How do you know if your breathlessness, fatigue and weakness are long Covid, post-TB lung disease, post-ICU syndrome or another disabling condition?
This is what the experts say about these diseases in South Africa, their prevalence and diagnosis. People suffering persistent symptoms need to consult a doctor.
Post-TB lung disease
UCT professor of respiratory medicine Keertan Dheda, who established the post-Covid lung disease clinic at Groote Schuur Hospital in July 2020, says patients attend their clinic because of “ongoing difficulty in breathing, shortness of breath, chest pain and fatigue and most of them have post-TB lung disease.
“There are millions of patients in South Africa with post-TB lung disease, which is far more common than Covid,” he notes.
TB remains the most common cause of death in South Africa
— Keertan Dheda, UCT professor of respiratory medicine
“Post-TB lung disease is the most common cause of pulmonary disability in South Africa, causing ongoing shortness of breath, poor effort tolerance, chronic cough etc.”
While the most common and severe symptoms are respiratory, Dheda says many patients suffer a range of symptoms, such as musculoskeletal pain and fatigue.
“TB remains the most common cause of death in South Africa, and there are about 400,000 new patients who are newly ill every year,” says Dheda, professor of mycobacteriology and global health at the London School of Hygiene and Tropical Medicine.
Post-ICU syndrome and other respiratory conditions
Pre-existing lung disease, structural damage to the lung and post-ICU syndrome can also contribute to distressing respiratory symptoms, says Dheda.
“This makes treatment complex. Thus therapy is not a one-size-fits-all. Post-ICU syndrome is a form of PTSD (post-traumatic stress disorder). Post-ICU syndrome is characterised by weakness, fatigue, difficulty in breathing and other symptoms.
“I see it in many patients who have been in the intensive care unit for a long time,” he says.
“It remains unclear how many of these chronic symptoms, both respiratory and non-respiratory, are exclusively due to Covid or may be seen in other severe infections and diseases, and especially those that have been in the ICU for whatever reason.”
Research test gives clue in long Covid diagnosis
Traditional lab tests cannot readily pick up long Covid, but a research test — developed by Stellenbosch University physiologist Prof Resia Pretorius and her team — offers hope to patients suffering devastating symptoms for months, even years, after being infected with the virus.
The Stellenbosch team have developed a test, which reveals abnormal microclot formations with inflammatory molecules trapped inside them, with the potential to diagnose long Covid.
Pretorius collaborated with Harvard, Yale, MIT and Mount Sinai and the findings have been published in peer-reviewed scientific journals, starting with Cardiovascular Diabetology.
She said the lingering tiny microclots and hyperactivated platelets (involved in clotting), found in the blood of long Covid patients, could be damaging tiny blood vessels and starving the body of oxygen — triggering a range of disabling symptoms.
Early in the pandemic, Pretorius started analysing the blood of acutely ill patients. She got samples from her collaboration with physician Dr Jaco Laubscher from Stellenbosch, who was treating patients with Covid-19.
Early in 2021, she began investigating the blood of long Covid patients, running a proteomics test. What she saw shining inside the test tube was unexpected.
“I rushed back to my side of campus to see what was happening in the samples under a fluorescent microscope,” she recalls.
In healthy adults, microclots in the blood show up as a few green specks under the fluorescent microscope. A galaxy of green flared in the blood samples of long Covid patients.
This microclot test, now patented, has potential therefore as a biomarker to diagnose long Covid.
For patients who test positive with it, Pretorius said that anticoagulant and antiplatelet regimens, and a dialysis-type treatment, are showing promising results.
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