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Vonbank K, Nics H, Zwick RH, Maasz J, Sabic B, Potzmann M, Brandhofer G, Fuchs J, Yeghiazaryan L, Burtscher M, Paternostro-Sluga T. Decreased phrenic nerve compound muscle action potential, inspiratory muscle strength, and exercise capacity after COVID-19. Front Neurol 2024; 14:1308443. [PMID: 38292031 PMCID: PMC10824925 DOI: 10.3389/fneur.2023.1308443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024] Open
Abstract
Objectives Respiratory muscle weakness with higher ventilatory demands were reported even in patients recovering from only mild COVID-19 symptoms. Aim of this study was to assess the function of phrenic nerve and inspiratory respiratory muscle as well as cardiopulmonary exercise capacity in patients with prolonged exertional dyspnea after COVID-19 infection. Methods In this observational exploratory study, electrophysiological examination of the phrenic nerve, inspiratory muscle capacity as well as lung function test, 6-min walk distance (6MWD) and cardiopulmonary exercise test, have been performed in 22 patients post COVID-19 diagnosis (post-CoV). Results Exercise capacity (peak workload, Wpeak % predicted and peak oxygen uptake, VO2peak % predicted) were significantly affected in the post-CoV patients (61.8 ± 23.3 Wpeak % and 70.9 ± 22.3 VO2peak %). Maximum inspiratory pressure (MIP) was reduced (60.1 ± 25.5 mbar). In 6 of the 22 patients the electrophysiological response of the phrenic nerve was pathologically decreased (reduced compound muscle action potential, CMAP), while nerve conduction velocity (NCV) was normal, which corresponds to reduced muscle fiber contraction capacity. Positive relationships were demonstrated between 6MWD and MIP (rs = 0.88) as well as quality of life questionnaire (CRQ) and MIP (rs = 0.71) only in patients with reduced CMAP. Discussion Respiratory muscle weakness and exercise capacity is associated with reduced phrenic nerve CMAP without signs of neuropathy. This indicates that muscle fiber pathology of the diaphragm may be one pathophysiological factor for the prolonged respiratory symptoms after COVID-19 infections.
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Affiliation(s)
- Karin Vonbank
- Klinik Pirawarth in Wien, Vienna, Austria
- Medical University of Vienna, Vienna, Austria
| | - Helena Nics
- Department of Physical Medicine and Rehabilitation, Klinik Floridsdorf, Vienna, Austria
| | - Ralf Harun Zwick
- Ludwig Boltzmann Institute for Rehabilitation Research, Therme Wien Med, Vienna, Austria
| | | | | | | | | | | | - Lusine Yeghiazaryan
- Medical University of Vienna, Center for Medical Data Science, Institute of Medical Statistics, Vienna, Austria
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
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Ousseiran ZH, Fares Y, Chamoun WT. Neurological manifestations of COVID-19: a systematic review and detailed comprehension. Int J Neurosci 2023; 133:754-769. [PMID: 34433369 PMCID: PMC8506813 DOI: 10.1080/00207454.2021.1973000] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/25/2021] [Accepted: 08/16/2021] [Indexed: 12/13/2022]
Abstract
The current pandemic caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) is accompanied with a rapid increase of reports and papers detailing its neurological effects and symptoms. The virus infection causes respiratory illness named by the world health organization as corona virus 19 (COVID-19).This systematic review aims to study and summarize the different neurological manifestations of this virus. All articles published and indexed via Pubmed, Medline and Google Scholar databases between January 1st 2020 and February 28th 2021 that reported neurological symptoms of SARS-CoV-2 are reviewed following the Preferred Reporting Items for Systemic review and Meta-Analysis (PRISMA) guidelines.We included data from 113 articles: eight prospective studies, 25 retrospective studies and the rest were case reports/series. COVID-19 can present with central nervous system manifestations, such as headache, encephalitis and encephalopathy, peripheral nervous system manifestations, such as anosmia, ageusia and Guillian Barre syndrome, and skeletal muscle manifestations, such as myalgia and myasthenia gravis. Our systematic review showed that COVID-19 can be manifested by a wide spectrum of neurological symptoms reported either in the early stage or within the course of the disease. However, a detailed comprehension of these manifestations is required and more studies are needed in order to improve our scientific knowledge and to develop preventive and therapeutic measures to control this pandemic.
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Affiliation(s)
- Zeina Hassan Ousseiran
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Youssef Fares
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Wafaa Takash Chamoun
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
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Swarnakar R, Jenifa S, Wadhwa S. Musculoskeletal complications in long COVID-19: A systematic review. World J Virol 2022; 11:485-495. [PMID: 36483107 PMCID: PMC9724204 DOI: 10.5501/wjv.v11.i6.485] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/01/2022] [Accepted: 10/14/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has crippled humanity since early 2020. Various sequelae of COVID-19 have been reported in different body systems. Musculoskeletal symptoms are widely reported during COVID-19 infection, but musculoskeletal complications in long COVID-19 are underreported. However, post-COVID-19 survivors have reported complaints of persisting or new-onset fatigue, myalgia, arthralgia, arthritis, muscle weakness, etc in clinical practice. The well-known detrimental effects of steroids on the musculoskeletal system coupled with their over-the-counter availability can also be anticipated since they were the cornerstone of life-saving management in this pandemic. AIM To determine the musculoskeletal complications in long COVID. METHODS We performed a systematic review of 'systematic reviews and meta-analyses'. RESULTS Of the 63 articles screened, 24 articles were included. Two articles specifically discussed children and adolescents. One article discussed rehabilitation intervention. No article addressed rehabilitation of musculoskeletal issues in long COVID-19 in particular. Fatigue was the most common musculoskeletal complication. CONCLUSION Fatigue is found to be very common along with myalgia and arthralgia. There were no studies on rehabilitation intervention in musculoskeletal complications specifically. Considering the lacuna in literature and the needs of the current situation, further studies are warranted to standardize effective rehabilitation interventions in musculoskeletal complications. More homogenous studies are needed. Studies on functional impairment due to musculoskeletal involvement are essential.
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Affiliation(s)
- Raktim Swarnakar
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| | - Shoibam Jenifa
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| | - Sanjay Wadhwa
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
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Godoy IRB, Rodrigues TC, Zamariolli GDS, Dias GPDF, Yamada AF, Skaf AY. Imaging findings of lower limb involvement following COVID-19. BJR Case Rep 2022; 8:20210219. [PMID: 36211610 PMCID: PMC9518738 DOI: 10.1259/bjrcr.20210219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 05/21/2022] [Accepted: 06/14/2022] [Indexed: 11/29/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is known mainly by the severe acute respiratory syndrome, with myalgia as a common clinical symptom. Recent reports described musculoskeletal complications related to COVID-19 such as myositis, neuropathy and arthropathy. Radiologists and ordering physicians should be aware of lower limb complications following severe COVID-19 for optimal patient care.
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Affiliation(s)
- Ivan Rodrigues Barros Godoy
- Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil
- Department of Diagnostic Imaging, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- ALTA Diagnostic Center (DASA Group), São Paulo, Brazil
| | | | | | | | - André Fukunishi Yamada
- Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil
- Department of Diagnostic Imaging, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- ALTA Diagnostic Center (DASA Group), São Paulo, Brazil
| | - Abdalla Youssef Skaf
- Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil
- ALTA Diagnostic Center (DASA Group), São Paulo, Brazil
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Omar IM, Weaver JS, Samet JD, Serhal AM, Mar WA, Taljanovic MS. Musculoskeletal Manifestations of COVID-19: Currently Described Clinical Symptoms and Multimodality Imaging Findings. Radiographics 2022; 42:1415-1432. [PMID: 35867593 PMCID: PMC9341171 DOI: 10.1148/rg.220036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
COVID-19, the clinical syndrome produced by infection with SARS-CoV-2, can result
in multisystem organ dysfunction, including respiratory failure and
hypercoagulability, which can lead to critical illness and death.
Musculoskeletal (MSK) manifestations of COVID-19 are common but have been
relatively underreported, possibly because of the severity of manifestations in
other organ systems. Additionally, patients who have undergone sedation and who
are critically ill are often unable to alert clinicians of their MSK symptoms.
Furthermore, some therapeutic measures such as medications and vaccinations can
worsen existing MSK symptoms or cause additional symptoms. Symptoms may persist
or occur months after the initial infection, known as post-COVID condition or
long COVID. As the global experience with COVID-19 and the vaccination effort
increases, certain patterns of MSK disease involving the bones, muscles,
peripheral nerves, blood vessels, and joints have emerged, many of which are
likely related to a hyperinflammatory host response, prothrombotic state, or
therapeutic efforts rather than direct viral toxicity. Imaging findings for
various COVID-19–related MSK pathologic conditions across a variety of
modalities are being recognized, which can be helpful for diagnosis, treatment
guidance, and follow-up. The online slide presentation from the RSNA Annual Meeting is
available for this article. ©RSNA, 2022
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Affiliation(s)
- Imran M Omar
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair St, Suite 800, Chicago, IL 60611 (I.M.O., A.M.S.); Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, N.M. (J.S.W., M.S.T.); Department of Medical Imaging, Ann & Robert Lurie Children's Hospital, Chicago, Ill (J.D.S.); Department of Radiology, University of Illinois at Chicago College of Medicine, Chicago, Ill (W.A.M.); and Departments of Medical Imaging and Orthopaedics, University of Arizona College of Medicine, Tucson, Ariz (M.S.T.)
| | - Jennifer S Weaver
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair St, Suite 800, Chicago, IL 60611 (I.M.O., A.M.S.); Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, N.M. (J.S.W., M.S.T.); Department of Medical Imaging, Ann & Robert Lurie Children's Hospital, Chicago, Ill (J.D.S.); Department of Radiology, University of Illinois at Chicago College of Medicine, Chicago, Ill (W.A.M.); and Departments of Medical Imaging and Orthopaedics, University of Arizona College of Medicine, Tucson, Ariz (M.S.T.)
| | - Jonathan D Samet
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair St, Suite 800, Chicago, IL 60611 (I.M.O., A.M.S.); Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, N.M. (J.S.W., M.S.T.); Department of Medical Imaging, Ann & Robert Lurie Children's Hospital, Chicago, Ill (J.D.S.); Department of Radiology, University of Illinois at Chicago College of Medicine, Chicago, Ill (W.A.M.); and Departments of Medical Imaging and Orthopaedics, University of Arizona College of Medicine, Tucson, Ariz (M.S.T.)
| | - Ali M Serhal
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair St, Suite 800, Chicago, IL 60611 (I.M.O., A.M.S.); Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, N.M. (J.S.W., M.S.T.); Department of Medical Imaging, Ann & Robert Lurie Children's Hospital, Chicago, Ill (J.D.S.); Department of Radiology, University of Illinois at Chicago College of Medicine, Chicago, Ill (W.A.M.); and Departments of Medical Imaging and Orthopaedics, University of Arizona College of Medicine, Tucson, Ariz (M.S.T.)
| | - Winnie A Mar
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair St, Suite 800, Chicago, IL 60611 (I.M.O., A.M.S.); Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, N.M. (J.S.W., M.S.T.); Department of Medical Imaging, Ann & Robert Lurie Children's Hospital, Chicago, Ill (J.D.S.); Department of Radiology, University of Illinois at Chicago College of Medicine, Chicago, Ill (W.A.M.); and Departments of Medical Imaging and Orthopaedics, University of Arizona College of Medicine, Tucson, Ariz (M.S.T.)
| | - Mihra S Taljanovic
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair St, Suite 800, Chicago, IL 60611 (I.M.O., A.M.S.); Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, N.M. (J.S.W., M.S.T.); Department of Medical Imaging, Ann & Robert Lurie Children's Hospital, Chicago, Ill (J.D.S.); Department of Radiology, University of Illinois at Chicago College of Medicine, Chicago, Ill (W.A.M.); and Departments of Medical Imaging and Orthopaedics, University of Arizona College of Medicine, Tucson, Ariz (M.S.T.)
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Pires RE, Reis IGN, Waldolato GS, Pires DD, Bidolegui F, Giordano V. What Do We Need to Know About Musculoskeletal Manifestations of COVID-19?: A Systematic Review. JBJS Rev 2022; 10:01874474-202206000-00001. [PMID: 35658089 DOI: 10.2106/jbjs.rvw.22.00013] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
» COVID-19 is a disease that is challenging science, health-care systems, and humanity. An astonishingly wide spectrum of manifestations of multi-organ damage, including musculoskeletal, can be associated with SARS-CoV-2. » In the acute phase of COVID-19, fatigue, myalgia, and arthralgia are the most common musculoskeletal symptoms. » Post-COVID-19 syndrome is a group of signs and symptoms that are present for >12 weeks. The associated musculoskeletal manifestations are fatigue, arthralgia, myalgia, new-onset back pain, muscle weakness, and poor physical performance. » Data on COVID-19 complications are growing due to large absolute numbers of cases and survivors in these 2 years of the pandemic. Additional musculoskeletal manifestations encountered are falls by the elderly, increased mortality after hip fracture, reduced bone mineral density and osteoporosis, acute sarcopenia, rhabdomyolysis, Guillain-Barré syndrome, muscle denervation atrophy, fibromyalgia, rheumatological disease triggering, septic arthritis, adhesive capsulitis, myositis, critical illness myopathy, onset of latent muscular dystrophy, osteonecrosis, soft-tissue abscess, urticarial vasculitis with musculoskeletal manifestations, and necrotizing autoimmune myositis. » A wide range of signs and symptoms involving the musculoskeletal system that affect quality of life and can result in a decrease in disability-adjusted life years. This powerful and unpredictable disease highlights the importance of multimodality imaging, continuing education, and multidisciplinary team care to support preventive measures, diagnosis, and treatment.
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Affiliation(s)
- Robinson E Pires
- Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Serviço de Ortopedia e Traumatologia, Hospital Felicio Rocho, Belo Horizonte, Brazil.,Serviço de Ortopedia e Traumatologia, Instituto Orizonti, Belo Horizonte, Brazil
| | - Igor G N Reis
- Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Gustavo S Waldolato
- Serviço de Ortopedia e Traumatologia, Hospital Felicio Rocho, Belo Horizonte, Brazil.,Serviço de Ortopedia e Traumatologia, Instituto Orizonti, Belo Horizonte, Brazil
| | - Diego D Pires
- Cedimagem Medicina Diagnóstica, Grupo Alliar, Juiz de Fora, Brazil
| | - Fernando Bidolegui
- Servicio de Ortopedia y Traumatologia, Hospital Sirio-Libanes, ECICARO, Buenos Aires, Argentin
| | - Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil
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dos Santos PK, Sigoli E, Bragança LJ, Cornachione AS. The Musculoskeletal Involvement After Mild to Moderate COVID-19 Infection. Front Physiol 2022; 13:813924. [PMID: 35492595 PMCID: PMC9040683 DOI: 10.3389/fphys.2022.813924] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/01/2022] [Indexed: 12/13/2022] Open
Abstract
COVID-19, a disease caused by the novel coronavirus SARS-CoV-2, has been drastically affecting the daily lives of millions of people. COVID-19 is described as a multiorgan disease that affects not only the respiratory tract of infected individuals, but it has considerable effects on the musculoskeletal system, causing excessive fatigue, myalgia, arthralgia, muscle weakness and skeletal muscle damage. These symptoms can persist for months, decreasing the quality of life of numerous individuals. Curiously, most studies in the scientific literature focus on patients who were hospitalized due to SARS-CoV-2 infection and little is known about the mechanism of action of COVID-19 on skeletal muscles, especially of individuals who had the mild to moderate forms of the disease (non-hospitalized patients). In this review, we focus on the current knowledge about the musculoskeletal system in COVID-19, highlighting the lack of researches investigating the mild to moderate cases of infection and pointing out why it is essential to care for these patients. Also, we will comment about the need of more experimental data to assess the musculoskeletal manifestations on COVID-19-positive individuals.
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Affiliation(s)
- Patty K. dos Santos
- Muscle Physiology and Biophysics Laboratory, Department of Physiological Sciences, Federal University of São Carlos (UFSCar), São Carlos, Brazil
| | | | | | - Anabelle S. Cornachione
- Muscle Physiology and Biophysics Laboratory, Department of Physiological Sciences, Federal University of São Carlos (UFSCar), São Carlos, Brazil
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Batista KS, Cintra VM, Lucena PAF, Manhães-de-Castro R, Toscano AE, Costa LP, Queiroz MEBS, de Andrade SM, Guzman-Quevedo O, Aquino JDS. The role of vitamin B12 in viral infections: a comprehensive review of its relationship with the muscle-gut-brain axis and implications for SARS-CoV-2 infection. Nutr Rev 2022; 80:561-578. [PMID: 34791425 PMCID: PMC8689946 DOI: 10.1093/nutrit/nuab092] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This comprehensive review establishes the role of vitamin B12 as adjunct therapy for viral infections in the treatment and persistent symptoms of COVID-19, focusing on symptoms related to the muscle-gut-brain axis. Vitamin B12 can help balance immune responses to better fight viral infections. Furthermore, data from randomized clinical trials and meta-analysis indicate that vitamin B12 in the forms of methylcobalamin and cyanocobalamin may increase serum vitamin B12 levels, and resulted in decreased serum methylmalonic acid and homocysteine concentrations, and decreased pain intensity, memory loss, and impaired concentration. Among studies, there is much variation in vitamin B12 doses, chemical forms, supplementation time, and administration routes. Larger randomized clinical trials of vitamin B12 supplementation and analysis of markers such as total vitamin B12, holotranscobalamin, total homocysteine and methylmalonic acid, total folic acid, and, if possible, polymorphisms and methylation of genes need to be conducted with people with and without COVID-19 or who have had COVID-19 to facilitate the proper vitamin B12 form to be administered in individual treatment.
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Affiliation(s)
- Kamila S Batista
- K.S. Batista and J.d.S. Aquino are with the Experimental Nutrition Laboratory, Department of Nutrition and Post Graduate Program in Nutrition Sciences, Federal University of Paraíba, Paraíba, Brazil. V.M. Cintra and P.A.F Lucena are with the Department of Medicine, Faculty of Medical Sciences of Paraíba, and the Department of Nutrition, Integrated Colleges of Patos, Paraíba, Brazil. V.M. Cintra is with the the Multiprofessional Residence in Child Health of Secretariat of Health of the State of Paraíba, Brazil. P.A.F Lucena is with Coordination of Neurology Services, Hospital Metropolitano Dom José Maria Pires, Santa Rita, Paraíba and Emergency, Trauma Hospital Senador Humberto Lucena, João Pessoa, Paraíba, Brazil. R. Manhães-de-Castro is with the Studies in Nutrition and Phenotypic Plasticity Unit, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil. R. Manhães-de-Castro and A.E. Toscano are with the Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil. A.E. Toscano is with the Department of Nursing, CAV, Federal University of Pernambuco, Pernambuco, Brazil. A.E. Toscano and O. Guzman-Quevedo are with the Post Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil. L.P. Costa, M.E.B.S. Queirozj, and S.M. de Andrade are with the Ageing and Neuroscience Laboratory, Health Sciences Center, Federal University of Paraíba, Paraíba, Brazil. O. Guzman-Quevedo is with the Higher Technological Institute of Tacámbaro, Tacámbaro, Michoacán, Mexico. O. Guzman-Quevedo is with the Center for Biomedical Research of Michoacán, Mexican Institute of Social Security, Morelia, Michoacán, Mexico
| | - Vanessa M Cintra
- K.S. Batista and J.d.S. Aquino are with the Experimental Nutrition Laboratory, Department of Nutrition and Post Graduate Program in Nutrition Sciences, Federal University of Paraíba, Paraíba, Brazil. V.M. Cintra and P.A.F Lucena are with the Department of Medicine, Faculty of Medical Sciences of Paraíba, and the Department of Nutrition, Integrated Colleges of Patos, Paraíba, Brazil. V.M. Cintra is with the the Multiprofessional Residence in Child Health of Secretariat of Health of the State of Paraíba, Brazil. P.A.F Lucena is with Coordination of Neurology Services, Hospital Metropolitano Dom José Maria Pires, Santa Rita, Paraíba and Emergency, Trauma Hospital Senador Humberto Lucena, João Pessoa, Paraíba, Brazil. R. Manhães-de-Castro is with the Studies in Nutrition and Phenotypic Plasticity Unit, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil. R. Manhães-de-Castro and A.E. Toscano are with the Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil. A.E. Toscano is with the Department of Nursing, CAV, Federal University of Pernambuco, Pernambuco, Brazil. A.E. Toscano and O. Guzman-Quevedo are with the Post Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil. L.P. Costa, M.E.B.S. Queirozj, and S.M. de Andrade are with the Ageing and Neuroscience Laboratory, Health Sciences Center, Federal University of Paraíba, Paraíba, Brazil. O. Guzman-Quevedo is with the Higher Technological Institute of Tacámbaro, Tacámbaro, Michoacán, Mexico. O. Guzman-Quevedo is with the Center for Biomedical Research of Michoacán, Mexican Institute of Social Security, Morelia, Michoacán, Mexico
| | - Paulo A F Lucena
- K.S. Batista and J.d.S. Aquino are with the Experimental Nutrition Laboratory, Department of Nutrition and Post Graduate Program in Nutrition Sciences, Federal University of Paraíba, Paraíba, Brazil. V.M. Cintra and P.A.F Lucena are with the Department of Medicine, Faculty of Medical Sciences of Paraíba, and the Department of Nutrition, Integrated Colleges of Patos, Paraíba, Brazil. V.M. Cintra is with the the Multiprofessional Residence in Child Health of Secretariat of Health of the State of Paraíba, Brazil. P.A.F Lucena is with Coordination of Neurology Services, Hospital Metropolitano Dom José Maria Pires, Santa Rita, Paraíba and Emergency, Trauma Hospital Senador Humberto Lucena, João Pessoa, Paraíba, Brazil. R. Manhães-de-Castro is with the Studies in Nutrition and Phenotypic Plasticity Unit, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil. R. Manhães-de-Castro and A.E. Toscano are with the Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil. A.E. Toscano is with the Department of Nursing, CAV, Federal University of Pernambuco, Pernambuco, Brazil. A.E. Toscano and O. Guzman-Quevedo are with the Post Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil. L.P. Costa, M.E.B.S. Queirozj, and S.M. de Andrade are with the Ageing and Neuroscience Laboratory, Health Sciences Center, Federal University of Paraíba, Paraíba, Brazil. O. Guzman-Quevedo is with the Higher Technological Institute of Tacámbaro, Tacámbaro, Michoacán, Mexico. O. Guzman-Quevedo is with the Center for Biomedical Research of Michoacán, Mexican Institute of Social Security, Morelia, Michoacán, Mexico
| | - Raul Manhães-de-Castro
- K.S. Batista and J.d.S. Aquino are with the Experimental Nutrition Laboratory, Department of Nutrition and Post Graduate Program in Nutrition Sciences, Federal University of Paraíba, Paraíba, Brazil. V.M. Cintra and P.A.F Lucena are with the Department of Medicine, Faculty of Medical Sciences of Paraíba, and the Department of Nutrition, Integrated Colleges of Patos, Paraíba, Brazil. V.M. Cintra is with the the Multiprofessional Residence in Child Health of Secretariat of Health of the State of Paraíba, Brazil. P.A.F Lucena is with Coordination of Neurology Services, Hospital Metropolitano Dom José Maria Pires, Santa Rita, Paraíba and Emergency, Trauma Hospital Senador Humberto Lucena, João Pessoa, Paraíba, Brazil. R. Manhães-de-Castro is with the Studies in Nutrition and Phenotypic Plasticity Unit, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil. R. Manhães-de-Castro and A.E. Toscano are with the Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil. A.E. Toscano is with the Department of Nursing, CAV, Federal University of Pernambuco, Pernambuco, Brazil. A.E. Toscano and O. Guzman-Quevedo are with the Post Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil. L.P. Costa, M.E.B.S. Queirozj, and S.M. de Andrade are with the Ageing and Neuroscience Laboratory, Health Sciences Center, Federal University of Paraíba, Paraíba, Brazil. O. Guzman-Quevedo is with the Higher Technological Institute of Tacámbaro, Tacámbaro, Michoacán, Mexico. O. Guzman-Quevedo is with the Center for Biomedical Research of Michoacán, Mexican Institute of Social Security, Morelia, Michoacán, Mexico
| | - Ana E Toscano
- K.S. Batista and J.d.S. Aquino are with the Experimental Nutrition Laboratory, Department of Nutrition and Post Graduate Program in Nutrition Sciences, Federal University of Paraíba, Paraíba, Brazil. V.M. Cintra and P.A.F Lucena are with the Department of Medicine, Faculty of Medical Sciences of Paraíba, and the Department of Nutrition, Integrated Colleges of Patos, Paraíba, Brazil. V.M. Cintra is with the the Multiprofessional Residence in Child Health of Secretariat of Health of the State of Paraíba, Brazil. P.A.F Lucena is with Coordination of Neurology Services, Hospital Metropolitano Dom José Maria Pires, Santa Rita, Paraíba and Emergency, Trauma Hospital Senador Humberto Lucena, João Pessoa, Paraíba, Brazil. R. Manhães-de-Castro is with the Studies in Nutrition and Phenotypic Plasticity Unit, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil. R. Manhães-de-Castro and A.E. Toscano are with the Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil. A.E. Toscano is with the Department of Nursing, CAV, Federal University of Pernambuco, Pernambuco, Brazil. A.E. Toscano and O. Guzman-Quevedo are with the Post Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil. L.P. Costa, M.E.B.S. Queirozj, and S.M. de Andrade are with the Ageing and Neuroscience Laboratory, Health Sciences Center, Federal University of Paraíba, Paraíba, Brazil. O. Guzman-Quevedo is with the Higher Technological Institute of Tacámbaro, Tacámbaro, Michoacán, Mexico. O. Guzman-Quevedo is with the Center for Biomedical Research of Michoacán, Mexican Institute of Social Security, Morelia, Michoacán, Mexico
| | - Larissa P Costa
- K.S. Batista and J.d.S. Aquino are with the Experimental Nutrition Laboratory, Department of Nutrition and Post Graduate Program in Nutrition Sciences, Federal University of Paraíba, Paraíba, Brazil. V.M. Cintra and P.A.F Lucena are with the Department of Medicine, Faculty of Medical Sciences of Paraíba, and the Department of Nutrition, Integrated Colleges of Patos, Paraíba, Brazil. V.M. Cintra is with the the Multiprofessional Residence in Child Health of Secretariat of Health of the State of Paraíba, Brazil. P.A.F Lucena is with Coordination of Neurology Services, Hospital Metropolitano Dom José Maria Pires, Santa Rita, Paraíba and Emergency, Trauma Hospital Senador Humberto Lucena, João Pessoa, Paraíba, Brazil. R. Manhães-de-Castro is with the Studies in Nutrition and Phenotypic Plasticity Unit, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil. R. Manhães-de-Castro and A.E. Toscano are with the Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil. A.E. Toscano is with the Department of Nursing, CAV, Federal University of Pernambuco, Pernambuco, Brazil. A.E. Toscano and O. Guzman-Quevedo are with the Post Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil. L.P. Costa, M.E.B.S. Queirozj, and S.M. de Andrade are with the Ageing and Neuroscience Laboratory, Health Sciences Center, Federal University of Paraíba, Paraíba, Brazil. O. Guzman-Quevedo is with the Higher Technological Institute of Tacámbaro, Tacámbaro, Michoacán, Mexico. O. Guzman-Quevedo is with the Center for Biomedical Research of Michoacán, Mexican Institute of Social Security, Morelia, Michoacán, Mexico
| | - Maria E B S Queiroz
- K.S. Batista and J.d.S. Aquino are with the Experimental Nutrition Laboratory, Department of Nutrition and Post Graduate Program in Nutrition Sciences, Federal University of Paraíba, Paraíba, Brazil. V.M. Cintra and P.A.F Lucena are with the Department of Medicine, Faculty of Medical Sciences of Paraíba, and the Department of Nutrition, Integrated Colleges of Patos, Paraíba, Brazil. V.M. Cintra is with the the Multiprofessional Residence in Child Health of Secretariat of Health of the State of Paraíba, Brazil. P.A.F Lucena is with Coordination of Neurology Services, Hospital Metropolitano Dom José Maria Pires, Santa Rita, Paraíba and Emergency, Trauma Hospital Senador Humberto Lucena, João Pessoa, Paraíba, Brazil. R. Manhães-de-Castro is with the Studies in Nutrition and Phenotypic Plasticity Unit, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil. R. Manhães-de-Castro and A.E. Toscano are with the Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil. A.E. Toscano is with the Department of Nursing, CAV, Federal University of Pernambuco, Pernambuco, Brazil. A.E. Toscano and O. Guzman-Quevedo are with the Post Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil. L.P. Costa, M.E.B.S. Queirozj, and S.M. de Andrade are with the Ageing and Neuroscience Laboratory, Health Sciences Center, Federal University of Paraíba, Paraíba, Brazil. O. Guzman-Quevedo is with the Higher Technological Institute of Tacámbaro, Tacámbaro, Michoacán, Mexico. O. Guzman-Quevedo is with the Center for Biomedical Research of Michoacán, Mexican Institute of Social Security, Morelia, Michoacán, Mexico
| | - Suellen M de Andrade
- K.S. Batista and J.d.S. Aquino are with the Experimental Nutrition Laboratory, Department of Nutrition and Post Graduate Program in Nutrition Sciences, Federal University of Paraíba, Paraíba, Brazil. V.M. Cintra and P.A.F Lucena are with the Department of Medicine, Faculty of Medical Sciences of Paraíba, and the Department of Nutrition, Integrated Colleges of Patos, Paraíba, Brazil. V.M. Cintra is with the the Multiprofessional Residence in Child Health of Secretariat of Health of the State of Paraíba, Brazil. P.A.F Lucena is with Coordination of Neurology Services, Hospital Metropolitano Dom José Maria Pires, Santa Rita, Paraíba and Emergency, Trauma Hospital Senador Humberto Lucena, João Pessoa, Paraíba, Brazil. R. Manhães-de-Castro is with the Studies in Nutrition and Phenotypic Plasticity Unit, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil. R. Manhães-de-Castro and A.E. Toscano are with the Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil. A.E. Toscano is with the Department of Nursing, CAV, Federal University of Pernambuco, Pernambuco, Brazil. A.E. Toscano and O. Guzman-Quevedo are with the Post Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil. L.P. Costa, M.E.B.S. Queirozj, and S.M. de Andrade are with the Ageing and Neuroscience Laboratory, Health Sciences Center, Federal University of Paraíba, Paraíba, Brazil. O. Guzman-Quevedo is with the Higher Technological Institute of Tacámbaro, Tacámbaro, Michoacán, Mexico. O. Guzman-Quevedo is with the Center for Biomedical Research of Michoacán, Mexican Institute of Social Security, Morelia, Michoacán, Mexico
| | - Omar Guzman-Quevedo
- K.S. Batista and J.d.S. Aquino are with the Experimental Nutrition Laboratory, Department of Nutrition and Post Graduate Program in Nutrition Sciences, Federal University of Paraíba, Paraíba, Brazil. V.M. Cintra and P.A.F Lucena are with the Department of Medicine, Faculty of Medical Sciences of Paraíba, and the Department of Nutrition, Integrated Colleges of Patos, Paraíba, Brazil. V.M. Cintra is with the the Multiprofessional Residence in Child Health of Secretariat of Health of the State of Paraíba, Brazil. P.A.F Lucena is with Coordination of Neurology Services, Hospital Metropolitano Dom José Maria Pires, Santa Rita, Paraíba and Emergency, Trauma Hospital Senador Humberto Lucena, João Pessoa, Paraíba, Brazil. R. Manhães-de-Castro is with the Studies in Nutrition and Phenotypic Plasticity Unit, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil. R. Manhães-de-Castro and A.E. Toscano are with the Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil. A.E. Toscano is with the Department of Nursing, CAV, Federal University of Pernambuco, Pernambuco, Brazil. A.E. Toscano and O. Guzman-Quevedo are with the Post Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil. L.P. Costa, M.E.B.S. Queirozj, and S.M. de Andrade are with the Ageing and Neuroscience Laboratory, Health Sciences Center, Federal University of Paraíba, Paraíba, Brazil. O. Guzman-Quevedo is with the Higher Technological Institute of Tacámbaro, Tacámbaro, Michoacán, Mexico. O. Guzman-Quevedo is with the Center for Biomedical Research of Michoacán, Mexican Institute of Social Security, Morelia, Michoacán, Mexico
| | - Jailane de S Aquino
- K.S. Batista and J.d.S. Aquino are with the Experimental Nutrition Laboratory, Department of Nutrition and Post Graduate Program in Nutrition Sciences, Federal University of Paraíba, Paraíba, Brazil. V.M. Cintra and P.A.F Lucena are with the Department of Medicine, Faculty of Medical Sciences of Paraíba, and the Department of Nutrition, Integrated Colleges of Patos, Paraíba, Brazil. V.M. Cintra is with the the Multiprofessional Residence in Child Health of Secretariat of Health of the State of Paraíba, Brazil. P.A.F Lucena is with Coordination of Neurology Services, Hospital Metropolitano Dom José Maria Pires, Santa Rita, Paraíba and Emergency, Trauma Hospital Senador Humberto Lucena, João Pessoa, Paraíba, Brazil. R. Manhães-de-Castro is with the Studies in Nutrition and Phenotypic Plasticity Unit, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil. R. Manhães-de-Castro and A.E. Toscano are with the Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil. A.E. Toscano is with the Department of Nursing, CAV, Federal University of Pernambuco, Pernambuco, Brazil. A.E. Toscano and O. Guzman-Quevedo are with the Post Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil. L.P. Costa, M.E.B.S. Queirozj, and S.M. de Andrade are with the Ageing and Neuroscience Laboratory, Health Sciences Center, Federal University of Paraíba, Paraíba, Brazil. O. Guzman-Quevedo is with the Higher Technological Institute of Tacámbaro, Tacámbaro, Michoacán, Mexico. O. Guzman-Quevedo is with the Center for Biomedical Research of Michoacán, Mexican Institute of Social Security, Morelia, Michoacán, Mexico
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9
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Soares MN, Eggelbusch M, Naddaf E, Gerrits KHL, van der Schaaf M, van den Borst B, Wiersinga WJ, van Vugt M, Weijs PJM, Murray AJ, Wüst RCI. Skeletal muscle alterations in patients with acute Covid-19 and post-acute sequelae of Covid-19. J Cachexia Sarcopenia Muscle 2022; 13:11-22. [PMID: 34997689 PMCID: PMC8818659 DOI: 10.1002/jcsm.12896] [Citation(s) in RCA: 136] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/11/2021] [Accepted: 11/22/2021] [Indexed: 12/14/2022] Open
Abstract
Skeletal muscle-related symptoms are common in both acute coronavirus disease (Covid)-19 and post-acute sequelae of Covid-19 (PASC). In this narrative review, we discuss cellular and molecular pathways that are affected and consider these in regard to skeletal muscle involvement in other conditions, such as acute respiratory distress syndrome, critical illness myopathy, and post-viral fatigue syndrome. Patients with severe Covid-19 and PASC suffer from skeletal muscle weakness and exercise intolerance. Histological sections present muscle fibre atrophy, metabolic alterations, and immune cell infiltration. Contributing factors to weakness and fatigue in patients with severe Covid-19 include systemic inflammation, disuse, hypoxaemia, and malnutrition. These factors also contribute to post-intensive care unit (ICU) syndrome and ICU-acquired weakness and likely explain a substantial part of Covid-19-acquired weakness. The skeletal muscle weakness and exercise intolerance associated with PASC are more obscure. Direct severe acute respiratory syndrome coronavirus (SARS-CoV)-2 viral infiltration into skeletal muscle or an aberrant immune system likely contribute. Similarities between skeletal muscle alterations in PASC and chronic fatigue syndrome deserve further study. Both SARS-CoV-2-specific factors and generic consequences of acute disease likely underlie the observed skeletal muscle alterations in both acute Covid-19 and PASC.
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Affiliation(s)
- Madu N Soares
- Laboratory for Myology, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Moritz Eggelbusch
- Laboratory for Myology, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Nutrition and Dietetics, Amsterdam UMC, Location VUmc, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Faculty of Sports and Nutrition, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Elie Naddaf
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Karin H L Gerrits
- Laboratory for Myology, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Merem Medical Rehabilitation, Hilversum, The Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Bram van den Borst
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - W Joost Wiersinga
- Center for Experimental and Molecular Medicine (CEMM), Amsterdam University Medical Centers - Location AMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Internal Medicine, Division of Infectious Diseases, Amsterdam University Medical Centers - Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Michele van Vugt
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam University Medical Centers - Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter J M Weijs
- Department of Nutrition and Dietetics, Amsterdam UMC, Location VUmc, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Faculty of Sports and Nutrition, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Andrew J Murray
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Rob C I Wüst
- Laboratory for Myology, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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10
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Untersmayr E, Förster-Waldl E, Bonelli M, Boztug K, Brunner PM, Eiwegger T, Eller K, Göschl L, Grabmeier-Pfistershammer K, Hötzenecker W, Jordakieva G, Moschen AR, Pfaller B, Pickl W, Reinisch W, Wiedermann U, Klimek L, Bergmann KC, Brehler R, Novak N, Merk HF, Rabe U, Schlenter WW, Ring J, Wehrmann W, Mülleneisen NK, Wrede H, Fuchs T, Jensen-Jarolim E. Immunologisch relevante Aspekte der neuen COVID-19-Impfstoffe. ALLERGO JOURNAL 2021; 30:34-47. [PMID: 34393384 PMCID: PMC8349614 DOI: 10.1007/s15007-021-4848-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- Eva Untersmayr
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich
| | - Elisabeth Förster-Waldl
- Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
| | - Michael Bonelli
- Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Kaan Boztug
- St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
| | - Patrick M. Brunner
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Thomas Eiwegger
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich
- Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
- St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Kathrin Eller
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich
- Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
- St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Lisa Göschl
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich
- Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
- St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Katharina Grabmeier-Pfistershammer
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich
- Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
- St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Wolfram Hötzenecker
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich
- Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
- St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Galateja Jordakieva
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich
- Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
- St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Alexander R. Moschen
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich
- Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
- St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Birgit Pfaller
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich
- Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
- St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Winfried Pickl
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich
- Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
- St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Walter Reinisch
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich
- Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
- St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Ursula Wiedermann
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich
- Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
- St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Ludger Klimek
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich
- Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
- St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Karl-Christian Bergmann
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich
- Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
- St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Randolf Brehler
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich
- Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
- St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Natalija Novak
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich
- Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
- St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Hans F. Merk
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich
- Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
- St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Uta Rabe
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich
- Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
- St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Wolfgang W. Schlenter
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich
- Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
- St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Johannes Ring
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich
- Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
- St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Wolfgang Wehrmann
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich
- Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
- St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Norbert K. Mülleneisen
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich
- Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
- St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Holger Wrede
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich
- Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
- St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Thomas Fuchs
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich
- Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
- St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Erika Jensen-Jarolim
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich
- Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
- St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
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Abstract
PURPOSE Myositis as a rare manifestation of COVID-19 is only recently being reported. This review examines the current literature on COVID-19-induced myositis focusing on etiopathogenesis, clinical presentations, diagnostic practices, and therapeutic challenges with immunosuppression, and the difficulties experienced by rheumatologists in established myositis in the COVID-19 era. RECENT FINDINGS COVID-19 is associated with a viral myositis attributable to direct myocyte invasion or induction of autoimmunity. COVID-19-induced myositis may be varied in presentation, from typical dermatomyositis to rhabdomyolysis, and a paraspinal affliction with back pain. It may or may not present with acute exponential elevations of enzyme markers such as creatine kinase (CK). Virus-mediated muscle inflammation is attributed to ACE2 (angiotensin-converting enzyme) receptor-mediated direct entry and affliction of muscle fibers, leading on to innate and adaptive immune activation. A greater recognition of the stark similarity between anti-MDA5-positive myositis with COVID-19 has thrown researchers into the alley of exploration - finding common etiopathogenic basis as well as therapeutic strategies. For patients with established myositis, chronic care was disrupted during the pandemic with several logistic challenges and treatment dilemmas leading to high flare rates. Teleconsultation bridged the gap while ushering in an era of patient-led care with the digital transition to tools of remote disease assessment. COVID-19 has brought along greater insight into unique manifestations of COVID-19-related myositis, ranging from direct virus-induced muscle disease to triggered autoimmunity and other etiopathogenic links to explore. A remarkable shift in the means of delivering chronic care has led patients and caregivers worldwide to embrace a virtual shift with teleconsultation and opened doorways to a new era of patient-led care.
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Affiliation(s)
- Ahmad Saud
- Department of Medicine, Royal College of Surgeons Ireland, Dublin, Ireland
| | - R Naveen
- Department of Clinical Immunology and Rheumatology, C Block, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareilley Road, Lucknow, 226014, India
| | - Rohit Aggarwal
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Latika Gupta
- Department of Clinical Immunology and Rheumatology, C Block, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareilley Road, Lucknow, 226014, India.
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12
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Untersmayr E, Förster-Waldl E, Bonelli M, Boztug K, Brunner PM, Eiwegger T, Eller K, Göschl L, Grabmeier-Pfistershammer K, Hötzenecker W, Jordakieva G, Moschen AR, Pfaller B, Pickl W, Reinisch W, Wiedermann U, Klimek L, Bergmann KC, Brehler R, Pfützner W, Novak N, Merk H, Rabe U, Schlenter W, Ring J, Wehrmann W, Mülleneisen N, Wrede H, Fuchs T, Jensen-Jarolim E. Immunologically relevant aspects of the new COVID-19 vaccines-an ÖGAI (Austrian Society for Allergology and Immunology) and AeDA (German Society for Applied Allergology) position paper. ALLERGO JOURNAL INTERNATIONAL 2021; 30:155-168. [PMID: 34178577 PMCID: PMC8212077 DOI: 10.1007/s40629-021-00178-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/08/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND The vaccines against the coronavirus disease 2019 (COVID-19) approved in the European Union represent a decisive step in the fight against the pandemic. The application of these available vaccines to patients with pre-existing immunological conditions leads to a multitude of questions regarding efficacy, side effects and the necessary patient information. RESULTS This review article provides insight into mechanisms of action of the currently available severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines and summarises the current state of science as well as expert recommendations regarding tolerability of the vaccines. In addition, the potential to develop protective immune responses is determined. A special focus is given on patients under immunosuppression or in treatment with immunomodulatory drugs. Special groups of the population such as children, pregnant women and the elderly are also considered. CONCLUSION Despite the need for a patient-specific risk-benefit assessment, the consensus among experts is that patients with immunological diseases in particular benefit from the induced immune protection after COVID-19 vaccination and do not have an increased risk of side effects.
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Affiliation(s)
- Eva Untersmayr
- Institute of Pathophysiology and Allergy Research, Centre for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria
| | - Elisabeth Förster-Waldl
- Department of Neonatology, Paediatric Intensive Care Medicine and Neuropaediatrics with Centre for Congenital Immunodeficiencies, University Clinics of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Bonelli
- Clinical Department of Rheumatology, University Clinics of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Kaan Boztug
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
- St. Anna Children’s Hospital and University Clinic for Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- St. Anna Kinderkrebsforschung GmbH, Vienna, Austria
- CeMM Research Centre for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Patrick M. Brunner
- University Clinics of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Thomas Eiwegger
- Translational Medicine Program, Research Institute, Hospital for Sick Children, Toronto, Ontario Canada
- Department of Immunology, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
- Clinical Department of Pediatrics, University Hospital St. Pölten, St. Pölten, Austria
| | - Kathrin Eller
- Clinical Department of Nephrology, Internal Medicine, Medical University of Graz, Graz, Austria
| | - Lisa Göschl
- Clinical Department of Rheumatology, University Clinics of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | | | - Wolfram Hötzenecker
- University Clinics of Dermatology and Venereology, Kepler University Hospital, Comprehensive Allergy Centre, Linz, Austria
| | - Galateja Jordakieva
- University Clinics of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Alexander R. Moschen
- University Clinics of Internal Medicine, Department of Gastroenterology and Hepatology, Kepler University Hospital, Linz, Austria
| | - Birgit Pfaller
- Department of Internal Medicine 1, Karl Landsteiner University of Health Sciences, University Hospital, St. Pölten, Austria
| | - Winfried Pickl
- Institute of Immunology, Centre for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Walter Reinisch
- Clinical Division of Gastroenterology and Hepatology, University Clinics of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Ursula Wiedermann
- Institute of Specific Prophylaxis and Tropical Medicine, Centre for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Ludger Klimek
- Centre for Rhinology and Allergology, Wiesbaden, Germany
| | - Karl-Christian Bergmann
- Department of Dermatology, Venereology and Allergy, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Randolf Brehler
- Department of Skin Diseases—General Dermatology and Venereology—Outpatient Clinic for Allergology, Occupational Dermatology and Environmental Medicine, University Hospital Münster, Münster, Germany
| | - Wolfgang Pfützner
- Department of Dermatology and Allergology, University Hospital Marburg (UKGM), Philipps University Marburg, Marburg, Germany
| | - Natalija Novak
- Clinic and Polyclinic for Dermatology and Allergology, University Hospital Bonn, Bonn, Germany
| | - Hans Merk
- Department of Dermatology and Allergology, RWTH Aachen University, Aachen, Germany
| | - Uta Rabe
- Clinic for Allergology, Johanniter-Krankenhaus im Fläming Treuenbrietzen GmbH, Treuenbrietzen, Germany
| | | | | | | | | | | | - Thomas Fuchs
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen (UMG), Georg-August-University, Göttingen, Germany
| | - Erika Jensen-Jarolim
- Institute of Pathophysiology and Allergy Research, Centre for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria
- Interuniversity Messerli Research Institute, University of Veterinary Medicine Vienna, Medical University of Vienna, University of Vienna, Vienna, Austria
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