Persistierende Beschwerden nach akuter COVID-19-Erkrankung: „Long-COVID“?

Was ist neu?

Prävalenz und Risikofaktoren Die Gesamthäufigkeit von Langzeitbeschwerden ist unklar. Als Risikofaktoren konnten bisher der Schweregrad der Akuterkrankung, weibliches Geschlecht und Grunderkrankungen identifiziert werden.

Klinik und Pathogenese Die Pathogenese ist nicht geklärt. Ebenso unbekannt ist die Prognose über den Verlauf der Beschwerden. Wichtig erscheint ein symptomgeleiteter Ausschluss von behandlungsbedürftigen Alternativdiagnosen. Für den Beschwerdekomplex gibt es bislang weder einen einheitlichen Begriff („Long-COVID“) noch eine einheitliche Definition. Häufig wird die Definition des NICE verwendet, das zwischen anhaltendem COVID-19 bei Beschwerden 4–12 Wochen bzw. einem Post-COVID-19-Syndrom mehr als 12 Wochen nach Akuterkrankung unterscheidet.

Eine verzögerte Rekonvaleszenz oder persistierende Beschwerden scheinen nach COVID-19 häufiger als nach anderen akuten Infektionskrankheiten aufzutreten und beinhalten vor allem ein Erschöpfungssyndrom mit Belastungsintoleranz, Brustschmerzen/Belastungsdyspnoe und verschiedene neurologische bzw. neuropsychiatrische Symptome.

Diagnostik und Therapie Diagnostik und Therapie sollten interdisziplinär erfolgen. Physiotherapie, psychologische/psychosomatische Anbindung und Möglichkeiten der Rehabilitation sollten erwogen werden. Insbesondere bei persistierender pulmonaler Symptomatik können Patienten von einer Rehabilitationsmaßnahme profitieren. Daten zur Effektivität einer Impfung im Sinne eine Beschwerdelinderung bei Long- COVID fehlen.

Persisting symptoms after COVID-19: „Long COVID“?

Some patients complain of persisting symptoms after acute COVID-19. There is no universal definition yet for these post-acute sequelae, also termed Long COVID. Although their prevalence remains to be established, a delayed recovery seems to be more common than after other acute infectious diseases. Common complaints include fatigue with exercise intolerance, dyspnea on exertion, chest pain, and neuropsychiatric symptoms. Female sex, comorbidities, and severity of the acute disease have been identified as risk factors for persisting symptoms. It is, however, important to highlight that they are not limited to patients after severe COVID-19. Whilst their pathogenesis and prognosis is largely unknown, diagnostic evaluation should focus on exclusion of objective organ dysfunctions. Due to the variable presentation, management is interdisciplinary and may include physiotherapy, rehabilitation programmes, and psychological support. This article aims to summarize the current – limited – evidence on persisting symptoms after COVID-19.

Schlüsselwörter

Long-COVID - COVID-19 - SARS-CoV-2 - Post-COVID Syndrom

Key words

Long-COVID - COVID-19 - SARS-CoV-2 - Post-COVID syndrome

Publication History

Article published online:
03 August 2021

• Literatur

• 1 National Institute for Health and Care Excellence (NICE). COVID-19 rapid guideline: managing the long-term effects of COVID-19. 2020. Im Internet: https://www.nice.org.uk/guidance/ng188
• 2 WHO Europe. In the wake of the pandemic: preparing for Long COVID (2021). Im Internet:(Stand: 01.03.2021) https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/publications-and-technical-guidance/2021/in-the-wake-of-the-pandemic-preparing-for-long-covid-2021
• 3 Lenzen-Schulte M. Long COVID: Der lange Schatten von COVID-19. Dtsch Arztebl International 2020; 117: A-2416
• 4 Jacobson KB, Rao M, Bonilla H. et al. Patients with uncomplicated COVID-19 have long-term persistent symptoms and functional impairment similar to patients with severe COVID-19: a cautionary tale during a global pandemic. Clinical Infectious Diseases 2021;
• 5 Huang C, Huang L, Wang Y. et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. The Lancet 2021; 397: 220-232
• 6 Frontera JA, Yang D, Lewis A. et al. A prospective study of long-term outcomes among hospitalized COVID-19 patients with and without neurological complications. Journal of the Neurological Sciences 2021; 426: 117486
• 7 Goërtz YMJ, Van Herck M, Delbressine JM. et al. Persistent symptoms 3 months after a SARS-CoV-2 infection: the post-COVID-19 syndrome?. ERJ Open Res 2020; 6
• 8 Bliddal S, Banasik K, Pedersen OB. et al. Acute and persistent symptoms in non-hospitalized PCR-confirmed COVID-19 patients. medRxiv 2021;
• 9 Augustin M, Schommers P, Stecher M. et al. Post-COVID syndrome in non-hospitalised patients with COVID-19: a longitudinal prospective cohort study. Lancet Reg Health Eur 2021; 6: 100122
• 10 Daugherty SE, Guo Y, Heath K. et al. Risk of clinical sequelae after the acute phase of SARS-CoV-2 infection: retrospective cohort study. BMJ 2021; 373: n1098
• 11 Nalbandian A, Sehgal K, Gupta A. et al. Post-acute COVID-19 syndrome. Nature Medicine 2021; 27: 601-615
• 12 Sudre CH, Murray B, Varsavsky T. et al. Attributes and predictors of long COVID. Nature Medicine 2021; 27: 626-631
• 13 Perlis RH, Green J, Santillana M. et al. Persistence of symptoms up to 10 months following acute COVID-19 illness. medRxiv 2021;
• 14 Carfì A, Bernabei R, Landi F. et al. Persistent Symptoms in Patients After Acute COVID-19. JAMA 2020; 324: 603
• 15 Sonnweber T, Sahanic S, Pizzini A. et al. Cardiopulmonary recovery after COVID-19 – an observational prospective multi-center trial. Eur Respir J 2020;
• 16 Marx V. Scientists set out to connect the dots on long COVID. Nature Methods 2021; 1-5
• 17 Kondratiuk AL, Pillay TD, Kon OM. et al. A conceptual framework to accelerate the clinical impact of evolving research into long COVID. The Lancet Infectious Diseases 2021;
• 18 Herridge MS, Tansey CM, Matté A. et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med 2011; 364: 1293-1304
• 19 van den Borst B, Peters JB, Brink M. et al. Comprehensive health assessment three months after recovery from acute COVID-19. Clinical Infectious Diseases 2020;
• 20 Townsend L, Dyer AH, Jones K. et al. Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection. PLOS ONE 2020; 15: e0240784
• 21 Del Brutto OH, Wu S, Mera RM. et al. Cognitive decline among individuals with history of mild symptomatic SARS-CoV-2 infection: A longitudinal prospective study nested to a population cohort. Eur J Neurol 2021;
• 22 Raman B, Cassar MP, Tunnicliffe EM. et al. Medium-term effects of SARS-CoV-2 infection on multiple vital organs, exercise capacity, cognition, quality of life and mental health, post-hospital discharge. EClinicalMedicine 2021; 31: 100683
• 23 Buchwald DS, Rea TD, Katon WJ. et al. Acute infectious mononucleosis: characteristics of patients who report failure to recover. The American Journal of Medicine 2000; 109: 531-537
• 24 Waterer G. Recovery from community acquired pneumonia: the view from the top of the iceberg. Eur Respir J 2017; 49: 1700571
• 25 Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Pressemitteilung: DGP: Long-COVID: Leitlinie zur Diagnostik und Therapie auf dem Weg. 18. März 2021. Im Internet: https://idw-online.de/de/news?print=1&id=765168
• 26 Greenhalgh T, Knight M, A’Court C. et al. Management of post-acute covid-19 in primary care. BMJ 2020; m3026
• 27 Ärzteblatt DÄG Redaktion Deutsches. AWMF-Leitlinie: Rehabilitation nach einer COVID-19-Erkrankung. Deutsches Ärzteblatt 2021. Im Internet: (Stand: 21.04.2021) https://www.aerzteblatt.de/archiv/218662/AWMF-Leitlinie-Rehabilitation-nach-einer-COVID-19-Erkrankung
• 28 Meeting the psychological needs of people recovering from severe coronavirus | BPS. Im Internet: (Stand: 04.05.2021) https://www.bps.org.uk/coronavirus-resources/professional/psychological-needs-recovering-severe-coronavirus
• 29 Whitaker M, Elliott J, Chadeau-Hyam M. et al Persistent symptoms following SARS-CoV-2 infection in a random community sample of 508,707 people. 2021 Im Internet: (Stand: 29.06.2021) http://spiral.imperial.ac.uk/handle/10044/1/89844
• 30 Petersen MS, Kristiansen MF, Hanusson KD. et al. Long COVID in the Faroe Islands – a longitudinal study among non-hospitalized patients. Clin Infect Dis 2020;
• 31 Blomberg B, Mohn KGI, Brokstad KA. et al. Long COVID in a prospective cohort of home-isolated patients. Nat Med 2021; 1-7
• 32 Menges D, Ballouz T, Anagnostopoulos A. et al. Burden of Post-COVID-19 Syndrome and Implications for Healthcare Service Planning: A Population-based Cohort Study. medRxiv 2021;
• 33 Havervall S, Rosell A, Phillipson M. et al. Symptoms and Functional Impairment Assessed 8 Months After Mild COVID-19 Among Health Care Workers. JAMA 2021;