The post covid-19 syndrome has highlighted the need for precise attention to the symptoms of a disease that appear after an apparent recovery and in a chronic form.

Covid-19 is one of those diseases that leaves after-effects, it never goes away completely. At least that is how it is for 32% of people who were infected with SARS-Cov2 virus, had symptoms of covid-19 and, after 6 months, still have some kind of symptoms or sequelae. In addition, there are 12.5% of those who, without presenting subsequent symptoms, have not recovered their pre-COVID-19 state of health and whose quality of life remains impaired.

After analysing the situation that many people are experiencing in this pandemic and in order to facilitate the diagnosis, or at least the possibilities to be taken into account, Dr. Mariano Bueno, medical director of Biosalud Day Hospital, offers us an analysis of the differences between persistent Covid and Chronic Lyme reactivated as the two pathologies have many similarities.s but "their treatment is obviously very different and may require medical expertise".

After one year of the SARS-Cov2 pandemic, a number of common symptoms have been described that remain after COVID-19. These tend to be:

- Fatigue, reduced resistance to exertion
- Headache, various pains all over the body, neuropathies
- Cognitive impairment, problems with memorisation or concentration, feeling of dazedness
- Depression, low self-esteem, sleep disorders
- Conjunctivitis
- Intestinal problems of the small or large intestine, digestive discomfort
- Shortness of breath, sometimes inability to take a deep breath in to fill the lungs, feeling short of breath
- Loss of smell and/or taste

These symptoms vary from person to person, and some even vary from one person to another. these patients, once they have passed COVID-19, may develop new symptoms that they did not have during the process infectious. These can range from hair loss resistant to any treatment, tachycardia or anxiety.

The million-dollar question that is increasingly being asked by Lyme experts is: "What is the best way to prevent Lyme disease? Can some cases of Post COVID-19 reactivate tick-borne disease? - explains Dr. Mariano Bueno - and to answer it, we have to establish three premises that justify the question.

These three assumptions regarding persistent Covid and the Chronic Lyme are:

- Both diseases are chronicles
- Both are multi-systemic (affecting various organs and tissues)
– El immune compromise post COVID-19 can reactivate latent infections

Comparison between persistent Covid and chronic Lyme

The Symptoms common to both pathologies areFatigue, sweating, conjunctivitis, headache, chills, intestinal problems, arthralgia, myalgia, shortness of breath, anxiety, depression, cognitive deficits, cough, sleep disorders, tachycardia or palpitations or dizziness.

There are oother signs that are not as obvious but are common between the two:

- Fever
- False-positive ANA (anti-nuclear antibodies)
- False positive rheumatoid factor
- False positive antiphospholipid antibodies
– Cytokines activated
- Altered scans (MRI, SPECT)
- Cardiac and pericardial alterations

Fortunately, there are clear differences between the two processes that allow us to understand the character of the patient's syndrome or disease:

CHRONIC LYME:
o Background on Lyme disease or exposure to ticks.
o Migratory and cyclical symptoms.
o Lymecheck positive or suggestive of tick-borne disease, in cell-mediated immunity (IFG-gamma and IL-2 ) against Borrelia or any of the co-infections and/or in humoral immunity (IgG and IgM against Borrelia and/or associated co-infections).

CHRONIC COVID-19:
o Background on previous COVID-19
o Non-migratory symptoms. They are constant.
o Organ damage: renal failure, hypoxia, abnormal chest x-ray, intravascular embolism,...

The bad thing," explains Dr. Mariano Bueno, "is that a person can be suffering from both processes, although it is not the most frequent.

What are the tests that can help us diagnose chronic COVID-19?

Among the tests that will most accurately help us to diagnose chronic covid-19 are:

SARS-Cov2 test comprising:

o Serology and immunoblot preferably
o Consider that PCR is less valid in chronic processes.
o Arterial O2 level, chest x-ray, renal function and ferritin
o Consider the stress pulmonary
o Echocardiogram, cardiac MRI with signs of myocarditis or pericarditis

Test for chronic Lyme:

o It is necessary to carry out a Lymecheck according to the patient's symptoms and co-infections that may cause them, in addition to checking for Borrelia; and even detection of Borrelia DNA in urine or blood.

On the other hand, if the test results are not clear, there is the possibility of a therapeutic test as an aid to diagnosis. At Biosalud Day Hospital there are two possibilities to follow:

Antivirals and COVID-19:
o Some studies have shown significant symptomatic improvements after a course of treatment with Ivermectin.
o However, Ivermectin also has antibacterial properties, which may also improve the symptoms of chronic reactivated Lyme.

Lyme antibiotics and COVID-19:
o Many of the antibiotics that are used in the treatment of Lyme disease o Lyme disease and some co-infections are also antivirals, such as tetracyclines, macrolides and antifungal azoles.
o Many of the treatments for Babesia are antiviral and those based on quinine or artemisinin (from Artemisia annua), but in addition to macrolides are also used.
o The antifungal azoles are also antiviral.

An improvement with these treatments can exclude the persistence of SARS Cov2.

In conclusion, it is possible that a patient who has suffered a COVID-19 and whose symptoms persist or whose quality of life has not recovered more than 6 months after being diagnosed, may be suffering a reactivation of a chronic latent Lyme, so it is very important to establish the differential diagnosis, and more specific tests such as the Lymecheck are often necessary, and of course to consult a Lyme expert, so that he/she can prescribe the appropriate treatment.

In-depth investigation is essential in case of persistent symptoms after months of SARS-Cov2 infection despite negative tests for SARS-Cov2.

An article by Dr. Mariano Bueno
Medical Director BDH
Lyme expert