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Orthostatic Intolerance in Long-Haul COVID after SARS-CoV-2: A Case-Control Comparison with Post-EBV and Insidious… (van Campen & Visser, 2022)

Orthostatic Intolerance in Long-Haul COVID after SARS-CoV-2: A Case-Control Comparison with Post-EBV and Insidious-Onset Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients


Background: As complaints of long-haul COVID patients are similar to those of ME/CFS patients and as orthostatic intolerance (OI) plays an important role in the COVID infection symptomatology, we compared 14 long-haul COVID patients with 14 ME/CFS patients with a post-viral Ebstein-Barr (EBV) onset and 14 ME/CFS patients with an insidious onset of the disease. Methods: In all patients, OI analysis by history taking and OI assessed during a tilt test, as well as cerebral blood flow measurements by extracranial Doppler, and cardiac index measurements by suprasternal Doppler during the tilt test were obtained in all patients. Results: Except for disease duration no differences were found in clinical characteristics. The prevalence of POTS was higher in the long-haul patients (100%) than in post-EBV (43%) and in insidious-onset (50%) patients (p = 0.0002). No differences between the three groups were present in the prevalence of OI, heart rate and blood pressure changes, changes in cerebral blood flow or in cardiac index during the tilt test. Conclusion: OI symptomatology and objective abnormalities of OI (abnormal cerebral blood flow and cardiac index reduction during tilt testing) are comparable to those in ME/CFS patients. It indicates that long-haul COVID is essentially the same disease as ME/CFS.

The study https://www.mdpi.com/2227-9032/10/10/2058


Senior Member
U.S., Earth
Thanks for posting this new (van Campen and Visser, 2022) publication!

For comparison with their other publications, see:

It's very interesting to see that it is part of a topical collection called "Why Some Patients Never Fully Recover: Post Active Phase of Infection Syndromes (PAPIS)":
Dear Colleagues,

With estimates of Long-haul COVID, also known as PASC (post-acute sequelae SARS-CoV-2 infection), increasing to above 30 percent of COVID-19 infected patients, it is time to recognize the existence of multiple Post Active Phase of Infection Syndromes (PAPIS) and focus attention on the appropriate mechanisms for diagnosing, treating and curing these devastating illnesses and their societal impact. The inventory of symptoms of Long-haul COVID-19 patients, many of whom never achieve pre-illness levels of wellness, is not unique to this chronic illness but echoes the symptoms of other post-acute phases of infection patients described in the medical literature. Examples of other illnesses that should be considered included are: Coxsackie B, Ebola, Epstein-Barr virus, Herpes viruses, myalgic encephalomyelitis/chronic fatigue syndrome,post-polio syndrome, and Zika virus. While the aforementioned are all viral infections, there is also an overlap of symptoms with conditions of non-viral origin such as chronic Lyme disease and untreated syphilis. Fungal infections, as well as chemical and other environmental sensitivities, may be additional triggers of PAPIS. This suggests that untreated and undertreated parasitic, viral and bacterial infections and other triggers should all be considered for study and comparison.

More productive research is urgently needed to enhance our understanding of the underlying pathophysiology or pathophysiologies of these conditions and to enable more effective patient care.

The intent of the PAPIS Topical Collection is broad. We welcome descriptions of syndromes satisfying the broad case definition of PAPIS, improved case definitions of the diseases satisfying the PAPIS criteria, proposed mechanisms of pathophysiology, outcomes of treatment trials and case reports of PAPIS diseases, and both pharmacological and non-pharmacological approaches to PAPIS patient management. Because of the unprecedented number of PAPIS patients anticipated worldwide in the wake of the COVID-19 pandemic, manuscripts concerning the economic, public health and societal experiences of PAPIS patients fall within the purview of the PAPIS Topical Collection.

Kenneth Friedman
Patricia A. Fennell
Derek F. H. Pheby
Evan Spivack
James M. Oleske
Nancy Klimas
Pawel Zalewski
Susan M. Levine
Collection Editors
(emphasis added)