LONG-COVID, POST-COVID sau AMBELE ?

 

Infectia COVID imbraca forme diverse, pentru ca fiecare persoana are un raspuns unic la virus datorita unui profil imunitar unic, dat de predispozitia genetica,variatiile epigenetice, profilul nutritional, profilul hormonal /stres etc. Durata bolii este extrem de variabila, de la 3 zile pana la 3-6 luni, desi  se intrevad cazuri in care sechelele pot dura toata viata !

 

Exista o constelatie de simptome aparute dupa boala acuta, denumita LONG-COVID, persistenta timp de una , trei sau chiar  sase luni de la boala, Ele pot fi:  oboseala, epuizare, “brain fog”,  ameteala,  palpitatii , disfunctie gustativa, anosmie etc . Aceasta varianta este cea “pozitiva” in care sistemul imunitar reuseste sa controleze in mod natural virusul abia in cateva luni si raman doar de combatut sechelele cronice de tipul: capacitate pulmonara redusa (fibroza pulmonara), probleme cardiovasculare tranzitorii (aritmii, vasculite etc), hiperlipidemie,  etc. Se estimeaza ca sindromul LONG-COVID afecteaza cca o cincime din bolnavii de COVID-19.

 

Exista o categorie de pacienti la care sistemul imunitar nu ajunge sa controleze virusul SARS si/sau virusii reactivati de acesta si pot aparea boli majoritar autoimune detectabile mult tarziu, atat de tarziu incat nu se poate face o conexiune cu infectia initiala. Aceste afectiuni: neurologice, neuromusculare, cardiace, renale, etc – sunt denumite generic POST-COVID. Pacientii din aceasta categorie sunt cei care: (a) au avut o forma severa a bolii, eventual cu ventilare mecanica; (b) au suferit de o  boala autoimuna ante-COVID;  (c) au avut infectii majore ante-COVID  etc.

 

Atat sindromul LONG-COVID, cat si cel POST-COVID reprezinta doua fete ale aceleiasi probleme: o infectie virala puternica necontrolata, cu o particularitatea notabila: numarul foarte mare de organe si sisteme ce pot fi afectate: plamani, inima, vase de sange, sange, nervi cranieni,  trunchiul cerebral, ganglionii bazali, nervii motori, rinichi, articulatii, organe reproductive (B) etc

 

  • Plamanii reprezinta cel mai afectat organ in majoritatea cazurilor: reactia sistemului imunitar la virus poate declansa, in cazurile usoare, pneumonie / pneumonita interstitiala, iar in cazurile severe, furtuna de citokine specifica sindromului respirator acut (= Severe acute respiratory syndrome: acronim = SARS). La nivel pulmonar, exista sechelele vizibile radiografic, caracteristice fibrozei pulmonare induse de citokinele profibrotice: IL-1, TNF, IL-13 si TGF-β. Caile de activare TGF-β conduc la producerea de fibrina, colagen și proteaze (MMP). Procesul de vindecare este mediat de EGFR, a carui activare are o serie de etape, cum ar fi inhibarea apoptozei, creșterea proliferării și migrației celulare, activarea răspunsului inflamator și creșterea producției de mucus. In cazul in care exista un proces exagerat de vindecare (EGFR crescut), atunci apare fibroza pulmonara.  In afara de procesele locale la nivelul plamanilor, functia respiratorie poate fi afectata de infectia COVID prin inducerea unui rapuns autoimun la nivelul centrilor de respiratie din creier, detectabila prin evaluarea COV-STOP oferita la EuVITA.

 

  • Aparatul cardiovascular este si el afectat de catre infectia COVID-19, uneori cu consecinte acute si/sau periculoase. Inima poate fi afectata de o miocardita autoimuna declansata de virusul SARS-2, care poate imbraca forma unei miocardite fulminante [1], sau se poate manifesta silentios si pe termen foarte lung.  In special la persoanele varstnice sau cu probleme cardiace pre-existente, miocardita autoimuna poate declasa o cardiomiopatie dilatata insotita de congestie cardiaca severa. Aceste afectari ale muschiului cardiac pot fi insotite si de fenomene tromboembolice, si aceste probleme post-COVID pot contribui semnificativ a aparitia unor situatii periculaose: infarct miocardic, tromboembolism pulmonar, accident vascular ischemic etc.  Evaluarea COV-STOP constata afectarea muschiului cardiac si ofera terapii-suport pentru reducerea inflamatiei cardiace si regenerarea (in timp) a muschiului cardiac. Aceste terapii sunt complementare tratamentelor alopate.

 

  • Infectia cu SARS-CoV-2 a alterat profilul imunitar intr-un numar semnificativ de cazuri, demonstrate prin aparitia unor afecțiuni autoimune sistemice, precum lupus eritematos sistemic, anemie hemolitica autoimuna, trombocitopenie autoimuna, sindrom Guillain-Barré, vasculita sau scleroza multipla, precum și unele afectiuni autoinflamatorii la copii, inclusiv boala Kawasaki. Mai multe simptome asociate bolilor autoimune sistemice pot aparea chiar in timpul infectiei si pot persista după controlul acesteia, precum oboseala, dureri articulare, sindrom uscaciune si mialgii.

 

  • Infectia COVID poate avea efecte majore si greu controlabile la nivelul sistemului nervos central si periferic, incepand cu simptomele evidente:  dureri de cap si anosmie, si teminand cu efectele severe: encefalopatie, atac cerebral, manifestari epileptice, neuropatii autoimune ale nervilor cranieni etc  sau sechele detectabile mult mai tarziu:  Parkinson, Alzheimer etc. Cca 2/3 din pacientii ventilati vor avea sechele cognitive si emotionale. Infectia cu SARS-CoV-2 poate fi implicata in aparitia bolilor neuromusculare severe de tipul  sindrom Guillain‐Barre, sindromul Miller Fisher, miastenia gravis, miopatii inflamatorii, miozita etc

 

  • Infectia SARS-2 afecteaza rinichii in cca 30% dintre persoanele infectate,  atat direct : legare directa de celule + furtuna de citokine, cat si indirect, prin consecintele slabei oxigenari si a unei eventuale vasculite sau micro-tromboze.

 

Noi venim in ajutorul pacientilor prin doua mijloace: eveluarea energetica functionala COV-STOP si suportul terapeutic personalizat aferent.

 

Evaluarea COV-STOP stabileste modul de raspuns individual la virus, adica reactivitatea personala si profilului imunitar prezent. Ea permite identificarea precoce a peste 12 tipuri de reactii autoimune (anticorpi predictivi, Vojdani, 2008). De asemenea ea  estimeaza incarcatura microbiana pre-existenta, in special cea virala, care poate induce forme severe de boala sau de sechele post-COVID prin reactivarea secundara a altor patogeni. Sunt evidentiate dezechilibrele nutritionale ce afecteaza imunitatea.

 

In urma evaluarii se propune un plan de tratament personalizat, compus din terapii energetice, ortomoleculare si fitoterapie, care permite re-echilibrarea sistemului imunitar si minimizarea efectelor infectiei prin: imunomodulatie,  terapii anti-fibroza pulmonara si cardiaca, terapii regenerare muschi cardiac, protectie renala (in caz de hematurie si/sau proteinurie)  etc.

 

 

 

 

 

 

 

 

 

REFERINTE:

 

[1]  “Recurrent autoimmune myocarditis in a young woman during the coronavirus disease 2019 pandemic” -

Raphael Caraffa, Renzo Marcolongo, Tomaso Bottio, Stefania Rizzo etc – https://onlinelibrary.wiley.com/doi/10.1002/ehf2.13028
[2] “Delayed acute myocarditis and COVID‐19‐related multisystem inflammatory syndrome”- Martin Nicol, Lea Cacoub, Mathilde Baudet, Yoram Nahmani, Patrice Cacoub – https://onlinelibrary.wiley.com/doi/full/10.1002/ehf2.13047
[3] “The triggering of post-COVID-19 autoimmunity phenomena could be associated with both transient immunosuppression and an inappropriate form of immune reconstitution in susceptible individuals” – Carlos A. Cañas – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7556280/
[4] “Neurological Manifestations of COVID‐19: A systematic review and current update”-  Abigail Whittaker, Matthew Anson, Amer Harky -  https://onlinelibrary.wiley.com/doi/full/10.1111/ane.13266
[5] “Highly Sensitive Test Detects MG in Patient After COVID-19 Diagnosis” – https://myastheniagravisnews.com/news-posts/2021/01/19/highly-sensitive-test-detects-mg-in-patient-after-covid-19-diagnosis/

[6] “COVID-19 and neuromuscular disorders”  – Amanda Guidon, Anthony Amato -

https://www.researchgate.net/publication/340621859_COVID-19_and_neuromuscular_disorders

 

[7] “Coronavirus: Kidney Damage Caused by COVID-19″  - C. John Sperati -

https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-kidney-damage-caused-by-covid19

 

[8] “Viral arthritis and COVID-19″ – Simone Parisi, Richard Borelli, Sabina Biachi, Enrico Fusaro -

https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(20)30348-9/fulltext

 

 

 

 

 

93 thoughts on “COVID-19

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