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. 2023 Feb 24:14:1090747.
doi: 10.3389/fneur.2023.1090747. eCollection 2023.

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome is common in post-acute sequelae of SARS-CoV-2 infection (PASC): Results from a post-COVID-19 multidisciplinary clinic

Hector Bonilla  1 , Tom C Quach  1 , Anushri Tiwari  1 , Andres E Bonilla  2 , Mitchell Miglis  1 , Phillip C Yang  1 , Lauren E Eggert  1 , Husham Sharifi  1 , Audra Horomanski  1 , Aruna Subramanian  1 , Liza Smirnoff  1 , Norah Simpson  1 , Houssan Halawi  1 , Oliver Sum-Ping  1 , Agnieszka Kalinowski  1 , Zara M Patel  1 , Robert William Shafer  1 , Linda N Geng  1
Affiliations

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome is common in post-acute sequelae of SARS-CoV-2 infection (PASC): Results from a post-COVID-19 multidisciplinary clinic

Hector Bonilla et al. Front Neurol. .

Abstract

Background: The global prevalence of PASC is estimated to be present in 0·43 and based on the WHO estimation of 470 million worldwide COVID-19 infections, corresponds to around 200 million people experiencing long COVID symptoms. Despite this, its clinical features are not well-defined.

Methods: We collected retrospective data from 140 patients with PASC in a post-COVID-19 clinic on demographics, risk factors, illness severity (graded as one-mild to five-severe), functional status, and 29 symptoms and principal component symptoms cluster analysis. The Institute of Medicine (IOM) 2015 criteria were used to determine the Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) phenotype.

Findings: The median age was 47 years, 59.0% were female; 49.3% White, 17.2% Hispanic, 14.9% Asian, and 6.7% Black. Only 12.7% required hospitalization. Seventy-two (53.5%) patients had no known comorbid conditions. Forty-five (33.9%) were significantly debilitated. The median duration of symptoms was 285.5 days, and the number of symptoms was 12. The most common symptoms were fatigue (86.5%), post-exertional malaise (82.8%), brain fog (81.2%), unrefreshing sleep (76.7%), and lethargy (74.6%). Forty-three percent fit the criteria for ME/CFS, majority were female, and obesity (BMI > 30 Kg/m2) (P = 0.00377895) and worse functional status (P = 0.0110474) were significantly associated with ME/CFS.

Interpretations: Most PASC patients evaluated at our clinic had no comorbid condition and were not hospitalized for acute COVID-19. One-third of patients experienced a severe decline in their functional status. About 43% had the ME/CFS subtype.

Keywords: ME/CFS; PASC; post-COVID-19 clinic; prevalence; symptoms.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart. *Positive SARC-CoV-2 test and over 28 days with symptoms. **Severe fatigue, unrefreshing sleep, PEM, and brain fog or orthostatic intolerance.
Figure 2
Figure 2
Distribution of the frequency and severity of the symptoms on the PASC clinic intake questionnaire for subgroup of 105 patients with persistent symptoms for six or more months. Symptom severity was measured on the Likert scale with a severity score of 5 being the most severe. CP, Chest pain; GISx, Gastrointestinal symptoms; Anex/Depr, Anxiety/Depression; HA, Headache; UnRefreSleep, Unrefreshed sleep; PEM, Post-Exertional Malaise; NCongest, Nasal congestion.
Figure 3
Figure 3
Quality of representation of 13 most common symptoms mapped to the first five dimensions (A) and principal components analysis correlation circle (B). Insomnia and ageusia were not included in the analysis. The closer the variable to the correlation circle, the better the representation on the factor map. The quality of the representation of the symptom on the first five dimensions is measured by the squared cosine between the symptom vector and its projection on the dimension. The proportions on the left side of the factor map represent a color scale (14). CP, Chest pain; GISx, Gastrointestinal symptoms; Anex/Depr, Anxiety/Depression; HA, Headache; Lethargy, daytime sleepiness; UnRefrSleep, Unrefreshed sleep; PEM, Post-Exertional Malaise.
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