Differentials
Your Organizational Guidance
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Opvolging en revalidatie van patiënten met aanhoudende klachten na COVID-19 in de eerste lijnPublished by: KU Leuven | Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2023Suivi et revalidation des patients présentant des symptômes persistants après la COVID-19 en première lignePublished by: KU Leuven | Groupe de Travail Développement de recommmandations de première ligneLast published: 2023Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)
SIGNS / SYMPTOMS
There is substantial overlap between ME/CFS and long COVID. There are diagnostic criteria for ME/CFS (noting that many individuals with long COVID fulfill these criteria).[99]
The DePaul symptom questionnaire is a checklist of 54 items that provides a thorough evaluation and grading of patient complaints. DePaul Symptom Questionnaire Opens in new window
Overall, long COVID is an umbrella term that likely includes individuals with ME/CFS.
INVESTIGATIONS
There are specific diagnostic criteria that exist for ME/CFS that many individuals with long COVID meet.[100]
Post-intensive care syndrome
SIGNS / SYMPTOMS
Post-intensive care syndrome is common and should be suspected in individuals who were previously hospitalized, particularly in the intensive care unit.[101][102][103][104][105][106]
Overall, long COVID is an umbrella term that includes individuals with post-intensive care syndrome.
INVESTIGATIONS
Imaging or laboratory findings consistent with pulmonary fibrosis, organizing pneumonia, or other end-organ dysfunction would be more consistent with ongoing symptoms being due to the patient’s initial severe, critical illness.
Postural orthostatic tachycardia syndrome (POTS)
SIGNS / SYMPTOMS
Individuals with POTS have an increase in heart rate of 30 beats per minute or more (or over 120 beats per minute) within the first 10 minutes of standing, in the absence of orthostatic hypotension.[107]
Overall, long COVID is an umbrella term that likely includes individuals with POTS.[87]
INVESTIGATIONS
24-hour Holter monitor may demonstrate an association between tachycardia and orthostatic changes.
Mast cell activation syndrome (MCAS)
SIGNS / SYMPTOMS
Diagnostic criteria for MCAS includes the involvement of two or more organ systems, evidence of systemic mast cell-mediator release (typically serum tryptase), and response to drugs that stabilize mast cells.[108]
INVESTIGATIONS
Elevated acute tryptase level of at least 20% above baseline +2 ng/mL (1.2 x baseline +2). Tryptase must return to the patient’s baseline level once symptoms resolve.
Elevated urinary metabolites of histamine and/or prostaglandin D2 and/or leukotriene C4 (LTC4). Specific cut-off levels have not been established.
Arrhythmias and/or potential ST changes on 12-lead ECG.
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