Chronic fatigue syndrome after coronavirus infection
After a coronavirus infection, most patients recover, but some continue to have complaints. In patients who feel well, the virus can remain in the body even after the complaints have stopped. How to manage such situations is still being researched. Antibodies and the body's immune responses are being studied intensively, so besides isolating the virus, medicine is also following the development of antibodies, with the aim of developing a vaccine. A vaccine is already being developed at a number of major institutes, as are potential new medicines and old medicines with new indications. Post-infectious syndrome includes fatigue, malaise, lack of strength, breathlessness, reduced exercise tolerance, sweating, muscle and joint pain, sometimes swollen joints, and neurological symptoms such as headache, tingling and muscle weakness, which can accompany and follow any viral or bacterial infection. When the acute symptoms of the infection stop, the person may still go on having complaints. If the complaints persist, it is a good idea to contact a doctor to decide on the next steps. Our polyclinic has extensive experience with post-infectious conditions such as reactive arthritis, so feel free to contact us online at www.faktorzdravlje.com. After a detailed medical history and evaluation of your complaints, we will recommend what to do next and how, which medicines are best for you and which further diagnostic tests you need!
Physiotherapy that includes passive modalities, as well as exercise therapy and general conditioning, is the best way back to your usual activities. We recommend that you see your physiatrist or rheumatologist, who can rule out or confirm other diseases such as rheumatoid arthritis, polymyalgia rheumatica and reactive arthritis, which often develop after an infection.
During viral and bacterial illnesses, and also after them, joint and muscle pain, fatigue and weakness are common symptoms, and they alert us to the seriousness of the condition. When other symptoms and signs are added, such as cough, fever, loss of appetite and a rash, the person certainly needs to be examined carefully, so that these complaints do not lead to a deterioration in health.
Musculoskeletal disorders are an integral part of post-infectious complaints, especially pain in the lower back and legs, both at rest and on movement. Any greater exertion, especially while the person has a fever, causes the patient problems, and the complaints often continue even after the fever has gone.
Interestingly, once the cough has settled and the acute symptoms and fever have stopped, some of the musculoskeletal symptoms may persist in the form of fatigue, loss of strength, a need for more rest, and a lack of agility and of the will to be active. Post-bacterial forms of arthritis are well known, such as rheumatic fever, one symptom of which is a painful migratory arthritis accompanied by joint swelling, redness and warmth.
Infectious and post-infectious bacterial or viral arthritis often presents as transient synovitis (temporary swelling of the joint and joint capsule). Besides flu, post-infectious arthritis is also common with rubella, parvovirus B19 and hepatitis B, and it is now being described with COVID-19 as well. We do not yet have all the information, but we have known for some time that there is a genetic predisposition to reactive arthritis (especially the bacterial form), which is associated with HLA-B27, a human leukocyte antigen of the major histocompatibility complex, but also with other genes and antigens. T lymphocytes react with the antigen and produce an immune response. Viral particles are rarely isolated. More often we cannot identify them in the synovial (joint) fluid, which supports the hypothesis of a cell-mediated immune reaction. Molecular mimicry is based on the interaction between a microbial antigen and the body's own proteins, together with stimulation of a Th2-mediated autoimmune response. Cytokines produced by Th2 cells are involved in joint damage. The pathogenesis of post-viral arthritis is much more complex, as it often does not meet the classic definition of reactive arthritis. With rubella, varicella zoster, herpes simplex, CMV and adenoviruses, the virus or parts of it can sometimes be isolated in the affected tissue, and there are now indications that some patients still have the SARS-CoV-2 virus on their mucous membranes even after recovering from COVID-19. Interestingly, post-infectious arthritis more often affects the lower limbs (ankles, knees), and does so asymmetrically. Neurological manifestations are common, such as polyradiculoneuritis (Guillain–Barré syndrome), facial nerve palsy and encephalitis. Multiple sclerosis can also develop after an infection, and a number of rheumatological and neurological diseases may worsen. Dizziness is a common result of viral inflammation of the vestibular nerve, accompanied by loss of balance and faintness, both at rest and on movement. Muscle inflammations belong to the group of diseases we call myositis, and they are accompanied by raised inflammatory markers (CRP, ESR) and raised levels of muscle enzymes such as CPK, LDH and aldolase.
Lyme disease, i.e. infection with the bacterium Borrelia burgdorferi, is also an example of a bacterial arthritis that is common in our part of the world, and it can affect the brain, skin and joints.
The features of post-infectious arthritis include:
• asymmetric arthritis of 2–5 joints, especially in the lower limbs, accompanied by enthesitis (inflammation where a tendon attaches to bone) and dactylitis (diffuse swelling of a finger or toe)
• a recent infection in the medical history
• a symptom-free interval of 2–4 weeks after the infection
A post-infectious syndrome involving joint and muscle pain requires careful evaluation by an infectious disease specialist, a rheumatologist and a physiatrist. The condition needs careful clinical and laboratory evaluation to reach an accurate diagnosis, provide adequate treatment and establish the prognosis. Post-infectious arthritis has a good outcome and prognosis with symptomatic treatment, and recovery usually takes a few weeks (about 6 weeks). It rarely requires specific treatment (e.g. with glucocorticoids or disease-modifying drugs).
It is important to rule out other causes, such as septic arthritis and spondyloarthropathies (spondyloarthritides), juvenile arthritis and systemic lupus. Do not ignore bone, joint and muscle complaints, because they are often the result of viral and bacterial infections.
Contact us – our experts regularly follow the scientific findings in this field so that they can help you.
