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Myopathy as a cause of fatigue in long‐term post‐COVID‐19 symptoms: Evidence of skeletal muscle histopathology.

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Title: Myopathy as a cause of fatigue in long‐term post‐COVID‐19 symptoms: Evidence of skeletal muscle histopathology.
Authors: Hejbøl, Eva K. (AUTHOR), Harbo, Thomas (AUTHOR), Agergaard, Jane (AUTHOR), Madsen, Line B. (AUTHOR), Pedersen, Thomas H. (AUTHOR), Østergaard, Lars J. (AUTHOR), Andersen, Henning (AUTHOR), Schrøder, Henrik D. (AUTHOR), Tankisi, Hatice (AUTHOR)
Source: European Journal of Neurology. Sep2022, Vol. 29 Issue 9, p2832-2841. 10p.
Subjects: COVID-19 pandemic, Skeletal muscle, Fatigue (Physiology), Cytochrome oxidase, HLA histocompatibility antigens, Cancer fatigue
Abstract: Background and purpose: Among post‐COVID‐19 symptoms, fatigue is reported as one of the most common, even after mild acute infection, and as the cause of fatigue, myopathy diagnosed by electromyography has been proposed in previous reports. This study aimed to explore the histopathological changes in patients with post‐COVID‐19 fatigue. Methods: Sixteen patients (mean age = 46 years) with post‐COVID‐19 complaints of fatigue, myalgia, or weakness persisting for up to 14 months were included. In all patients, quantitative electromyography and muscle biopsies analyzed with light and electron microscopy were taken. Results: Muscle weakness was present in 50% and myopathic electromyography in 75%, and in all patients there were histological changes. Muscle fiber atrophy was found in 38%, and 56% showed indications of fiber regeneration. Mitochondrial changes, comprising loss of cytochrome c oxidase activity, subsarcollemmal accumulation, and/or abnormal cristae, were present in 62%. Inflammation was found in 62%, seen as T lymphocytes and/or muscle fiber human leukocyte antigen ABC expression. In 75%, capillaries were affected, involving basal lamina and cells. In two patients, uncommon amounts of basal lamina were found, not only surrounding muscle fibers but also around nerves and capillaries. Conclusions: The wide variety of histological changes in this study suggests that skeletal muscles may be a major target of SARS‐CoV‐2, causing muscular post‐COVID‐19 symptoms. The mitochondrial changes, inflammation, and capillary injury in muscle biopsies can cause fatigue in part due to reduced energy supply. Because most patients had mild–moderate acute affection, the new variants that might cause less severe acute disease could still have the ability to cause long‐term myopathy. [ABSTRACT FROM AUTHOR]
Copyright of European Journal of Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Myopathy as a cause of fatigue in long‐term post‐COVID‐19 symptoms: Evidence of skeletal muscle histopathology.
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  Data: <searchLink fieldCode="AR" term="%22Hejbøl%2C+Eva+K%2E%22">Hejbøl, Eva K.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Harbo%2C+Thomas%22">Harbo, Thomas</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Agergaard%2C+Jane%22">Agergaard, Jane</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Madsen%2C+Line+B%2E%22">Madsen, Line B.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Pedersen%2C+Thomas+H%2E%22">Pedersen, Thomas H.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Østergaard%2C+Lars+J%2E%22">Østergaard, Lars J.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Andersen%2C+Henning%22">Andersen, Henning</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Schrøder%2C+Henrik+D%2E%22">Schrøder, Henrik D.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Tankisi%2C+Hatice%22">Tankisi, Hatice</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22European+Journal+of+Neurology%22">European Journal of Neurology</searchLink>. Sep2022, Vol. 29 Issue 9, p2832-2841. 10p.
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  Data: <searchLink fieldCode="DE" term="%22COVID-19+pandemic%22">COVID-19 pandemic</searchLink><br /><searchLink fieldCode="DE" term="%22Skeletal+muscle%22">Skeletal muscle</searchLink><br /><searchLink fieldCode="DE" term="%22Fatigue+%28Physiology%29%22">Fatigue (Physiology)</searchLink><br /><searchLink fieldCode="DE" term="%22Cytochrome+oxidase%22">Cytochrome oxidase</searchLink><br /><searchLink fieldCode="DE" term="%22HLA+histocompatibility+antigens%22">HLA histocompatibility antigens</searchLink><br /><searchLink fieldCode="DE" term="%22Cancer+fatigue%22">Cancer fatigue</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background and purpose: Among post‐COVID‐19 symptoms, fatigue is reported as one of the most common, even after mild acute infection, and as the cause of fatigue, myopathy diagnosed by electromyography has been proposed in previous reports. This study aimed to explore the histopathological changes in patients with post‐COVID‐19 fatigue. Methods: Sixteen patients (mean age = 46 years) with post‐COVID‐19 complaints of fatigue, myalgia, or weakness persisting for up to 14 months were included. In all patients, quantitative electromyography and muscle biopsies analyzed with light and electron microscopy were taken. Results: Muscle weakness was present in 50% and myopathic electromyography in 75%, and in all patients there were histological changes. Muscle fiber atrophy was found in 38%, and 56% showed indications of fiber regeneration. Mitochondrial changes, comprising loss of cytochrome c oxidase activity, subsarcollemmal accumulation, and/or abnormal cristae, were present in 62%. Inflammation was found in 62%, seen as T lymphocytes and/or muscle fiber human leukocyte antigen ABC expression. In 75%, capillaries were affected, involving basal lamina and cells. In two patients, uncommon amounts of basal lamina were found, not only surrounding muscle fibers but also around nerves and capillaries. Conclusions: The wide variety of histological changes in this study suggests that skeletal muscles may be a major target of SARS‐CoV‐2, causing muscular post‐COVID‐19 symptoms. The mitochondrial changes, inflammation, and capillary injury in muscle biopsies can cause fatigue in part due to reduced energy supply. Because most patients had mild–moderate acute affection, the new variants that might cause less severe acute disease could still have the ability to cause long‐term myopathy. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of European Journal of Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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      – SubjectFull: Cytochrome oxidase
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      – SubjectFull: HLA histocompatibility antigens
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      – SubjectFull: Cancer fatigue
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              Text: Sep2022
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