Descriptive and Narrative Study of Long Covid Cases in General Practice and Diagnostic Value of Single Photon Emission Computed Tomography (SPECT scan)

  1. Marc Jamoulle
  2. Gisèle Kazeneza-Mugisha
  3. Ayoub Zayane

Reviewed by

Read the full article See related articles

Listed in

Log in to save this article

Abstract

Primary care is under great pressure from patients with Covid -19 and those affected by Long Covid. The issue of Long Covid, its diagnosis and therapeutic approach are discussed here in detail. The Long Covid is described on the basis of a review of the literature and also on the basis of clinical experience in general practice. The main characteristics of thirty four cases (twenty five women) of Long Covid encountered in 2021 and early 2022 are outlined. The experience of six of them is reported on the basis of notes from their medical records. These six patients were interviewed and each was asked to reread and correct the texts concerning them. This is therefore a descriptive study based on clinical and narrative experience, verified by the patients.

Long Covid, the first disease in the history of medicine to be described first by patients themselves on social networks, is not yet precisely defined and the multi -systemic symptoms may be non-specific or vary according to the organs affected.

Diagnosis is based on careful listening to the patient’s history. Previously unknown irrepressible fatigue, brain fog, working memory disorders with possible anomia, anosmia, dysgeusia or other muli-systemic symptoms occurring after an acute Covid are varying characteristics of Long Covid. Biological evidence of Covid is missing in fourteen patients as PCRs may have been not done or came back negative in the acute phase of the disease. Anti-SARS-CoV-2 antibodies are not always present or are indistinguishable from post-vaccine antibodies. In fourteen severe cases presented, Single Photon Emission Computed Tomography (SPECT scan) after intravenous administration of Technetium-99m (Tc-99m HM-PAO) were able to demonstrate a disorder of cerebral perfusion. Two follow -up brain SPECT at three months showed significant improvement. Further genetic and immunologic study is ongoing for all patient with the help of the international consortium COVID Human Genetic Effort. A patient who presents after a Covid with medically unexplained symptoms may well be a Long Covid. Despite some interesting hypothesis, there is no known specific treatment. Neurocognitive revalidation and physiotherapy may help those patients who need long -term empathic support to cope with their condition.

Key messages

  • □

    Long Covid is a recent onset, multi-systemic, long-term condition that can be very debilitating.

  • □

    The main symptoms are severe fatigue, exertional exhaustion, and cognitive and memory problems, among others.

  • □

    Patients who suffer from it may not realize it, may not talk about it, or may attribute their problem to other causes.

  • □

    Single Photon Emission Computed Tomography (SPECT CT) contributes to the hypothesis of a vascular perfusion disorder induced by SARS -coV-2 and should be validated as a diagnostic tool in neurological Long Covid.

  • □

    Tissue immunity should be available to prove Long Covid in case of humoral seronegativity

  • □

    There is no identified treatment that can be recommended yet. Careful listening, empathic support and cognitive and physical rehabilitation are suggested and should be organised or supported by the Belgian state.

    • Article activity feed

    1. ScreenIT

      SciScore for 10.1101/2022.03.01.22270897: (What is this?)

      Please note, not all rigor criteria are appropriate for all manuscripts.

      Table 1: Rigor

      EthicsConsent: Each patient interviewed gave formal written consent to use their data and to publish their story under a pseudonym.
      IRB: The ethics committee of the University Hospital of Liège, Belgium, gave its full approval to this study under the number 2022/23. 2.7 Bibliographic follow-up: In parallel with the clinical follow-up, a bibliographic watch on PubMed and Google Scholar on the subject of Long Covid allowed us to address the complexity of this new situation.
      Sex as a biological variablenot detected.
      Randomizationnot detected.
      Blindingnot detected.
      Power Analysisnot detected.

      Table 2: Resources

      Software and Algorithms
      SentencesResources
      The ethics committee of the University Hospital of Liège, Belgium, gave its full approval to this study under the number 2022/23. 2.7 Bibliographic follow-up: In parallel with the clinical follow-up, a bibliographic watch on PubMed and Google Scholar on the subject of Long Covid allowed us to address the complexity of this new situation.
      Google Scholar
      suggested: (Google Scholar, RRID:SCR_008878)
      The following MeSH descriptors “post-acute Covid-19 syndrome” [Supplementary Concept] OR “Long Covid” [TW] were incorporated into the PubMed alert system.
      MeSH
      suggested: (MeSH, RRID:SCR_004750)
      PubMed
      suggested: (PubMed, RRID:SCR_004846)

      Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

      Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

      Results from TrialIdentifier: No clinical trial numbers were referenced.

      Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

      Results from JetFighter: We did not find any issues relating to colormaps.

      Results from rtransparent:
      • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
      • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
      • No protocol registration statement was detected.

      Results from scite Reference Check: We found no unreliable references.

      About SciScore

      SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

    2. Version published to 10.1101/2022.03.01.22270897v1 on medRxiv