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Evaluation of diseases complicating long COVID: A retrospective chart review
Tomoya Tsuchida1, Masanori Hirose1, Hirotoshi Fujii1
1Department of General Internal Medicine St. Marianna University School of Medicine Kawasaki Japan.
Insights
Many post-COVID-19 symptoms may stem from pre-existing conditions, not long COVID itself. A thorough differential diagnosis is crucial for accurate patient management and treatment strategies.
Area of Science:
- Medical Research
- Infectious Diseases
- Public Health
Background:
- Limited understanding of long COVID pathogenesis and treatment.
- Economic impact of long COVID necessitates urgent clarification of its causes.
- Pre-existing conditions may complicate post-COVID-19 symptoms.
Purpose of the Study:
- To evaluate diseases complicating long COVID.
- To differentiate new-onset conditions from exacerbations of pre-existing diseases post-COVID-19.
- To inform diagnostic and treatment approaches for persistent post-COVID-19 symptoms.
Main Methods:
- Retrospective, cross-sectional study design.
- Analysis of medical records from 798 patients with confirmed COVID-19 and persistent symptoms (≥60 days).
- Investigation of symptoms and new-onset diseases, excluding pre-existing condition exacerbations.
Main Results:
- 57% of patients (452/798) presented with complicating diseases.
- Common symptoms included fatigue, anxiety, and lack of motivation.
- Identified conditions included postural tachycardia syndrome, mood disorders, pulmonary thromboembolism, and arthritis.
Conclusions:
- Persistent symptoms post-COVID-19 are not always long COVID.
- A differential diagnosis approach is essential for accurate identification of underlying conditions.
- Distinguishing new diseases from pre-existing condition exacerbations is key for effective medical treatment.
Background:
Evidence for the pathogenesis and treatment of postacute coronavirus disease 2019 (COVID-19) (long COVID) is lacking. As long COVID symptoms are predicted to have an impact on the global economy, clarification of the pathogenesis is urgently needed. Our experiences indicated that some symptoms were complicated by diseases established before the COVID-19 pandemic.
Methods:
Using a retrospective, cross-sectional study, we aimed to evaluate the diseases complicating long COVID. Using the medical records of patients with confirmed COVID-19 exhibiting residual symptoms lasting ≥60 days postinfection who visited our clinic in January 2021-February 2023, we investigated the symptoms and diseases observed. We identified diseases that occurred after COVID-19 and excluded those that were exacerbations of existing diseases.
Results:
During the first visit, the most common symptoms reported in a total of 798 patients were fatigue (523 patients), anxiety (349 patients), and lack of motivation (344 patients). Complicating diseases were observed in 452 patients (57%). There were 115, 65, and 60 patients with postural tachycardia syndrome, postural syndrome without tachycardia, and mood disorders, respectively. Some diseases requiring immediate treatment included pulmonary thromboembolism, purulent shoulder arthritis, cerebellopontine angle tumors, myasthenia gravis, and cervical myelopathy.
Conclusion:
Not all symptoms that occur after COVID-19 should be treated as long COVID. Similar to normal medical treatment, a list of differential diagnoses should be maintained based on symptoms to obtain definitive diagnoses.
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