Follow-Up of a Cohort of Patients with Post-Acute COVID-19 Syndrome in a Belgian Family Practice, 2022, Jamoulle et al

[Andy]

Abstract

Fifty-five patients who suffered from COVID-19, who were still very ill after several months, with extreme fatigue, effort exhaustion, brain fog, anomia, memory disorder, anosmia, dysgeusia, and other multi-systemic health problems have been followed in a family practice setting between May 2021 and July 2022. Data extracted from the medical records of the 55 patients (40 women), mean age 42.4 (12 to 79 years), and a qualitative study of 6 of them using a semi-open-ended questionnaire allowed to highlight the clinical picture described by WHO as post-acute COVID-19 syndrome (PACS) also known as long COVID.

We used brain single-photon emission computed tomography (SPECT-CT) in thirty-two patients with a high severity index and a highly impaired functional status, demonstrating vascular encephalopathy in twenty nine patients and supporting the hypothesis of a persistent cerebral vascular flow disorder in post COVID-19 condition. The patients will benefit from the consortium COVID Human Genetic Effort (covidhge.com) to explore the genetic and immunological basis of their problem, as 23/55 cases don’t have immunological certainty of a COVID-19 infection. There is no known verified treatment.

Analyzing the data from the first 52 patients, three categories of patients emerged over time: 16 patients made a full recovery after 6–8 months, 15 patients were able to return to life and work after 12–18 months with some sequelae, both groups being considered cured. In the third group, 21 patients are still very ill and unable to resume their work and life after 18 months.

The biopsychosocial consequences on patients’ lives are severe and family doctors are left out in the cold. It is necessary to test the reproducibility of this description, conducted on a small number of patients. Nevertheless, identifying, monitoring and supporting these patients is a necessity in family medicine.

Open access, https://www.mdpi.com/1999-4915/14/9/2000/htm

 

[forestglip]

SPECT-CT were ordered in thirty-TWO patients judged severely affected and reporting significant functional impairment. Cerebral perfusion changes are visible in twenty-nine on thirty-two patients. The lesions found are consistent with the severity of the problem experienced by these patients. Brain SPECT-CT, as a diagnostic tool for demonstration of brain damage, measures brain perfusion and indirectly brain oxygenation. SPECT-CT was useful in 90% of suspected PACS patients showing brain disorder. This kind of result is highly unusual in a family practice setting. In daily practice, the selection bias is the rule as the doctor is searching for cases and a 29/32 (90%) efficiency is hence very surprising. [...]

Fifteen affected patients each had a follow-up SPECT-CT after three to nine months. The SPECT-CT showed a clear improvement in eight cases and an aggravation in seven, corresponding with the clinical improvement or aggravation of the condition. The improvement in metabolism in the PACS at six months has already been shown using 18FDG PET-CT [61]. In the patients discussed in this study, the SPECT-CT examination looks to be useful for the follow-up of the most severe cases.

Same author, looks like an abstract for a presentation at Demystifying Long Covid 2023 conference:

Single-photon emission computed tomography facilitates the diagnosis of vascular encephalitis in cases of severe Long Covid and correlates with transcriptomic studies, 2023, Jamoulle et al

[...] A total of 53 patients with severe long-standing long covid agreed to undergo SPECT-CT. Cerebral flow disorders were detected in 48 of them. This kind of protocol is usual in such cases ;The tracer fixation exhibits marked heterogeneity, with more pronounced hypo-fixations observed in the right parieto-occipital, left parietal, right fronto-parietal, and bilateral posterior parietal regions. There exists a robust correlation between SARS-CoV-2 viral RNA levels and the outcomes observed in SPECT-CT scans.

So what is going on with SPECT? I know there's controversy about its diagnostic ability, but the above seems promising for long COVID. Is there good evidence that it is not a promising biomarker or diagnostic tool, at least in severe folk, as described in the above two sources?

 

[Hutan]

Since July 2021, a cohort exceeding 100 Long Covid patients has been identified during family medicine consultations in Charleroi, Belgium.

From the 2023 poster, 102 patients from family medicine consultations (from one practice? in Charleroi, Belgium). 66.3% female

SPECT (Single Proton Emission Computed Tomography using 99mTc-ethyl cysteinate dimer)

As I understand it, the SPECT scan with that tracer can show areas of relative hypoperfusion.

Decreased brain perfusion (blue to green) shown as compared to a database of age-and sex-matched controls,

I'm not sure if SPECT scans can show decreased brain perfusion compared to controls though.

SPECT-CT shows vascular perfusion defects damage. On 53 SPECT-CT ordered, 45 (84%) cerebral blood flow defects identified. (1 confirmed by 18FDG PET scan, 5 18FDG PET scans negative.)

PET scans can show absolute hypoperfusion, but it looks as though only 1 out of 6 PET scans found that the hypoperfusion seen in the SPECT scan was low in absolute terms.

 

[forestglip]

PET scans can show absolute hypoperfusion

Interesting. Here's a bit more from the first paper on PET:

18FDG PET-CT allows brain metabolism to be directly assessed [59]. In a recent study by Verger et al., 47% of the scans of 143 patients with suspected neurological PACS were visually interpreted as abnormal [51]. 18FDG PET-CT has a superior sensitivity over SPECT-CT and provides better contrast and spatial resolution. Studies suggest superiority of 18FDG PET-CT over SPECT-CT, but the evidence base for this is actually quite limited [60].

The spectacular but very expensive 18FDG PET-CT images enforces the use of SPECT-CT as much more cost-effective from an environmental and economical point of view in primary care for the diagnosis of PACS brain perfusion disorders. Nevertheless, the question of which patients should benefit from this procedure has to be addressed cautiously.

That's interesting that PET was much less sensitive:

On 53 SPECT-CT ordered, 45 (84%) cerebral blood flow defects identified. (1 confirmed by 18FDG PET scan, 5 18FDG PET scans negative.)

I'm not sure why the poster says 45 but the abstract says 48, though:

A total of 53 patients with severe long-standing long covid agreed to undergo SPECT-CT. Cerebral flow disorders were detected in 48 of them.

 

[Eleanor]

Analyzing the data from the first 52 patients, three categories of patients emerged over time: 16 patients made a full recovery after 6–8 months, 15 patients were able to return to life and work after 12–18 months with some sequelae, both groups being considered cured.

hmmm