COVID-19 is one of those diseases that leaves lasting effects; it never completely goes away. At least, that is the case for 32% of people who contracted the SARS-CoV-2 virus, had COVID-19 symptoms, and, after six months, still have some type of symptom or lasting effect. In addition, 12.5% of those who did not experience subsequent symptoms have not regained their pre-COVID-19 health and continue to suffer from a reduced quality of life.
After analyzing this situation that many people are experiencing during this pandemic, and in order to facilitate diagnosis, or at least the possibilities to be taken into account, Dr. Mariano Bueno, medical director of Biosalud Day Hospital, suggests that we analyze the differences between persistent COVID and reactivated chronic Lyme disease, since both pathologies have numerous similaritiesbut "their treatment is obviously very different and may require expert physicians."
After a year of the SARS-CoV-2 pandemic, a series of more common symptoms have been described that persist after COVID-19. These tend to be:
– Fatigue, decreased endurance
– Headaches, various pains throughout the body, neuropathies
– Cognitive impairment, memory or concentration problems, feeling of lightheadedness
– Depression, low self-esteem, sleep disorders
– Conjunctivitis
– Intestinal problems in the small or large intestine, digestive discomfort
– Breathing difficulties, sometimes inability to take a deep breath to fill the lungs, feeling short of breath
– Loss of smell and/or taste
These symptoms vary from person to person, and even some of these patients, once they have recovered from COVID-19, may develop new symptoms that they did not have during the infectious process. These can range from hair loss resistant to any treatment, tachycardia, or anxiety.
"The million-dollar question that is increasingly common among Lyme disease experts is: Can some cases of post-COVID-19 reactivate the tick-borne disease? " explains Dr. Mariano Bueno. "To answer this question, we need to establish three premises that justify the question."
These three premises regarding persistent COVID and chronic Lyme disease are:
– Both diseases are chronic
– Both are multisystemic (affecting multiple organs and tissues)
– Post-COVID-19 immune compromise can reactivate latent infections
The symptoms common to both conditions are: fatigue, sweating, conjunctivitis, headache, chills, intestinal problems, arthralgia, myalgia, shortness of breath, anxiety, depression, cognitive impairment, cough, sleep disorders, tachycardia or palpitations, or dizziness.
There areother signs that are not as obvious but are common to both:
– Fever
– False positive ANA (anti-nuclear antibodies)
– False positive rheumatoid factor
– False positive antiphospholipid antibodies
– Activated cytokines
– Abnormal scans (MRI, SPECT)
– Cardiac and pericardial abnormalities
Fortunately, there are clear differences between the two processes that allow us to understand the nature of the patient's syndrome or disease:
CHRONIC LYME:
o History of Lyme disease or exposure to ticks.
o Migratory and cyclical symptoms.
o Positive or suggestive Lymecheck for tick-borne disease, in cellular 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 History of previous COVID-19
o Non-migratory symptoms. They are constant.
o Organ damage: kidney failure, hypoxia, abnormal chest plaque, intravascular embolism, etc.
"The problem," explains Dr. Mariano Bueno, "is that a person can be suffering from both processes, although this is not the most common scenario."
Among the tests that will most accurately help us 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 pulmonary stress
o Echocardiogram, cardiac resonance with signs of myo- or pericarditis
Test for chronic Lyme disease:
A Lymecheck should be performed based on the patient's symptoms and any co-infections that may cause them, in addition to checking for Borrelia; and even detecting Borrelia DNA in urine or blood.
On the other hand, if the test results are unclear, there is the possibility of performing a therapeutic test to aid in the diagnosis. At Biosalud Day Hospital, we find two possibilities to follow:
Antivirals and COVID-19:
o Some studies have shown significant symptomatic improvement after a course of treatment with Ivermectin.
o However, Ivermectin also has antibacterial properties, which means it can also improve the symptoms of reactivated chronic Lyme disease.
Lyme antibiotics and COVID-19:
o Many of the antibiotics used to treat Borreliosis or Lyme disease and some co-infections are also antiviral, such as tetracyclines, macrolides, and antifungal azoles.
o Many of the treatments for Babesia are antiviral and based on quinine or artemisinin (from Artemisia annua), but macrolides are also used.
o Antifungal azoles are also antiviral.
Improvement with these treatments may rule out the persistence of SARS Cov2.
In conclusion, it is possible that a patient who has suffered from COVID-19 and whose symptoms persist or who has not fully recovered their previous quality of life more than six months after being diagnosed may be suffering from a reactivation of latent chronic Lyme disease. It is therefore very important to establish a differential diagnosis, More specific tests such as Lymecheck are often necessary, and of course, it is essential to consult a Lyme expert so that they can prescribe the appropriate treatment.
An in-depth study is essential in cases of persistent symptoms months after suffering a SARS-CoV-2 infection, despite negative test results.
An article by Dr. Mariano Bueno
Medical Director, BDH
Lyme Disease Expert
