Prevalent symptoms and characteristics of the Long COVID-19 population: a scoping review

Prediger, Karina Marques; Ribeiro, Ana Cristina; Uehara, Sílvia Carla da Silva André

doi:10.1590/1518-8345.7353.4479

person Karina Marques Prediger

Substantial contributions to the conception or design of the work · or the acquisition, analysis, or interpretation of data for the work · drafting the work or reviewing it critically for important intellectual content · final approval of the version to be published and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved

schoolUniversidade Federal de São Carlos, Departamento de Enfermagem, São Carlos, SP, BrazilschoolScholarship holder at the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), Brazil

0000-0001-8323-3632

person Ana Cristina Ribeiro

Substantial contributions to the conception or design of the work · or the acquisition, analysis, or interpretation of data for the work · drafting the work or reviewing it critically for important intellectual content · final approval of the version to be published and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved

schoolUniversidade Federal de São Carlos, Departamento de Enfermagem, São Carlos, SP, Brazil

0000-0002-0493-8376

person Sílvia Carla da Silva André Uehara

Substantial contributions to the conception or design of the work · or the acquisition, analysis, or interpretation of data for the work · drafting the work or reviewing it critically for important intellectual content · final approval of the version to be published and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved · Data curation · Obtaining financing · Project supervision and management

schoolUniversidade Federal de São Carlos, Departamento de Enfermagem, São Carlos, SP, Brazil

0000-0002-0236-5025

emailE-mail: karinaprediger@estudante.ufscar.br

Conflict of interest:

the authors have declared that there is no conflict of interest.

Associate Editor:

Maria Lúcia Zanetti

Database	Search strategy
LILACS*	“Síndrome Pós-COVID-19^† Aguda” OR^‡ “Afecções Pós-COVID” OR “COVID Longa” OR “Sequela Pós-Infecção por SARS-CoV-2^§ Aguda” OR “Sequela Pós-Infecção por SARS-CoV-2 Aguda” OR “Post-Acute COVID-19 Syndrome” OR “Síndrome Post Agudo de COVID-19” OR “COVID de Longo Curso” AND^\|\| “Sintomas Clínicos” OR “Sinais e Sintomas” OR “Sinais Clínicos” OR “Signs and Symptoms” OR “Signos y Síntomas”.
PubMed ^¶	“Síndrome Pós-COVID-19 Aguda” OR “Afecções Pós-COVID” OR ” COVID Longa” OR “Sequela Pós-Infecção por SARS-CoV-2 Aguda” OR “Sequela Pós-Infecção por SARS-CoV-2 Aguda” OR “Post-Acute COVID-19 Syndrome” OR “Síndrome Post Agudo de COVID-19” OR “COVID de Longo Curso” NEAD/4^** “Sintomas Clínicos” OR “Sinais e Sintomas” OR “Sinais Clínicos” OR “Signs and Symptoms” OR “Signos y Síntomas”.
Scopus	“Síndrome Pós-COVID-19 Aguda” OR “Afecções Pós-COVID” OR ” COVID Longa” OR “Sequela Pós-Infecção por SARS-CoV-2 Aguda” OR “Sequela Pós-Infecção por SARS-CoV-2 Aguda” OR “Post-Acute COVID-19 Syndrome” OR “Síndrome Post Agudo de COVID-19” OR “COVID de Longo Curso” AND “Sintomas Clínicos” OR “Sinais e Sintomas” OR “Sinais Clínicos” OR “Signs and Symptoms” OR “Signos y Síntomas”.
Web of Science	“Síndrome Pós-COVID-19 Aguda” OR “Afecções Pós-COVID” OR “COVID Longa” OR “Sequela Pós-Infecção por SARS-CoV-2 Aguda” OR “Sequela Pós-Infecção por SARS-CoV-2 Aguda” OR “Post-Acute COVID-19 Syndrome” OR “Síndrome Post Agudo de COVID-19” OR “COVID de Longo Curso” AND “Sintomas Clínicos” OR “Sinais e Sintomas” OR “Sinais Clínicos” OR “Signs and Symptoms” OR “Signos y Síntomas”.

Author, year and country	Objective	Type of study and sample (n)	Main results
Eita AAB, 2021, United States of America(7)	Presenting a case of post-acute COVID-19 syndrome*, showing parostomia, dysgeusia and a white-coated fatty tongue with prominent papillae	Case study. n = 1.	After 14 days of COVID-19* infection, a 31-year-old female patient complained of dysgeusia; she had a greasy, unpleasant white tongue and a distorted sense of smell. The symptoms improved over four weeks with drug treatment and after viral elimination.
Judant EM, 2021, France(8)	To determine the characteristics of patients with respiratory complaints and the relationships between dyspnoea, radiological abnormalities and functional impairment	Cohort study. n = 478 (case) and n =177 (control).	Individuals hospitalised for COVID-19* were assessed by telephone consultation. The average age of the sample was 61 and 42.1 per cent were female. 4 months after the diagnosis of the viral infection, 78 people reported dyspnoea and 23 reported coughing. Compared to individuals without dyspnoea, those with dyspnoea were younger (56.1±12.3 versus 61.9±16.6 years, ^p†=0.001). Individuals with dyspnoea had more severe initial episodes of COVID-19, longer hospital stays [13 (7-23) versus* 8 (4-14) days, p<0.001] and more frequent admissions to the Intensive Care Unit (56.4 versus 24.5%, p<0.001).
Moreno-Perez O, 2021, Spain(9)	Analysing the incidence of post-acute COVID-19 syndrome* and its components and assessing the risk factors associated with the acute phase of infection	Cohort study. n = 277.	Individuals with COVID-19* were assessed 77 days after infection. The average age was 62 years and 52.7 per cent were male. Post-COVID-19* symptoms were detected in 50.9 per cent of patients. The most frequent symptoms were dyspnoea and fatigue. Anosmia-dysgeusia was associated with younger age (<65 years 24.9% (48/194) vs >65 years 13.5% (11/83). Relevant neurological symptoms (headache, memory disorders/cognitive deterioration or both) were present in 33 patients (11.9%). After multivariate adjustment, no baseline clinical characteristics, intensive care unit admission, length of hospital stay or treatment behaved as independent predictors of post-COVID-19 syndrome*.
Penetra SLS, 2021, Brazil(2022)	To describe a case of prolonged COVID-19* after SARS-CoV-2 Gamma infection one year after the first infection in a healthcare worker vaccinated with CoronaVac in Brazil	Case study. n = 1.	A 43-year-old male patient with no comorbidities. When infected with COVID-19, he presented with fever, headache, rhinorrhoea and dry cough; symptoms disappeared within 14 days. Nine months after infection, she received the first dose of the vaccine and 28 days after the second dose. 67 days after the second dose, he developed a new episode of the COVID-19 Gamma strain. At the time, he had the same symptoms; however, they persisted for 18 weeks after the acute infection with the exception of headache and blurred vision. Both infections did not require hospitalisation.
Tleyjeh IM, 2021, Saudi Arabia(11)	To evaluate the frequency of new or persistent symptoms in COVID-19* patients after hospital discharge and identify associated risk factors	Cohort study. n = 222.	Follow-up telephone interviews were conducted with individuals with COVID-19* after a median of 122 days after hospital discharge. The majority of patients were men (77%) with a mean age of 52.47 (± 13.95) years. The time to diagnosis of post-COVID-19* symptoms ranged from 21 days to 4 months after discharge. 56.3 per cent of patients complained of symptoms persisting; 66 (29.7 per cent) experienced them for >21 days and 64 (28.8 per cent) reported not having returned to their initial health. Shortness of breath (40.1%), cough (27.5%) and fatigue (29.7%) were the most frequently reported symptoms. After multivariate adjustments, female gender, pre-existing hypertension and length of hospital stay were associated with an increased risk of new or persistent symptoms. Age, pre-existing lung disease and emergency room visits increased the likelihood of not recovering completely from acute COVID-19*.
Tohamy D, 2021, Egypt(12)	Evaluating the ocular manifestations of post-acute COVID-19 syndrome*	Cohort study. n = 100 (case) and n = 100 (control).	The time to diagnosis of post-COVID-19* conditions ranged from 1 to 3 months. The individuals in the sample had no history of COVID-19* vaccination. The average age was 55.5 years in the COVID group versus 56.5 years in the control group. In the COVID group, 57 per cent of the patients were male versus 51 per cent in the control group. In the COVID group, 5 patients had retinal vascular occlusion, 2 patients had anterior ischaemic optic neuropathy, 3 patients had uveitis and 2 patients had central serous chorioretinopathy. In the control group, 2 patients had retinal vascular occlusion and none had uveitis or central serous chorioretinopathy.
Carter SJ, 2022, United States of America(13)	To describe the concomitant effects of SARS-CoV-2 infection on functional status, mood and leisure-time physical activity in post-acute COVID-19 syndrome*	Case-control study. n =17 (case) and n =15 (control).	The diagnosis time for post-COVID-19* conditions was approximately 4 weeks. 32 women were included, 17 diagnosed with COVID-19* and 15 controls. Diastolic blood pressure (p = 0.031, ES = 0.80) and RPP^‡ (p = 0.039, ES = 0.75) were significantly higher among participants in the COVID-19* group. In the COVID-19* group, the following symptoms were observed: 41 per cent with joint/muscle pain for around 300 days, 53% with cough over the same period; 29 per cent with fatigue, 12 per cent with cognitive impairment and 71 per cent with loss of taste/smell over a period of approximately 100 days, as well as 35 per cent with shortness of breath.
Fanous J, 2022, London(14)	To objectively assess neuromuscular fatigability concomitant with fatigue and cognitive dysfunction related to COVID-19* 12 months after infection	Case study. n = 1.	The diagnosis time for the post-COVID-19* conditions was around 12 months. A 27-year-old male patient with ongoing post-COVID-19* complaints of fatigue and cognitive dysfunction, anosmia and ageusia, severe mental confusion, loss of appetite and insomnia for more than a year after infection.
Jamoulle M, 2022, Belgium(1)	To provide a qualitative and quantitative description of the state of health of patients with Post-Acute COVID-19 Syndrome*.	Cohort study. n = 55.	The time to diagnosis of post-COVID-19* conditions ranged from 3 to 27 months. 12% of the sample population had not been vaccinated during the study period. Among the patients, 72.7 per cent were women, aged between 12 and 79 years. After one year of follow-up, three types of clinical evolution can be distinguished from the onset of acute COVID-19* in 52 of the 55 patients: Grade 1 (mild) - duration of 3 to 8 months, respiratory impairment, fatigue, sternal pain and exhaustion on exertion (9 women and 7 men); Grade 2 (severe) - duration of 6 to 18 months, extreme fatigue, exhaustion on exertion, anosmia, cognitive disturbance, mnesic disturbance (12 women and 3 men); Grade 3 (very severe) - lasting from 12 to 27 months, constant exhaustion, impossible efforts, useless cognitive revalidation, hypersomnia, weight gain due to inactivity, severe and persistent memory disturbances and considerable anxiety. Other variable symptoms include brain fog with memory impairment and word retrieval deficit, dyspnoea on exertion and incapacitating state.
Kim Y, 2022, South Korea(15)	To identify prevalent symptoms after 12 months of COVID-19 infection* in recovered patients, factors associated with neurological symptoms and the long-term impact of COVID-19 on quality of life	Cohort study. n = 900 (case) and n = 241 (control)	The time taken to diagnose post-COVID-19* conditions ranged from 6 to 12 months. The average age of respondents was 37 years and 164 were women. Symptoms persisting for more than 12 months were higher in those classified as moderate or greater disease severity during acute COVID-19* infection. The most frequent symptom lasting up to 12 months was difficulty concentrating, observed in 54 people, followed by cognitive dysfunction (51), amnesia (48), depression (43) and fatigue and anxiety (39). Among the persistent symptoms related to COVID-19*, psychiatric problems had a greater impact on quality of life than any other symptoms. Older age, female gender and disease severity were identified as risk factors for persistent neuropsychiatric symptoms.
Liu Q, 2022, China(16)	To investigate whether the composition of the intestinal microbiota is linked to post-acute syndrome	Cohort study. n = 106 (case) and n = 68 (control)	The time to diagnosis of post-COVID-19* conditions ranged from 3 to 6 months. Patients with COVID-19* exacerbations were followed up from admission to six months. The average age of the COVID group was 48.3 years and 52.9 per cent were female. The following comorbidities were found: 17% hypertensive and 15.1% with diabetes mellitus. 81.1% of patients reported post-acute COVID-19 syndrome* within 3 months. The most common symptoms were: fatigue (31.3%), poor memory (28.3%), hair loss (21.7%), anxiety (20.8%) and difficulty sleeping (20.8%). There were no significant differences in age, gender, comorbidities, medication use and COVID-19* severity in patients with or without COVID-19* post-acute syndrome.
Mazzitelli M, 2022, Italy(17)	To assess the prevalence and factors associated with severe COVID-19* and post-acute COVID-19* syndrome	Cohort study. n = 123.	The diagnosis time for post-COVID-19* conditions was 6 months. Patients diagnosed with HIV^§ and concomitantly with COVID-19* were analysed. Of these, 79.7 per cent were male, 77.2 per cent were Caucasian and the average age was 51 years. None of the patients had been vaccinated for COVID-19. Regarding comorbidities: 30.9 per cent were hypertensive, 17.9 per cent diabetic and 15.4 per cent were overweight/obese; among the 75 patients who had symptomatic COVID-19 infection and survived, 26.7 per cent reported post-acute COVID-19* syndrome. As for symptoms: 80% reported asthenia; 50% exertion-related shortness of breath; 25% recurrent headache; 15% significant hair loss; 10% loss of sense of smell; 0.5% chronic diarrhoea; and 2 patients reported cardiovascular complications (acute myocardial infarction and rhythm changes).
Zachariou A, 2022, Greece(18)	To evaluate the consequences on bladder function in patients with post-acute COVID-19 syndrome* transferred to long-term care inpatient rehabilitation after initial treatment for COVID-19 pathophysiology*	Descriptive study. n = 147.	The time to diagnosis of post-COVID-19* conditions ranged from 4 to 7 weeks. A study of patients with post-COVID-19 syndrome* referred to the rehabilitation centre for long-term care. Of these, only 106 agreed to take part in the study, 45 (43.4%) female and 60 (56.6%) male. The average age of the patients was 59.5. We identified 75 patients with symptoms associated with overactive bladder (OAB) between 4 and 7 weeks after presenting COVID-19*. Of these, 9 patients refused to answer the questionnaires; 44 patients had newly diagnosed overactive bladder and 22 patients had worsening symptoms of overactive bladder. All the patients complained of nocturia.

[1] *LILACS = Latin American and Caribbean Health Sciences Literature;^†Post-COVID-19 = Post Corona Virus Disease 2019;^‡OR = Or; ^§SARS-CoV-2 = Severe Acute Respiratory Syndrome Coronavirus 2; ^||AND = E; ^¶PubMed = Public MedLars; **NEAD/4 = Proximity in up to 4 terms

Prevalent symptoms and characteristics of the Long COVID-19 population: a scoping review^*

Highlights:

Prevalent symptoms and characteristics of the Long COVID-19 population: a scoping review*

Highlights:

Prevalent symptoms and characteristics of the Long COVID-19 population: a scoping review^*