Long COVID research: Use of CPET to understand dyspnea & assess for ME/CFS

Posted on 02/04/2022 by wames

Use of cardiopulmonary stress testing for patients with unexplained dyspnea Ppost–Coronavirus Disease, by Donna M Mancini, Danielle L Brunjes, Anuradha Lala, Maria Giovanna Trivieri, Johanna P Contreras, and Benjamin H Natelson in J Am Coll Cardiol HF 2021 Dec, 9 (12) 927–937

 

Research abstract:

Objectives
The authors used cardiopulmonary exercise testing (CPET) to define unexplained dyspnea in patients with post-acute sequelae of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection (PASC). We assessed participants for criteria to diagnose myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

Background
Approximately 20% of patients who recover from coronavirus disease (COVID) remain symptomatic. This syndrome is named PASC. Its etiology is unclear. Dyspnea is a frequent symptom.

Methods
The authors performed CPET and symptom assessment for ME/CFS in 41 patients with PASC 8.9 ± 3.3 months after COVID. All patients had normal pulmonary function tests, chest X-ray, and chest computed tomography scans. Peak oxygen consumption (peak VO2), slope of minute ventilation to CO2 production (VE/VCO2 slope), and end tidal pressure of CO2 (PetCO2) were measured. Ventilatory patterns were reviewed with dysfunctional breathing defined as rapid erratic breathing.

Results
Eighteen men and 23 women (average age: 45 ± 13 years) were studied. Left ventricular ejection fraction was 59% ± 9%. Peak VO2 averaged 20.3 ± 7 mL/kg/min (77% ± 21% predicted VO2). VE/VCO2 slope was 30 ± 7. PetCO2 at rest was 33.5 ± 4.5 mm Hg. Twenty-four patients (58.5%) had a peak VO2 <80% predicted. All patients with peak VO2 <80% had a circulatory limitation to exercise. Fifteen of 17 patients with normal peak VO2 had ventilatory abnormalities including peak respiratory rate >55 (n = 3) or dysfunctional breathing (n = 12). For the whole cohort, 88% of patients (n = 36) had ventilatory abnormalities with dysfunctional breathing (n = 26), increased VE/VCO2 (n = 17), and/or hypocapnia PetCO2 <35 (n = 25). Nineteen patients (46%) met criteria for ME/CFS.

Conclusions
Circulatory impairment, abnormal ventilatory pattern, and ME/CFS are common in patients with PASC. The dysfunctional breathing, resting hypocapnia, and ME/CFS may contribute to symptoms. CPET is a valuable tool to assess these patients.

 

Physicians weekly: Abnormal ventilatory patterns common after COVID-19

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Research review: The gut microbiome in ME/CFS

Posted on 01/31/2022 by wames

The gut microbiome in Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS), by Rahel S König, Werner C Albrich, Christian R Kahlert, Lina Samira Bahr, Ulrike Löber, Pietro Vernazza, Carmen Scheibenbogen, Sofia K Forslund in Front Immunol  2022 Jan 3;12:628741 [doi: 10.3389/fimmu.2021.628741]

 

Review abstract:

Myalgic encephalomyelitis (ME) or Chronic Fatigue Syndrome (CFS) is a neglected, debilitating multi-systemic disease without diagnostic marker or therapy. Despite evidence for neurological, immunological, infectious, muscular and endocrine pathophysiological abnormalities, the etiology and a clear pathophysiology remains unclear.

The gut microbiome gained much attention in the last decade with manifold implications in health and disease. Here we review the current state of knowledge on the interplay between ME/CFS and the microbiome, to identify potential diagnostic or interventional approaches, and propose areas where further research is needed. We iteratively selected and elaborated on key theories about a correlation between microbiome state and ME/CFS pathology, developing further hypotheses.

Based on the literature we hypothesize that antibiotic use throughout life favours an intestinal microbiota composition which might be a risk factor for ME/CFS.

Main proposed pathomechanisms include gut dysbiosis, altered gut-brain axis activity, increased gut permeability with concomitant bacterial translocation and reduced levels of short-chain-fatty acids, D-lactic acidosis, an abnormal tryptophan metabolism and low activity of the kynurenine pathway.

We review options for microbiome manipulation in ME/CFS patients including probiotic and dietary interventions as well as fecal microbiota transplantations. Beyond increasing gut permeability and bacterial translocation, specific dysbiosis may modify fermentation products, affecting peripheral mitochondria.

Table 2  Possible treatment affecting the microbiome in ME/CFS patients

1. FECAL MICROBIOTA TRANSPLANTATION (FMT)

Findings - A beneficial response in 70% of ME/CFS patients to a rectal infusion of a specific combination of bacteria has been reported, but all patients suffered from gastrointestinal symptoms (20). Massive improvement, also concerning energy levels of the patients, have been seen in patients undergoing FMT, also comparing to probiotics (31).

Ideas for future research -We recommend larger studies with more patients and at different stages of the disease undergoing FMT observing the energy level and other symptoms after the treatment.

2. PROBIOTICS

Q.  Are there any positive effects in the symptoms of ME/CFS by manipulating the gut microbiota of the patients?

Findings – Until now, there is no evidence for an amelioration of the core symptoms of ME/CFS patients through the use of probiotics, although significant changes in the gut have been observed in different probiotic studies (32).

Ideas for future research – In future probiotic studies it would be interesting to take biopsies of the gut instead of taking stool samples, as well as coupling metagenomic and transcriptomic analysis. In particular interventions increasing abundance of SCFA producers should be investigated.

3. FASTING DIETARY INTERVENTIONS    

Q. Are different modes of fasting able to improve symptoms in ME/CFS patients?

Findings – Until now there is no evidence for fasting dietary or fasting mimicking interventions in ME/CFS.

Ideas for future research – Projection of findings from fasting interventions in other diseases may motivate such trials also in ME/CFS.

4. OTHER POTENTIALLY GUT MICROBIOME MEDIATED APPROACHES

Q.  Is Vitamin B1 and Ginseng supplementation safe and effective in ME/CFS?

Findings – A double-blind randomized-controlled cross-over study with 40 IBD patients suffering from severe fatigue investigated the effects of a 20-day high dose thiamine (Vitamin B1) supplementation and showed a significant treatment effect regarding fatigue (33)

- Oral administration of ginseng has been shown to have anti-fatigue properties in ME/CFS, MS-related fatigue and cancer-related fatigue in several blinded randomized-controlled studies (34–37)

- Acupuncture and moxibustion (traditional Chinese medicine practices) to relieve symptoms of fatigue have been extensively investigated, but study quality is partially low (38–40)

Considering the gut-brain axis we strongly suspect that the microbiome may contribute to neurocognitive impairments of ME/CFS patients. Further larger studies are needed, above all to clarify whether D-lactic acidosis and early-life antibiotic use may be part of ME/CFS etiology and what role changes in the tryptophan metabolism might play.

An association between the gut microbiome and the disease ME/CFS is plausible. As causality remains unclear, we recommend longitudinal studies. Activity levels, bedridden hours and disease progression should be compared to antibiotic exposure, drug intakes and alterations in the composition of the microbiota. The therapeutic potential of fecal microbiota transfer and of targeted dietary interventions should be systematically evaluated.

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Hypothesis: Circadian rhythm disruption in ME/CFS: implications for the post-acute sequelae of COVID-19

Posted on 01/28/2022 by wames

Circadian rhythm disruption in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Implications for the post-acute sequelae of COVID-19, by Michael J McCarthy in Brain, Behavior, & Immunity – Health, Vol 20, March 2022, [doi.org/10.1016/j.bbih.2022.100412]

 

Highlights

  • Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is characterized by ​disrupted ​sleep ​and activity ​implicating ​circadian clocks.
  • The incidence of ME/CFS is expected to increase as a result of the post-acute sequelae of COVID-19.
  • Biomarker studies in ME/CFS patients implicate Transforming Growth Factor B (TGFB).
  • TGFB has roles in synchronizing circadian rhythms in peripheral cells.
  • Identification of biomarkers and new methodologies may facilitate progress in the chronobiological basis of ME/CFS.

Abstract

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a common and disabling disorder primarily characterized by persistent fatigue and exercise intolerance, with associated sleep disturbances, autonomic dysfunction, and cognitive problems. The causes of ME/CFS are not well understood but may coincide with immune and inflammatory responses following viral infections.

During the current SARS-CoV2 coronavirus pandemic, ME/CFS has been increasingly reported to overlap with persistent “long COVID” symptoms, also called the post-acute sequelae of COVID-19 (PASC).

Given the prominence of activity and sleep problems in ME/CFS, circadian rhythm disruption has been examined as a contributing factor in ME/CFS. While these studies of circadian rhythms have been pursued for decades, evidence linking circadian rhythms to ME/CFS remains inconclusive.

A major limitation of older chronobiology studies of ME/CFS was the unavailability of modern molecular methods to study circadian rhythms and incomplete understanding of circadian rhythms outside the brain in peripheral organ systems. Major methodological and conceptual advancements in chronobiology have since been made. Over the same time, biomarker research in ME/CFS has progressed. Together, these new developments may justify renewed interest in circadian rhythm research in ME/CFS.

Presently, we review ME/CFS from the perspective of circadian rhythms, covering both older and newer studies that make use of modern molecular methods. We focus on transforming growth factor beta (TGFB), a cytokine that has been previously associated with ME/CFS and has an important role in circadian rhythms, especially in peripheral cells.

We propose that disrupted TGFB signaling in ME/CFS may play a role in disrupting physiological rhythms in sleep, activity, and cognition, leading to the insomnia, energy disturbances, cognition problems, depression, and autonomic dysfunction associated with ME/CFS.

Since SARS-like coronavirus infections cause persistent changes in TGFB and previous coronavirus outbreaks have caused ME/CFS-like syndromes, chronobiological considerations may have immediate implications for understanding ME/CFS in the context of the COVID-19 pandemic and possibly suggest new avenues for therapeutic interventions.

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Biomarker research: Submaximal exercise provokes increased activation of the anterior DMN during the resting state as a biomarker of PEM in ME/CFS

Posted on 01/19/2022 by wames

Submaximal exercise provokes increased activation of the anterior default mode network during the resting state as a biomarker of postexertional malaise in Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome, by Rakib U Rayhan and  James N Baraniuk in Front. Neurosci., 15 Dec 2021 [doi.org/10.3389/fnins.2021.748426]

 

Research abstract:

Background: 

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is characterized by disabling fatigue and postexertional malaise. We developed a provocation paradigm with two submaximal bicycle exercise stress tests on consecutive days bracketed by magnetic resonance imaging, orthostatic intolerance, and symptom assessments before and after exercise in order to induce objective changes of exercise induced symptom exacerbation and cognitive dysfunction.

Method: 

Blood oxygenation level dependent (BOLD) scans were performed while at rest on the preexercise and postexercise days in 34 ME/CFS and 24 control subjects. Seed regions from the FSL data library with significant BOLD signals were nodes that clustered into networks using independent component analysis. Differences in signal amplitudes between groups on pre- and post-exercise days were determined by general linear model and ANOVA.

Results:

The most striking exercise-induced effect in ME/CFS was the increased spontaneous activity in the medial prefrontal cortex that is the anterior node of the Default Mode Network (DMN). In contrast, this region had decreased activation for controls. Overall, controls had higher BOLD signals suggesting reduced global cerebral blood flow in ME/CFS.

Conclusion: 

The dynamic increase in activation of the anterior DMN node after exercise may be a biomarker of postexertional malaise and symptom exacerbation in CFS. The specificity of this postexertional finding in ME/CFS can now be assessed by comparison to post-COVID fatigue, Gulf War Illness, fibromyalgia, chronic idiopathic fatigue, and fatigue in systemic medical and psychiatric diseases.

 

Health Rising: Exercise Challenge Reveals a “Remarkable Discordance” in the Brains of People with ME/CFS

  • Using a two-day exercise challenge, Georgetown researchers found a part of the brain that gets turned off in the post-exercise period actually gets turned on in people with ME/CFS.
  • The authors proposed that something called the default mode network which is associated with rumination and internal assessments had become activated in the post-exercise period in ME/CFS. (It was not activated in the pre-exercise period.
  • Because the DMN has to be turned off in order for action to take place, its activation in ME/CFS made tasks more difficult to complete. The authors called the process task-related deactivation.
  • As similar findings have shown up in Gulf War Illness, it’s possible that DMN activation post-exercise is a feature of all fatiguing and exertionally intolerant diseases.
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Research review: Brainstem abnormalities in ME/CFS… evaluation of MRI findings

Posted on 01/12/2022 by wames

Brainstem abnormalities in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A scoping review and evaluation of Magnetic Resonance Imaging findings, by Todd Nelson, Lan-Xin Zhang, Hui Guo, Luis Nacul, Xiaowei Son in Frontiers in Neurology Vol 12, p 769511, Dec 2021 [doi:10.3389/fneur.2021.769511]

 

Review abstract:

Background

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a multisystem medical condition with heterogeneous symptom expression.

Currently, there is no effective cure or treatment for the standard care of patients. A variety of ME/CFS symptoms can be linked to the vital life functions of the brainstem, the lower extension of the brain best known as the hub relaying information back and forth between the cerebral cortex and various parts of the body.

Objective/Methods

Over the past decade, Magnetic Resonance Imaging (MRI) studies have emerged to understand ME/CFS with interesting findings, but there has lacked a synthesized evaluation of what has been found thus far regarding the involvement of the brainstem. We conducted this study to review and evaluate the recent MRI findings via a literature search of the MEDLINE database, from which 11 studies met the eligibility criteria.

Findings

Data showed that MRI studies frequently reported structural changes in the white and gray matter. Abnormalities of the functional connectivity within the brainstem and with other brain regions have also been found.

The studies have suggested possible mechanisms including astrocyte dysfunction, cerebral perfusion impairment, impaired nerve conduction, and neuroinflammation involving the brainstem, which may at least partially explain a substantial portion of the ME/CFS symptoms and their heterogeneous presentations in individual patients.

Conclusions

This review draws research attention to the role of the brainstem in ME/CFS, helping enlighten future work to uncover the pathologies and mechanisms of this complex medical condition, for improved management and patient care.

Excerpts from paper:

Taken together, the present review highlights the brainstem as a potential brain centre that may have a key role in the physiological defects in ME/CFS and recommends future MRI on ME/CFS studies to make the brainstem a specific target. Given the close association between the brainstem function impairments and the complex clinical expression of the disease, MRI, with its relatively high spatial and temporal resolutions for non-invasive in vivo applications, holds promise to uncover the mechanisms of the disease, and in turn enlightens effective strategies for improved patient care.

This review contributes to the research line by bringing the existing studies together and integrating them while highlighting the potential for more. As the big questions around ME/CFS remain unanswered (e.g., why does an initial viral event result in a debilitating ongoing life-long disease in some people, why does it not resolve like a typical infectious illness, and why are ME/CFS patients subject to frequent relapses), highlighting of the brainstem as a specific target is meaningful from both research and clinical practice perspectives.

…The paper draws increased attention to brainstem research in ME/CFS using multi-modality MRI, calling for improved experimental design, and increased sample size and follow-up duration. Targeting the brainstem abnormalities in relation to the heterogeneous symptoms has implications for uncovering ME/CFS mechanisms and thus improving management and patient care.

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Research: Experiences…on educational adaptations for students with CFS/ME (Norway)

Posted on 01/10/2022 by wames

Experiences among school personnel and school nurses on educational adaptations for students with CFS/ME: A qualitative interview study, by Wenche Ann Similä,  Torstein Baade Rø and  Torunn Hatlen Nøst in Front. Pediatr., 11 November 2021 [doi.org/10.3389/fped.2021.756963]

 

Research abstract:

Introduction:

Chronic fatigue syndrome (CFS/ME) is a disabling disease severely impacting school attendance, education, and social life in young students. Uncertainties surrounding CFS/ME etiology may impact the interpretation of CFS/ME in schools. Thus, school personnel need information from health care providers to make adequate adaptations to education and social life at school for these students.

Objectives:

To explore teachers, counselors, and school nurses’ experiences with adapting education for students with CFS/ME aged 13–19 in secondary and high schools.

Design:

A qualitative study with focus group interviews and individual interviews performed face-to-face or digitally between November 2020 and March 2021. Data were analyzed using Systematic text condensation.

Participants:

Six teachers, two counselors, and four school nurses in secondary and high school participated.

Results:

Adapting education for students with CFS/ME was challenging, especially before the students received a diagnosis. The challenges were related to identifying the students’ adaptational needs, maintaining a teacher-student relationship due to school absence, difficulties in maintaining continuity of education, and uncertainty regarding the diagnosis. Successful adaptations were related to quickly reacting to school absence, early referral to educational, psychological services, a close collaboration with the school management, and the development of digital teaching for students with CFS/ME. Interdisciplinary collaboration and a clear, constructive plan with adaptive measures, including maintained teacher-student communication and educational and social adaptations, may be useful in preventing the losses young people, with CFS/ME experience.

Conclusion:

Early interdisciplinary collaboration to adapt education and social life at school for students with CFS/ME, may support teachers, counselors, and school nurses in their efforts to adapt education and prevent losses related to academic and social development in students with CFS/ME.

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Research review: ME/CFS & POTS proposed as sub-types of long COVID

Posted on 01/06/2022 by wames

Proposed subtypes of post-COVID-19 syndrome (or long-COVID) and their respective potential therapies, by Shin Jie Yong, Shiliang Liu in Rev Med Virol. 2021 Dec 9; [doi: 10.1002/rmv.2315]

 

Review abstract:

The effects of coronavirus disease 2019 (COVID-19), a highly transmissible infectious respiratory disease that has initiated an ongoing pandemic since early 2020, do not always end in the acute phase. Depending on the study referred, about 10%-30% (or more) of COVID-19 survivors may develop long-COVID or post-COVID-19 syndrome (PCS), characterised by persistent symptoms (most commonly fatigue, dyspnoea, and cognitive impairments) lasting for 3 months or more after acute COVID-19.

While the pathophysiological mechanisms of PCS have been extensively described elsewhere, the subtypes of PCS have not. Owing to its highly multifaceted nature, this review proposes and characterises six subtypes of PCS based on the existing literature.

The subtypes are:

  1. non-severe COVID-19 multi-organ sequelae (NSC-MOS) [3.1]
  2. pulmonary fibrosis sequelae (PFS) [3.2]
  3. myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS) [3.3]
  4. postural orthostatic tachycardia syndrome (POTS) [3.4]
  5. post-intensive care syndrome (PICS) [3.5]
  6. medical or clinical sequelae (MCS) [3.6]

Original studies supporting each of these subtypes are documented in this review, as well as their respective symptoms and potential interventions. Ultimately, the subtyping proposed herein aims to provide better clarity on the current understanding of PCS.

One of the phenotypes is ME/CFS, which was two-fold more likely to happen to COVID-19-positive than—negative patients, especially among women younger than 65 years, at 6- to 9-month post-infection. [from section 3.3]

Read full paper

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Research: Compression stockings improve cardiac output & cerebral blood flow during tilt testing in ME/CFS patients

Posted on 01/05/2022 by wames

Compression stockings improve cardiac output and cerebral blood flow during tilt testing in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) patients: a randomized crossover trial by  C. (Linda) M C van Campen, Peter C Rowe and Frans C Visser in Medicina 2022 58:1 [10.3390/medicina58010051] (This article belongs to the Special Issue Chronic Fatigue Syndrome: From Clinical Observations to Unifying Hypotheses of Disease Mechanisms)

 

Research abstract

Background and Objectives:

Orthostatic intolerance (OI) is a clinical condition in which symptoms worsen upon assuming and maintaining upright posture and are ameliorated by recumbency. OI has a high prevalence in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Limited data are available to guide the treatment of OI in ME/CFS patients. We and others have previously described patient-reported subjective improvement in symptoms using compression stockings. We hypothesized that these subjective reports would be accompanied by objective hemodynamic improvements.

Materials and Methods:

We performed a randomized crossover trial in 16 ME/CFS patients. Each underwent two 15-min head-up tilt table tests, one with and one without wearing knee-high compression stockings that provided 20–25 mm Hg compression. The order of the tests was randomized. We measured heart rate and blood pressure as well as cardiac output and cerebral blood flow (CBF) using extracranial Doppler of the internal carotid and vertebral arteries.

Results:

There were no differences in supine measurements between the 2 baseline measurements. There were no differences in heart rate and blood pressure at either end-tilt testing period. Compared to the test with the stockings off, the mean percentage reduction in cardiac output during the test with compression stockings on was lower, 15 (4)% versus 27 (6)% (p < 0.0001), as was the mean percentage CBF reduction, 14 (4)% versus 25 (5)% (p < 0.0001).

Conclusion:

In ME/CFS patients with orthostatic intolerance symptoms, cardiac output and CBF are significantly reduced during a tilt test. These abnormalities were present without demonstrable heart rate and blood pressure changes and were ameliorated by the use of compression stockings.

Comment from full paper:

…using a questionnaire in our previous study on compression stockings, the positive and negative responses of wearing compression stockings to a variety of physical activities was variable and dependent on the degree of physical activity in question. In contrast, in the present study we found a uniform hemodynamic improvement when patients wore the stockings. Future work will be able to address whether specific symptoms such as exercise intolerance, pain, cognitive symptoms, lightheadedness or co-morbid disease will be more likely to improve with compression stockings.

This new finding supports the use of the compression stockings in these patients. Compression stockings may also be beneficial in non-ME/CFS populations with orthostatic intolerance.

See also:

Compression Garment Reduces Orthostatic Tachycardia and Symptoms in Patients With Postural Orthostatic Tachycardia Syndrome by Kate Bourne et al

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Research: Cerebral blood flow in long-haul COVID-19 patients: similarities with ME/CFS

Posted on 01/03/2022 by wames

Orthostatic symptoms and cerebral blood flow in long-haul COVID-19 patients: similarities with Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome, by C (Linda) MC van Campen, Peter C Rowe and Frans C Visser in Medicina 2022, 58(1), 28, 24 Dec 2021 [doi.org/10.3390/medicina58010028] (This article belongs to the Special Issue Chronic Fatigue Syndrome: From Clinical Observations to Unifying Hypotheses of Disease Mechanisms)

 

Research abstract:

Background and Objectives:

Symptoms and hemodynamic findings during orthostatic stress have been reported in both long-haul COVID-19 and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), but little work has directly compared patients from these two groups.

To investigate the overlap in these clinical phenotypes, we compared orthostatic symptoms in daily life and during head-up tilt, heart rate and blood pressure responses to tilt, and reductions in cerebral blood flow in response to orthostatic stress in long-haul COVID-19 patients, ME/CFS controls, and healthy controls.

Materials and Methods:

We compared 10 consecutive long-haul COVID-19 cases with 20 age- and gender-matched ME/CFS controls with postural tachycardia syndrome (POTS) during head-up tilt, 20 age- and gender-matched ME/CFS controls with a normal heart rate and blood pressure response to head-up tilt, and 10 age- and gender-matched healthy controls. Identical symptom questionnaires and tilt test procedures were used for all groups, including measurement of cerebral blood flow and cardiac index during the orthostatic stress.

Results:

There were no significant differences in ME/CFS symptom prevalence between the long-haul COVID-19 patients and the ME/CFS patients. All long-haul COVID-19 patients developed POTS during tilt. Cerebral blood flow and cardiac index were more significantly reduced in the three patient groups compared with the healthy controls. Cardiac index reduction was not different between the three patient groups. The cerebral blood flow reduction was larger in the long-haul COVID-19 patients compared with the ME/CFS patients with a normal heart rate and blood pressure response.

Conclusions:

The symptoms of long-haul COVID-19 are similar to those of ME/CFS patients, as is the response to tilt testing. Cerebral blood flow and cardiac index reductions during tilt were more severely impaired than in many patients with ME/CFS. The finding of early-onset orthostatic intolerance symptoms, and the high pre-illness physical activity level of the long-haul COVID-19 patients, makes it unlikely that POTS in this group is due to deconditioning. These data suggest that similar to SARS-CoV-1, SARS-CoV-2 infection acts as a trigger for the development of ME/CFS

Comments:

Health rising: The Reduced Brain Blood Flow Diseases? Long COVID, ME/CFS and POTS

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Research: CFS & FM sometimes mistakenly attributed to Lyme Disease (US)

Posted on 12/22/2021 by wames

Mistaken identity: many diagnoses are frequently misattributed to Lyme Disease, by Takaaki Kobayashi, Yvonne Higgins, Michael T Melia, Paul G Auwaerter in The American Journal of Medicine Nov 2021 [doi.org/10.1016/j.amjmed.2021.10.040]

 

Highlights

  • The majority of patients with long-term symptoms referred for evaluation of Lyme disease had alternative diagnoses to explain their symptoms.
  • Among 1061 patients, the 139 diagnoses described suggest that Lyme disease may be a frequent inappropriate diagnosis in this population.
  • Both new and pre-existing conditions should be considered in the differential diagnosis.
  • Patients referred for Lyme disease, especially with chronic symptoms, deserve careful assessment for diagnoses other than Lyme disease.

Research abstract:

Background:

Prior studies have demonstrated that Lyme disease is frequently over-diagnosed. However, few studies describe which conditions are misdiagnosed as Lyme disease.

Methods: 

This retrospective observational cohort study evaluated patients referred for Lyme disease to a Mid-Atlantic academic center between 2000-2013 who lacked evidence for Borrelia burgdorferi infection. The primary outcome is clinically described diagnoses contributing to symptoms. Secondary outcomes included symptom duration and determination whether diagnoses were new or attributed to existing medical conditions.

Results: 

Of 1261 referred patients, 1061 (84%) had no findings of active Lyme disease, with 690 (65%) receiving other diagnoses resulting in 405 (59%) having newly diagnosed medical conditions, 134 (19%) attributed to pre-existing medical issues, and 151 (22%) had both new and pre-existing conditions. Among the 690 patients, the median symptom duration was 796 days, and a total of 139 discrete diagnoses were made. Infectious disease diagnoses comprised only 3.2%.

Leading diagnoses were anxiety/depression 222 (21%), fibromyalgia 120 (11%), chronic fatigue syndrome 77 (7%), migraine disorder 74 (7%), osteoarthritis 62 (6%) and sleep disorder/apnea 48 (5%). Examples of less frequent but non-syndromic diseases newly diagnosed included multiple sclerosis (11), malignancy (8), Parkinson’s disease (8), sarcoidosis (4) or amyotrophic lateral sclerosis (4).

Categories of diagnoses in patients without Lyme disease (% of n = 690*) *Individual patients can have more than one diagnosis.

Conclusions:

Most patients with long-term symptoms have either new or pre-existing disorders accounting for their symptoms other than Lyme disease, suggesting overdiagnosis in this population. Patients referred for consideration of Lyme disease for chronic symptoms deserve careful assessment for diagnoses other than Borrelia burgdorferi infection.

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