THE EMERGENCE OF FIBROMYALGIA FOLLOWING ACUTE COVID-19 INFECTION

BackgroundThe exact pathogenesis of fibromyalgia (FM) syndrome is unclear. However, different infections including hepatitis C virus, Human immunodeficiency virus and Lyme disease have already been implicated with the development of FM after their acute phase[1]. Imbalance between pro-inflammatory and anti-inflammatory cytokines has been suggested as a possible mechanism that facilitates the neuropathic pain[2].ObjectivesTo investigate the incidence of FM syndrome among convalesced individuals following hospitalization for Acute Coronavirus Disease-2019 (COVID-19) and to identify possible risk factors.MethodsWe performed a cross-sectional study on patients who were discharged after COVID-19 hospitalization from the Sheba Medical Center, Israel, between July 2020 to November 2020. A phone interview was performed consisting of the following questionnaires: the Fibromyalgia Survey Diagnostic Criteria Questionnaire, Sense of Coherence Questionnaire to evaluate resilience, and the Subjective Traumatic Outlook Questionnaire to assess the associated psychological aspects of the trauma. The incidence of post-COVID FM was calculated and regression models were performed to identify predictors.ResultsThe study population consisted of 198 eligible patients who completed the phone interview. The median age was 64 (52-72) and 37% were women. The median follow-up was 5.2 months (IQR 4.4-5.8). The incidence of FM was 15% (30 patients) and 87% (172 patients) had at least one FM-related symptom. Female gender was significantly associated with post-COVID FM (OR 3.65, p=0.002). In addition, high median Subjective Traumatic Outlook scores and low median Sense of Coherence scores were both significantly associated with post-COVID FM (OR 1.19, p<0.001 and OR 0.92, p<0.001, respectively).ConclusionFM is highly prevalent among COVID-19 convalescent patients. Our finding suggests that a significant subjective traumatic experience and a low resilience are highly associated with post-COVID FM.References[1]Buskila D, Atzeni F, Sarzi-Puttini P. Etiology of fibromyalgia: the possible role of infection and vaccination. Autoimmun Rev. 2008;8: 41-43. https://doi.org/10.1016/j.autrev.2008.07.023[2]Amital M, Ben-Shabat N, Amital H, Buskila D, Cohen AD, Amital D. COVID-19 associated hospitalization in 571 patients with fibromyalgia—A population-based study. PLoS ONE. 2021:16: e0261772. https://doi.org/10.1371/journal.pone.0261772Acknowledgements:NIL.Disclosure of InterestsNone Declared.

Keeping patients safe from summertime illnesses

"5 However, more recent findings, such as the presentation of joint swelling without EM in Black children, are the result of research efforts to identify differences among racial and ethnic groups in presentations of disease symptoms, with the aim of greater diagnostic accuracy and reduced health care disparities.4 Treatment of Lyme disease Although most resources, such as the CDC's website,1 published articles and sites,2,3 and the Red Book,5 recommend that pediatric, adolescent, and young adult patients with Lyme disease receive an antibiotic, such as doxycycline, amoxicillin, or cefuroxime (for penicillin-allergic patients), these publications differ in recommended dosage and duration of treatment. [...]PHCPs who are unfamiliar with antibiotic treatments for Lyme disease should consult with infectious disease specialists. Children who have evidence of Lyme carditis, Lyme arthritis, cranial neuritis, Lyme meningitis, or radiculoneuritis should immediately be referred to infectious disease and the appropriate pediatric specialists.2 Respiratory infections and health care inequities Although researchers have reported studies on racial and ethnic inequities among children related to respiratory diseases over the last 20 years, few randomized controlled trials have scientifically investigated the problem or have identified and rigorously investigated evidencebased interventions. The COVID-19 pandemic brought a new focus in pediatric health care on the inequities experienced by Black, Hispanic, American Indian or Alaska Native, and Pacific Islander children living in poverty, who regularly experience a disproportionate number of respirator y illnesses and infections.6 Several studies have shown increased hospitalization rates for Blac k and H ispan ic children who contracted COVID-19.6 One team of researchers studying children from birth to 4 years old reported a hospitalization rate of 55% for Black and Hispanic children.7 For years, PHCPs have observed and treated children for asthma in all health care settings. Bhavnani et al reported that Black children had a 7-fold higher rate of emergency department visits compared with White children in 2019, 1 year before the pandemic began.8 However, the difference decreased to a 2-fold increase for Black children compared with White children in 2020, when COVID-19 measures such as masking, social distancing, and school closures were in place.8 Researchers are continuing to investigate why Black and Hispanic children are more vulnerable to upper respiratory infections with viruses such as influenza, rhinovirus, and adenovirus.8 Summertime prevention of respiratory infections Talking about prevention strategies with families is the first step toward reducing asthma episodes and exacerbations.

Corona With Lyme: A Long COVID Case Study.

The longevity of the coronavirus disease 2019 (COVID-19) pandemic has necessitated continued discussion about the long-term impacts of SARS-CoV-2 infection. Many who develop an acute COVID-19 infection will later face a constellation of enduring symptoms of varying severity, otherwise known as long COVID. As the pandemic reaches its inevitable endemicity, the long COVID patient population will undoubtedly grow and require improved recognition and management. The case presented describes the three-year arc of a previously healthy 26-year-old female medical student from initial infection and induction of long COVID symptomology to near-total remission of the disease. In doing so, the course of this unique post-viral illness and the trials and errors of myriad treatment options will be chronologized, thereby contributing to the continued demand for understanding this mystifying disease.

Loss of Bifidobacteria in Lyme Disease: Cause or Effect

Introduction: Lyme disease is a poorly understood condition which starts with a rash but may continue with chronic fatigue and neurological symptoms. Approximately 1 in 5 early Lyme disease patients have GI symptoms, such as nausea, anorexia, abdominal pain, or diarrhea. Lyme disease is thought to be cased by microbes in the spirochetes phylum transmitted by black legged ticks. Lyme-related healthcare costs in America exceed 1.3 billion dollars annually. Bifidobacteria are known for their beneficial probiotic actions within the human gut microbiome. Their numbers are reduced in severe COVID-19, Clostridioides difficile infection and Inflammatory Bowel Disease. To our knowledge Bifidobacteria levels have not been studied in Lyme disease patients. Given the importance of Bifidobacterium abundance in other diseases, we focused on relative abundance of Bifidobacterium in fecal samples of patients with Lyme disease compared to controls. Method(s): Fecal samples were assessed for relative abundance of Bifidobacterium in Healthy Control subjects without Lyme disease (n=20) compared to patients with Lyme disease (n=39). The average symptom duration in patients with Lyme disease was 5 years and none were on antibiotics 2 weeks prior to sample collection (range of symptoms from 1 month to 20 years, all treated initially with antibiotics).Metagenomics Next Generation sequencing was performed on fecal samples, where DNA samples were extracted and normalized for library downstream analysis using Shotgun Methodology. Mann- Whitney Statistical test was used for comparison. This study was IRB approved. Result(s): Relative Abundance of bifidobacteria was significantly decreased (p< 0.0001) in patients with Lyme disease. Median and interquartile range (IQR) were: Control (Median:4.175%;IQR:1.72-10.27%) and Lyme disease (Median:0.0014%;IQR:0.00%-0.96%)(Figure). 30/39 Lyme disease patients (77%) were found to possess < 1% relative abundance of Bifidobacterium in their stool sample. Of interest only 1/39 samples showed presence of Spirochetes in stool samples. Conclusion(s): This is the first study that demonstrates low levels of Bifidobacteria in patients with chronic Lyme disease. These results raise three questions;whether the disease was caused by 1. the original microbe creating loss of Bifidobacterium 2. baseline low Bifidobacteria due likely to either diet or medications or 3. excessive treatment. Given Lyme disease comprises a gut dysbiosis issue, therapies should also aim at restoration of depleted Bifidobacteria. (Figure Presented).

Hepatotoxicity From Marijuana Gummies

Introduction: We report a case of drug-induced liver injury (DILI) induced by cannabis gummies containing Corydalis Rhizome. Case Description/Methods: A 37-year-old female presented to her primary care clinic with recurrent fevers, night sweats, and myalgias for 7 weeks accompanied by eye redness, brain fog, headache, nausea, and abdominal pain. She denied rashes, tick-bites, cough, dyspnea, chest pain, joint swelling, or genitourinary symptoms. Past medical history was notable for IBS, migraines, and anxiety. She reported edible marijuana use four times a week, rare alcohol use, and denied tobacco use. She denied a family history of liver disease. Physical exam was notable for tachycardia to 110 and scleral injection with the remainder of vitals and exam unremarkable. Initial labs were notable for AST 61, ALT 44 and CRP of 12. CBC, BMP, urinalysis, ESR, blood cultures, blood smear for parasite screen, tests for Lyme disease, Babesia, Tularemia, Anaplasma, Ehrlichia, Rickettsia, EBV, HIV, RPR, ANA, CMV, parvovirus B19, and chest x-ray were all negative. The patient was referred to infectious disease with further testing for West Nile, Leptospira, lymphocytic choriomeningitis virus, and COVID-19 returning negative. Repeat LFTs showed worsening transaminitis with ALT 979 and AST 712, alkaline phosphatase 88, total bilirubin 0.7, and albumin 4.9. Hepatitis workup including hepatitis A, B, and C, HSV, EBV, VZV serologies, AMA, ASMA, antiLKM Ab, acetaminophen level, INR, iron panel, CPK, TSH, and abdominal ultrasound were all normal. It was later discovered that her marijuana gummies contained Corydalis rhizome extract known to be hepatotoxic. Cessation of this drug was strongly advised. She was discharged with hepatology follow-up and underwent a liver biopsy showing patchy periportal and lobular inflammation with extension across the limiting plate, hepatocyte injury and apoptosis, and increased lipofuscin for age compatible with mild to moderate hepatitis. She had complete recovery after cessation of Corydalis-containing gummies. (Figure) Discussion: Our patient consumed '1906 Midnight', an American cannabis brand containing Corydalis rhizopus 100 mg, advertised to improve sleep, pain, and have a liver protective effect. A Korean systematic review on herbal-induced liver injury reported that Corydalis was the 3rd most frequent causative herb, with 36 cases. Although there are several personal accounts on social networking sites and other websites, there are no American-based publications reported on DILI from Corydalis. (Table Presented).

To the 100th Anniversary of the Birth of Academician V.A. Nasonova. Infections and Rheumatic Diseases: From the Past to the Future

In rheumatology, the problem of infectious pathology is quite acute. This is primarily due to the participation of various infectious agents in the development of immuno-inflammatory rheumatic diseases (IIRD), in which microorganisms play a trigger role, triggering the immunopathological mechanisms of inflammation. Vivid examples of such diseases are acute rheumatic fever and reactive arthritis. The infectious etiology of Lyme disease has been proven. An equally difficult task is the fight against comorbid infection (CI), which often complicates the course of many IIRD due to a violation of the immune status caused by both the background disease and the use of immunosuppressive drugs. The predominance of respiratory tract lesions in the structure of CI in patients with IIRD makes it necessary to use influenza and pneumococcal vaccines in them, since the risk of deaths from these infections among these patients is quite high. During the development of the COVID-19 pandemic, which has become a challenge to all mankind, a large number of new fundamental and medical problems have been revealed concerning the relationship between viral infection and many widespread chronic non-communicable diseases, among which IIRDs occupy an important position. As one of the methods of combating the current COVID-19 pandemic, great hopes are pinned on the widespread use of vaccination. The possibility of using monoclonal antibodies for pre-exposure prophylaxis of COVID-19, including in patients with IIRD, is discussed.Copyright © 2023 Ima-Press Publishing House. All rights reserved.

The Troublesome Ticks Research Protocol: Developing a Comprehensive, Multidiscipline Research Plan for Investigating Human Tick-Associated Disease in Australia.

In Australia, there is a paucity of data about the extent and impact of zoonotic tick-related illnesses. Even less is understood about a multifaceted illness referred to as Debilitating Symptom Complexes Attributed to Ticks (DSCATT). Here, we describe a research plan for investigating the aetiology, pathophysiology, and clinical outcomes of human tick-associated disease in Australia. Our approach focuses on the transmission of potential pathogens and the immunological responses of the patient after a tick bite. The protocol is strengthened by prospective data collection, the recruitment of two external matched control groups, and sophisticated integrative data analysis which, collectively, will allow the robust demonstration of associations between a tick bite and the development of clinical and pathological abnormalities. Various laboratory analyses are performed including metagenomics to investigate the potential transmission of bacteria, protozoa and/or viruses during tick bite. In addition, multi-omics technology is applied to investigate links between host immune responses and potential infectious and non-infectious disease causations. Psychometric profiling is also used to investigate whether psychological attributes influence symptom development. This research will fill important knowledge gaps about tick-borne diseases. Ultimately, we hope the results will promote improved diagnostic outcomes, and inform the safe management and treatment of patients bitten by ticks in Australia.

Difficulties of differential diagnosis of polyneuropathy developed after Gam-COVID-Vac vaccination on the background of combined infectious pathology (clinical case).

The clinical case describes the difficulties of differential diagnosis of polyneuropathy that developed, after Gam-Covid-Vac vaccination on the background, of combined, infectious pathology (HIV infection, tick-borne borreliosis, COVID-19) in a young woman. It is shown that various infectious and noninfectious diseases with similar clinical symptoms (peripheral nervous system, affliction.) occurring simultaneously in one patient can significantly affect each other's course and. complicate the establishment of the true cause of polyneuropathy. It should, be noted, that in this example, the establishment of a final diagnosis was carried out collectively, by consensus, and. was based, on the effectiveness of etiotropic (antibacterial) treatment, which in fact was an exjuvantibus therapy option, which made it possible to establish the most probable etiology of polyneuropathy -tick-borne borreliosis. In turn, HIV infection and. possibly vaccination, according to the authors, could, cause immunosuppression, which, affected, the degree of dissemination, of Borrelia burgdorferi. It is also likely that the insufficient immune response in combination. with the cascade plasma filtration session affected the initial dubious results of the serological tests, which further complicated. the diagnosis.Copyright © 2022 Authors. All rights reserved.

Cerebellar syndrome as a complication of COVID-19 disease

COVID-19 disease is caused by the new coronavirus SARS-CoV-2. The disease first appeared in China in 2019 and quickly spread throughout the world. It primarily affects the respiratory tract, manifested by fever, cough and the devel-opment of dyspnoea, but the symptoms and complications can affect any organ system. Neurological symptoms include headaches, muscle and joint pain, taste and smell disorders. Complications include inflammatory diseases of the central nervous system, ataxia, peripheral nerve and muscle diseases, worsening of extra-pyramidal diseases, and neuropsychiatric disorders. This paper presents a case report of a 62-year-old man with cere bellar syndrome, ataxia, intentional tremor and hypermetria when dealing with COVID-19 disease.Copyright © 2021 Neuroendocrinology Letters.

Reactive Arthritis

Reactive arthritis develops as a sequela of a remote infection, usually of the gastrointestinal or genitourinary tract. The presence of acute arthritis and absence of specific diagnostic test markers can lead to misdiagnosis. Prompt recognition and proper management prevent reactive arthritis from progressing to a chronic destructive arthritis. The nurse practitioner's familiarity with reactive arthritis, signs and symptoms, diagnostic criteria, and treatment regimen promote early intervention for achieving the best outcomes, including remission.

Redox Imbalance and Its Metabolic Consequences in Tick-Borne Diseases.

One of the growing global health problems are vector-borne diseases, including tick-borne diseases. The most common tick-borne diseases include Lyme disease, tick-borne encephalitis, human granulocytic anaplasmosis, and babesiosis. Taking into account the metabolic effects in the patient's body, tick-borne diseases are a significant problem from an epidemiological and clinical point of view. Inflammation and oxidative stress are key elements in the pathogenesis of infectious diseases, including tick-borne diseases. In consequence, this leads to oxidative modifications of the structure and function of phospholipids and proteins and results in qualitative and quantitative changes at the level of lipid mediators arising in both reactive oxygen species (ROS) and ROS enzyme-dependent reactions. These types of metabolic modifications affect the functioning of the cells and the host organism. Therefore, links between the severity of the disease state and redox imbalance and the level of phospholipid metabolites are being searched, hoping to find unambiguous diagnostic biomarkers. Assessment of molecular effects of oxidative stress may also enable the monitoring of the disease process and treatment efficacy.

Difficulties of differential diagnosis of polyneuropathy developed after Gam-COVID-Vac vaccination on the background of combined infectious pathology (clinical case).

The clinical case describes the difficulties of differential diagnosis of polyneuropathy that developed, after Gam-Covid-Vac vaccination on the background, of combined, infectious pathology (HIV infection, tick-borne borreliosis, COVID-19) in a young woman. It is shown that various infectious and noninfectious diseases with similar clinical symptoms (peripheral nervous system, affliction.) occurring simultaneously in one patient can significantly affect each other's course and. complicate the establishment of the true cause of polyneuropathy. It should, be noted, that in this example, the establishment of a final diagnosis was carried out collectively, by consensus, and. was based, on the effectiveness of etiotropic (antibacterial) treatment, which in fact was an exjuvantibus therapy option, which made it possible to establish the most probable etiology of polyneuropathy -tick-borne borreliosis. In turn, HIV infection and. possibly vaccination, according to the authors, could, cause immunosuppression, which, affected, the degree of dissemination, of Borrelia burgdorferi. It is also likely that the insufficient immune response in combination. with the cascade plasma filtration session affected the initial dubious results of the serological tests, which further complicated. the diagnosis.Copyright © 2022 Authors. All rights reserved.

Difficulties of differential diagnosis of polyneuropathy developed after Gam-COVID-Vac vaccination on the background of combined infectious pathology (clinical case).

The clinical case describes the difficulties of differential diagnosis of polyneuropathy that developed, after Gam-Covid-Vac vaccination on the background, of combined, infectious pathology (HIV infection, tick-borne borreliosis, COVID-19) in a young woman. It is shown that various infectious and noninfectious diseases with similar clinical symptoms (peripheral nervous system, affliction.) occurring simultaneously in one patient can significantly affect each other's course and. complicate the establishment of the true cause of polyneuropathy. It should, be noted, that in this example, the establishment of a final diagnosis was carried out collectively, by consensus, and. was based, on the effectiveness of etiotropic (antibacterial) treatment, which in fact was an exjuvantibus therapy option, which made it possible to establish the most probable etiology of polyneuropathy -tick-borne borreliosis. In turn, HIV infection and. possibly vaccination, according to the authors, could, cause immunosuppression, which, affected, the degree of dissemination, of Borrelia burgdorferi. It is also likely that the insufficient immune response in combination. with the cascade plasma filtration session affected the initial dubious results of the serological tests, which further complicated. the diagnosis.Copyright © 2022 Authors. All rights reserved.

Historical perspectives, including chronic fatigue syndrome/Myalgic Encephalomyelitis and Fibromyalgia

The illnesses that most resemble long-COVID syndrome are Chronic Fatigue Syndrome (CFS)/Myalgic Encephalomyelitis (ME) and fibromyalgia. This chapter describes the similar symptoms of these conditions to long-COVID syndrome. It discusses what is termed chronic Lyme disease, or post-treatment Lyme disease syndrome, as an example of an analogous, unexplained syndrome following an infection. CFS/ME are diagnostic labels used to describe a syndrome characterized by chronic fatigue, post-exertional malaise, muscle pain, and cognitive disturbances often attributed to a possible infection but without a defined cause or pathology. Fibromyalgia, like CFS/ME, has been around for centuries in various guises. Abnormalities of the central and autonomic nervous system are prominent in fibromyalgia and CFS/ME. CFS/ME and fibromyalgia are sometimes referred to as functional, somatic syndromes. Patients with CFS/ME and fibromyalgia often express frustration with medical professionals' approach to their illness. © 2023 John Wiley & Sons Ltd. All rights reserved.

Consequences of Contracting COVID-19 or Taking the COVID-19 Vaccine for Individuals with a History of Lyme Disease.

Individuals with Lyme disease can be very symptomatic. This survey compares the burden of illness for individuals with a history of Lyme disease (HLD) with individuals with a HLD who have either contracted COVID-19 or who have taken the COVID-19 vaccine. The findings describe the relative symptom burden among these three groups using a cross-sectional descriptive survey investigating the burden of Lyme disease in a pandemic. The survey includes the General Symptom Questionnaire-30 (GSQ-30), a brief self-report scale designed to assess the symptom burden in Lyme disease (LD). The results of this survey show that the overall burden of illness among individuals with HLD is not significantly different after contracting COVID-19 or after COVID-19 vaccination. A new survey will be needed to better understand why one in five individuals with a HLD reported long COVID after contracting COVID-19. These results should help clinicians and their patients to discuss the consequences of contracting a COVID-19 infection or being vaccinated against COVID-19.

A Practical Ambulatory Approach to Atrioventricular Block Secondary to Lyme Carditis.

Lyme carditis (LC) is a potentially reversible cause of complete atrioventricular (AV) dissociation that rarely requires a permanent pacemaker. The time to resolution is variable, sometimes requiring weeks, making a temporary permanent pacemaker (TPPM) a suitable bridge to recovery. We report on a 31-year-old man with serology-confirmed Lyme disease with complete heart block during the peak of the coronavirus disease 2019 pandemic. A TPPM was implanted and the patient was discharged the following day with regular follow-up in the ambulatory setting. Once 1:1 AV conduction was reestablished, the TPPM was removed. Our case demonstrates that the use of a TPPM for AV-dissociation secondary to LC is a safe and feasible strategy in select individuals which can minimize patient morbidity as well as hospital length of stay and overall health care costs.

BIODIVERSITY, WHAT KIND OF RESEARCH TO FORSEE RISKS?

Biodiversity combines species, their genetic variability, their ecosystems and all the relationships between them. Endosymbiosis is one of the more important, the probable way between prokaryotes and eukaryotes. Evolution of life relies on combining previous elements into new ones. The discovery of microbiome changes the way microorganisms are considered within the whole biodiversity and for their links with sanitary challenges. Cooperation seems as important as competition. Is it then pertinent to see the development of genomics as the only possibility to discover new viruses in reservoir species before they start new pandemics and to prevent them? Is it the good way to ask the question of new sanitary risks emergence? What about considering the ecology of epidemiological cycles? Or working breeding practices with more connection to local biodiversity? How human sciences could be taken into account? A few examples will illustrate some of these points. © 2022 Academie Veterinaire de France. All rights reserved.

Mapping and monitoring tick (Acari, Ixodida) distribution, seasonality, and host associations in the United Kingdom between 2017 and 2020.

Tick-borne disease risk is intrinsically linked to the distribution of tick vector species. To assess risk and anticipate disease emergence, an understanding of tick distribution, host associations, and seasonality is needed. This can be achieved, to some extent, using passive surveillance supported by engagement with the public, animal health, and public health experts. The Tick Surveillance Scheme (TSS) collects data and maps tick distribution across the United Kingdom (UK). Between 2017 and 2020, 3720 tick records were received and 39 tick species were detected. Most records were acquired in the UK, with a subset associated with recent overseas travel. The dominant UK acquired species was Ixodes ricinus (Ixodida: Ixodidae, Linnaeus), the main vector of Lyme borreliosis. Records peaked during May and June, highlighting a key risk period for tick bites. Other key UK species were detected, including Dermacentor reticulatus (Ixodida: Ixodidae, Fabricius) and Haemaphysalis punctata (Ixodida: Ixodidae, Canestrini & Fanzago) as well as several rarer species that may present novel tick-borne disease risk to humans and other animals. Updated tick distribution maps highlight areas in the UK where tick exposure has occurred. There is evidence of increasing human tick exposure over time, including during the COVID-19 pandemic, but seasonal patterns remain unchanged.