Petracek Lindsay S, Suskauer Stacy J, Vickers Rebecca F, Patel Neel R, Violand Richard L, Swope Renee L, Rowe Peter C
Departments of Pediatrics, The Johns Hopkins University School of Medicine and the Kennedy Krieger Institute, Baltimore, MD, United States.
Departments of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine and the Kennedy Krieger Institute, Baltimore, MD, United States.
Front Med (Lausanne). 2021 Apr 29;8:668944. doi: 10.3389/fmed.2021.668944. eCollection 2021.
Fatigue is a common acute symptom following SARS-CoV-2 infection (COVID-19). The presence of persistent fatigue and impaired daily physical and cognitive function has led to speculation that like SARS-CoV-1 infection, COVID-19 will be followed by myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). We describe three adolescent and young adult patients who had confirmed or probable COVID-19 infections early on during the pandemic and were referred for evaluation to the Chronic Fatigue Clinic at the Johns Hopkins Children's Center. All patients reported orthostatic intolerance symptoms within the first 2 weeks of illness, and 10-min passive standing tests were consistent with postural tachycardia syndrome. After 6 months of illness, all three patients met criteria for ME/CFS. Clinical features of interest included strong histories of allergies in all three patients, two of whom had elevations in plasma histamine. Each demonstrated limitations in symptom-free range of motion of the limbs and spine and two presented with pathological Hoffman reflexes. These comorbid features have been reported in adolescents and young adults with ME/CFS. ME/CFS can be triggered by COVID-19 in adolescents and young adults. Further work is needed to determine the pathogenesis of ME/CFS after COVID-19 and optimal methods of treating these patients. Our preliminary study calls attention to several comorbid features that deserve further attention as potential targets for intervention. These include neuromuscular limitations that could be treated with manual forms of therapy, orthostatic intolerance and POTS for which there are multiple medications and non-pharmacologic therapies, treatable allergic and mast cell phenomena, and neurologic abnormalities that may require specific treatment. Larger studies will need to ascertain the prevalence of these abnormalities.
疲劳是新型冠状病毒2型感染（COVID-19）后常见的急性症状。持续性疲劳以及日常身体和认知功能受损的情况引发了一种推测，即与严重急性呼吸综合征冠状病毒1型感染一样，COVID-19之后会出现肌痛性脑脊髓炎/慢性疲劳综合征（ME/CFS）。我们描述了三名青少年和青年成人患者，他们在疫情早期确诊或可能感染了COVID-19，并被转诊至约翰·霍普金斯儿童中心的慢性疲劳诊所进行评估。所有患者在发病的前两周内均报告有直立不耐受症状，10分钟被动站立试验与体位性心动过速综合征相符。发病6个月后，所有三名患者均符合ME/CFS的标准。有趣的临床特征包括所有三名患者都有强烈的过敏史，其中两名患者血浆组胺升高。每名患者均表现出四肢和脊柱无症状活动范围的受限，两名患者出现病理性霍夫曼反射。这些合并症特征在患有ME/CFS的青少年和青年成人中已有报道。ME/CFS可由COVID-19在青少年和青年成人中引发。需要进一步开展工作以确定COVID-19后ME/CFS的发病机制以及治疗这些患者的最佳方法。我们的初步研究提请注意几个合并症特征，作为潜在的干预靶点，它们值得进一步关注。这些特征包括可通过手法治疗的神经肌肉受限、有多种药物和非药物疗法的直立不耐受和体位性心动过速综合征、可治疗的过敏和肥大细胞现象，以及可能需要特定治疗的神经学异常。需要更大规模的研究来确定这些异常的患病率。
