., Keller K., Ali A.S. et al. Neuropathological Features of Covid-19 // N Engl J Med. 2020. 383(10):989–992. doi: 10.1056/NEJMc2019373.
58. Steardo L., Steardo L., Verkhratsky A. Psychiatric face of COVID-19 // Transl Psychiatry. 2020. 10(1):261. doi: 10.1038/s41398- 020-00949-5 96.
59. Stracciari A., Bottini G., Guarino M. Cognitive and Behavioral Neurology Study Group of the Italian Neurological Society. Cognitive and behavioral manifestations in SARS-CoV-2 infection: not specific or distinctive features? // Neurol Sci. 2021. 1–9. doi: 10.1007/s10072-021-05231-0
60. Tang N., Li D., Wang X., Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia // J Thromb Haemost. 2020. 18: 844-7 10.1111/jth.14768.
61. Tenforde M.W., Kim S.S., Lindsell C.J. et al. Symptom duration and risk factors for delayed return to usual health among outpatients with COVID-19 in a multistate health care systems network - United States, March-June 2020 // MMWR Morb Mortal Wkly Rep. 2020. 69:993-8
62. Teuwen L.A., Geldhof V., Pasut A., Carmeliet P. COVID-19: the Vasculature Unleashed // Nat Rev Immunol. 2020. 20(7):389–391. doi: 10.1038/s41577020-0343-0.
63. Tian S., Hu W., Niu L., Liu H., Xu H., and Xiao S.Y. Pulmonary pathology of early phase 2019 novel coronavirus (COVID-19) pneumonia in two patients with lung cancer // J Thorac Oncol. 2020 DOI: https://doiorg/101016/jjtho202002010 (Accessed: 15.03.2020)
64. Troyer E.A., Kohn J.N., Hong S. Are we facing a crashing wave of neuropsychiatric sequelae of COVID-19? Neuropsychiatric symptoms and potential immunologic mechanisms // Brain Behav Immun. 2020. 87:34–39. doi: 10.1016/j.bbi.2020.04.027.
65. Tsai S.T., Lu M.K., San S., Tsai C.H. The Neurologic Manifestations of Coronavirus Disea-se 2019 Pandemic: A Systemic Review // Front Neurol. 2020. 11: 498. doi: 10.33 9/fneur.2020.00 498.
66. Varatharaj A., Thomas N., Ellul M.A. et al. Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study // Lancet Psychiatry. 2020. 7: 875–882
67. Varga Z., Flammer A.J., Steiger P. et al. Endothelial Cell Infection and Endotheliitis in COVID-19 // Lancet. 2020. 395(10234):1417–1418. doi: 10.1016/S0140-6736(20)30937-5
68. Vonck K., Garrez I., De Herdt V. et al. Neurological manifestations and neuroinvasive mechanisms of the severe acute respiratory syndrome Coronavirus Type 2 // Eur J Neurol. 2020. 10.1111/ene.14329. doi: 10.1111/ene.14329.
69. Walls A.C., Park Y.J., Tortorici M.A., Wall A., McGuire A.T., Veesler D. Structure, function, and antigenicity of the SARS-CoV-2 spike glycoprotein // Cell. 2020. 181:281–92.e6. doi: 10.1016/j.cell.2020.02.058.
70. Wang C., Pan R., Wan X., Tan Y., Xu L., McIntyre R.S. et al. A longitudinal study on the mental health of general population during the COVID-19 epidemic in China. Brain Behav Immun. 2020. 87:40–8. doi: 10.1016/j.bbi.2020.04.028
71. Whiteside D.M., Oleynick V., Holker E., et al. Neurocognitive deficits in severe COVID-19 infection: Case series and proposed model // Clin Neuropsychol. 2021. 1–20. doi: 10.1080/13854046.2021.1874056.
72. Wijeratne T., Crewther S. COVID-19 and long-term neurological problems: Challenges ahead with Post-COVID-19 Neurological Syndrome // Aust J Gen Pract. 2021. (50). doi: 10.31128/AJGP-COVID-43
73. Wrapp D., Wang N., Corbett K.S. et al. Cryo-EM structure of the 2019-nCoV Spike in the prefusion conformation // Science. 2020. 367 (6483): 1260–1263
74. Yang J., Zheng Y., Gou X., et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis // Int J Infect Dis. 2020. 94:91–95. doi: 10.1016/j.ijid.2020.03.017
75. Ye Q., Wang B., Mao J. The pathogenesis and treatment of the ‘Cytokine Storm’ in COVID-19 // J Infect. 2020. 80:607–13. doi: 10.1016/j.jinf.2020.03.037.
76. Zhang B., Zhou X., Zhu C., Feng F., Qiu Y., Feng J. et al. Immune phenotyping based on neutrophil-to-lymphocyte ratio and IgG predicts disease severity and outcome for patients with COVID-19 // Frontiers in Molecular Biosciences. 2020. 03. 12. 2003-5048.
77. Zhou P., Yang X.L., Wang X.G., Hu B., Zhang L., Zhang W. et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin // Nature. 2020. №77579:270-273.
78. Zhou H., Lu S., Chen J., Wei N., Wang D., Lyu H., et al. The landscape of cognitive function in recovered COVID-19 patients // J Psychiatr Res. 2020. 129:98–102. doi: 10.1016/j.jpsychires.2020.06.022.
79. Zhu N., Zhang D., Wang W., Li X., Yang B., Song J., et al. 2020. A novel coronavirus from patients with pneumonia in China, 2019 // N Engl J Med. 2020. COVID-19 Autopsies, Oklahoma, USA DOI: https://doi org/101093/ajcp/aqaa062
80. Zini G., Bellesi S., Ramundo F., d’Onofrio G. Morphological anomalies of circulating blood cells in COVID-19 // Am J Hematol. 2020, 95(7):870-87
81. Zuo Y., Yalavarthi S., Shi H., Gockman K. et al. Neutrophil extracellular traps in COVID-19 // JCI Insight. 2020. DOI. 10.1172/jci.insight.13899.
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Zhumabekova I.K., Molotov-Luchanskiy V.B., Macievskaya L.L. Consequences of the coronavirus infection: the post-Covid syndrome and mental manifestations. Literature Review // Nauka i Zdravookhranenie [Science & Healthcare]. 2024, (Vol.26) 1, pp. 147-155. doi 10.34689/SH.2024.26.1.019Похожие публикации:
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