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Researchers have found different clusters of symptoms persisting after coronavirus disease 2019 (COVID-19), with fatigue and higher levels of IL-6 common in women. About 75% of the patients they treated were female, indicating a link between sex hormones and the immune response.
A large portion of people who recover from COVID-19 experience persistent symptoms even six months after recovery. People have reported fatigue, joint pain and shortness of breath several months after their recovery. Studies estimate that about 10 to 30% of patients who recover have symptoms that persist months after recovering from acute illness.
Direct organ damage including loss of smell, cardiomyopathy, neuropathy, and interstitial lung disease has also been observed. In addition to organ damage, pain throughout the body and cognitive impairment in the brain, or “brain fog,” have also been reported. These chronic symptoms are similar to those seen after other viral infections such as Zika, SARS-CoV, and chikungunya.
Central sensitization syndrome is a group of chronic disorders like chronic headaches, irritable bowel syndrome, and fibromyalgia. They are thought to have shared physiological processes with inflammation of the brain and changing pathways in the brain and spinal cord. An increase in cytokine and chemokine levels has been observed, similar to that seen in COVID-19.
Researchers at the Mayo Clinic have seen patients with persistent symptoms after COVID-19. In a study published on the medRxiv* preprint server, they are reporting their first results on 107 patients they treated for persistent symptoms after recovering from COVID-19.
Categories of persistent symptoms
The study included patients seen between January and April 2021. Acute symptoms, those occurring within four weeks of the onset of COVID-19 and those persisting beyond four weeks, were recorded. All patients completed a standard questionnaire regarding symptoms, treatment, and current symptoms. About 75% of the patients were women.
The team identified six categories of predominant persistent symptoms: fatigue, shortness of breath, myalgia, chest pain, headache, and orthostatis (a decrease in blood pressure when sitting or standing). More women have suffered from fatigue, orthostasis and chest pain, while more men have headaches and shortness of breath.
Interleukin-6 (IL-6), an anti-inflammatory cytokine, was elevated in 69% of women (vs. 39% of men), which corresponded to an increase in fatigue, myalgia and pain. orthostasis. These three characteristics have been grouped under the central sensitization characteristic. This characteristic was predominant in women (80% versus 27% in men).
Differences based on gender
The study of patients shows that there is a predominance of women seeking care for persistent symptoms after COVID-19. They generally have higher IL-6 levels than men and have reported fatigue as the most common symptom. As is known for central sensitization, more women had symptoms similar to central sensitization.
Most patients had elevated IL-6 levels more than three months after infection, which had not been reported before. It is believed that higher levels of cytokines are the main cause of the adverse effects of COVID-19. IL-6 has also been associated with death in COVID-19 patients.
The higher levels of IL-6 may be partly responsible for the gender differences seen in chronic diseases. Symptoms of covid19. One of the factors affecting the overall immune response to COVID-19 is gender. Men appear to have higher rates of hospitalization and death. Studies have shown that men have higher IL-8 and IL-18 levels than women, but when women have a higher immune response, this is positively correlated with disease progression.
Changes in the immune response also vary throughout a person’s life cycle, with post-puberty / premenopausal women having higher levels of inflammatory cytokines than men. These effects may be due to sex hormones.
Symptoms seen in patients with central sensitization are similar to symptoms seen after other infections such as Lyme disease and post UHI syndrome. In all of these cases, there is an increase in IL-6 levels. IL-6 is associated with fatigue and sleep disturbances.
Dealing with these symptoms has generally been frustrating, as patients present with several of these debilitating symptoms, but almost no abnormalities in lab tests. The most convincing explanation would be that the brain and spinal cord become more sensitive to stimuli, reducing the threshold of perception and amplifying existing stimuli. It is also believed that there is a genetic component to central awareness as well as a certain personality type, such as attention to detail.
Based on these considerations, the authors hypothesize that the right genes, the right personality, and an event that causes distress to the system, such as viral infection or other forms of trauma such as surgery and events of the life, can lead to central awareness. Symptoms often last beyond the event, and there may be the development of new symptoms as well. Understanding the different characteristics of persistent symptoms can help better define treatment options.
*Important Notice
medRxiv publishes preliminary scientific reports that are not peer reviewed and, therefore, should not be considered conclusive, guide clinical practice / health-related behavior, or treated as established information.
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