Skip to main content Skip to main navigation menu Skip to site footer

Recent update on long COVID syndrome: Immunopathogenesis and clinical consequences

  • Gatot Soegiarto ,
  • Kenneth Martino Djajapranata ,


Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in a global pandemic with millions of confirmed cases. Despite the majority of patients recovered from the acute infection, a subset of individuals experiences persistent symptoms known as long COVID, creating a distinctive clinical entity. Immunopathogenesis emerges as a central player in the intricate web of long-term COVID, involving chronic inflammation, autoantibody formation, and sustained viral presence. The syndrome manifests across diverse organ systems, with neurological, cardiovascular, and musculoskeletal implications. Prolonged lung damage and neurological sequelae significantly contribute to the broad spectrum of symptoms observed, ranging from dyspnea to cognitive impairment. Although the understanding of long COVID continues to evolve, navigating the epidemiology of long COVID remains challenging due to varied definitions and study populations among published studies. In addition, various risk factors, encompassing age, gender, comorbidities, and initial COVID-19 symptomatology, further contribute to the complexity of long COVID. Therefore, this review aims to comprehensively explore long COVID in terms of its definition, epidemiology, recent insights into immunopathogenesis, clinical manifestations, underlying mechanisms, and possible management of long COVID syndrome.


  1. WHO. Coronavirus (COVID-19) Dashboard 2023. Available from: accessed January 6 2023.
  2. Cao Y, Hiyoshi A, Montgomery S. COVID-19 case-fatality rate and demographic and socioeconomic influencers: worldwide spatial regression analysis based on country-level data. BMJ open. 2020;10(11):e043560.
  3. Center for Disease Control and Prevention. Long COVID or Post-COVID Conditions 2022. Available from: accessed January 6 2023.
  4. O'Mahoney LL, Routen A, Gillies C, et al. The prevalence and long-term health effects of Long Covid among hospitalised and non-hospitalised populations: A systematic review and meta-analysis. EClinicalMedicine. 2023;55:101762.
  5. Staffolani S, Iencinella V, Cimatti M, et al. Long COVID syndrome as a fourth phase of SARS-CoV-2 infection. Le Infezioni in Medicina. 2022;30(1):22-29.
  6. Nalbandian A, Sehgal K, Gupta A, et al. Post-acute COVID-19 syndrome. Nature medicine. 2021;27(4):601-15.
  7. Maltezou HC, Pavli A, Tsakris A. Post-COVID syndrome: an insight on its pathogenesis. Vaccines. 2021;9(5):497.
  8. Peluso MJ, Deeks SG. Early clues regarding the pathogenesis of long-COVID. Trends in immunology. 2022;43(4):268-70.
  9. Castanares-Zapatero D, Chalon P, Kohn L, et al. Pathophysiology and mechanism of long COVID: a comprehensive review. Annals of medicine. 2022;54(1):1473-87.
  10. Raveendran A, Jayadevan R, Sashidharan S. Long COVID: an overview. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2021;15(3):869-75.
  11. Proal AD, VanElzakker MB. Long COVID or post-acute sequelae of COVID-19 (PASC): an overview of biological factors that may contribute to persistent symptoms. Frontiers in microbiology. 2021;12:1494.
  12. WHO. Post COVID-19 condition (Long COVID) 2023. Available from: condition#:~:text=It%20is%20defined%20as%20the,months%20with%20no%20other%20explanation. accessed January 6 2023.
  13. Sivan M, Taylor S. NICE guideline on long covid: British Medical Journal Publishing Group, 2020;9(2):129.
  14. Ojo AS, Balogun SA, Williams OT, et al. Pulmonary fibrosis in COVID-19 survivors: Predictive factors and risk reduction strategies. Pulmonary medicine 2020;2020
  15. Crook H, Raza S, Nowell J, et al. Long covid—mechanisms, risk factors, and management. BMJ. 2021;374:n1944
  16. Chen C, Haupert SR, Zimmermann L, et al. Global prevalence of post-coronavirus disease 2019 (COVID-19) condition or long COVID: a meta-analysis and systematic review. The Journal of infectious diseases. 2022;226(9):1593-607.
  17. Yong SJ. Long COVID or post-COVID-19 syndrome: putative pathophysiology, risk factors, and treatments. Infectious diseases. 2021;53(10):737-54.
  18. Zhang B-Z, Chu H, Han S, et al. SARS-CoV-2 infects human neural progenitor cells and brain organoids. Cell research. 2020;30(10):928-31.
  19. Lukiw WJ, Pogue A, Hill JM. SARS-CoV-2 infectivity and neurological targets in the brain. Cellular and molecular neurobiology. 2022;42:217-24.
  20. Matschke J, Lütgehetmann M, Hagel C, et al. Neuropathology of patients with COVID-19 in Germany: a post-mortem case series. The Lancet Neurology. 2020;19(11):919-29.
  21. von Weyhern CH, Kaufmann I, Neff F, et al. Early evidence of pronounced brain involvement in fatal COVID-19 outcomes. The Lancet. 2020;395(10241):e109.
  22. Paterson RW, Brown RL, Benjamin L, et al. The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings. Brain. 2020;143(10):3104-20.
  23. Batiha GE-S, Al-Kuraishy HM, Al-Gareeb AI, et al. Pathophysiology of Post-COVID syndromes: a new perspective. Virology Journal. 2022;19(1):158.
  24. Umesh A, Pranay K, Pandey RC, et al. Evidence mapping and review of long-COVID and its underlying pathophysiological mechanism. Infection. 2022;50(5):1053-66.
  25. Puntmann VO, Carerj ML, Wieters I, et al. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19). JAMA cardiology. 2020;5(11):1265-73.
  26. Carfì A, Bernabei R, Landi F. Persistent symptoms in patients after acute COVID-19. Jama. 2020;324(6):603-05.
  27. Dennis A, Wamil M, Alberts J, et al. Multiorgan impairment in low-risk individuals with post-COVID-19 syndrome: a prospective, community-based study. BMJ open. 2021;11(3):e048391.
  28. Garrigues E, Janvier P, Kherabi Y, et al. Post-discharge persistent symptoms and health-related quality of life after hospitalization for COVID-19. Journal of Infection. 2020;81(6):e4-e6.
  29. Carmo A, Pereira‐Vaz J, Mota V, et al. Clearance and persistence of SARS‐CoV‐2 RNA in patients with COVID‐19. Journal of medical virology. 2020;92(10):2227-31.
  30. Vibholm LK, Nielsen SS, Pahus MH, et al. SARS-CoV-2 persistence is associated with antigen-specific CD8 T-cell responses. EBioMedicine. 2021;64:103230.
  31. Wang X, Huang K, Jiang H, et al. Long-term existence of SARS-CoV-2 in COVID-19 patients: host immunity, viral virulence, and transmissibility. Virologica Sinica. 2020;35:793-802.
  32. Lamers MM, Beumer J, van der Vaart J, et al. SARS-CoV-2 productively infects human gut enterocytes. Science. 2020;369(6499):50-54.
  33. Wu Y, Guo C, Tang L, et al. Prolonged presence of SARS-CoV-2 viral RNA in faecal samples. The lancet Gastroenterology & hepatology. 2020;5(5):434-35.
  34. Xu Y, Li X, Zhu B, et al. Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding. Nature medicine. 2020;26(4):502-05.
  35. Chen Y, Chen L, Deng Q, et al. The presence of SARS‐CoV‐2 RNA in the feces of COVID‐19 patients. Journal of medical virology. 2020;92(7):833-40.
  36. Yeoh YK, Zuo T, Lui GC-Y, et al. Gut microbiota composition reflects disease severity and dysfunctional immune responses in patients with COVID-19. Gut. 2021;70(4):698-706.
  37. Venzon M, Bernard-Raichon L, Klein J, et al. Gut microbiome dysbiosis during COVID-19 is associated with increased risk for bacteremia and microbial translocation. Biorxiv. 2021;RS3:726620.
  38. Liu Q, Mak JWY, Su Q, et al. Gut microbiota dynamics in a prospective cohort of patients with post-acute COVID-19 syndrome. Gut 2022;71(3):544-52.
  39. Xu R, Zhou Y, Cai L, et al. Co‐Reactivation of Human Herpesvirus alpha Subfamily (HSV Ⅰ and VZV) in Critically Ill Patient with COVID‐19. The British Journal of Dermatology. 2020;183(6):1145-1147.
  40. Simonnet A, Engelmann I, Moreau A-S, et al. High incidence of Epstein–Barr virus, cytomegalovirus, and human-herpes virus-6 reactivations in critically ill patients with COVID-19. Infectious Diseases Now. 2021;51(3):296-99.
  41. Luyt C-E, Burrel S, Mokrani D, et al. Herpesviridae lung reactivation and infection in patients with severe COVID-19 or influenza virus pneumonia: a comparative study. Annals of Intensive Care. 2022;12(1):1-11.
  42. Shim C-H, Cho S, Shin Y-M, et al. Emerging role of bystander T cell activation in autoimmune diseases. BMB reports. 2022;55(2):57-64.
  43. Zhou Y, Han T, Chen J, et al. Clinical and autoimmune characteristics of severe and critical cases of COVID‐19. Clinical and translational science 2020;13(6):1077-86.
  44. Gao Z-w, Zhang H-z, Liu C, et al. Autoantibodies in COVID-19: frequency and function. Autoimmunity Reviews 2021;20(3):102754.
  45. Vlachoyiannopoulos PG, Magira E, Alexopoulos H, et al. Autoantibodies related to systemic autoimmune rheumatic diseases in severely ill patients with COVID-19. Annals of the Rheumatic Diseases. 2020;79(12):1661-1663.
  46. Asadi-Pooya AA, Akbari A, Emami A, et al. Risk factors associated with long COVID syndrome: a retrospective study. Iranian journal of medical sciences. 2021;46(6):428.
  47. Tenforde MW, Kim SS, Lindsell CJ, et al. Symptom duration and risk factors for delayed return to usual health among outpatients with COVID-19 in a multistate health care systems network—United States, March–June 2020. Morbidity and mortality weekly report. 2020;69(30):993.
  48. Subramanian A, Nirantharakumar K, Hughes S, et al. Symptoms and risk factors for long COVID in non-hospitalized adults. Nat Med. 2022;28(8):1706-1714.
  49. Ford E, Parfitt H, McCheyne I, et al. Risk factors and symptom clusters for Long Covid: analysis of United Kingdom symptom tracker app data. medRxiv 2022:2022.11. 14.22282285.
  50. Osmanov IM, Spiridonova E, Bobkova P, et al. Risk factors for post-COVID-19 condition in previously hospitalised children using the ISARIC Global follow-up protocol: a prospective cohort study. European Respiratory Journal. 2022;59(2):2101341.
  51. Mehandru S, Merad M. Pathological sequelae of long-haul COVID. Nature immunology. 2022;23(2):194-202.
  52. Yanti B, Asril AR, Hajar S. The relationship between disease severity and functional status of post-covid-19 patients in Banda Aceh, Indonesia. J Ners. 2022;17(2):176-82.
  53. UK Office for National Statistics. Prevalence of long COVID symptoms and COVID-19 complications. 2020.
  54. Kempuraj D, Selvakumar GP, Ahmed ME, et al. COVID-19, mast cells, cytokine storm, psychological stress, and neuroinflammation. The Neuroscientist. 2020;26(5-6):402-14.
  55. Ackermann M, Verleden SE, Kuehnel M, et al. Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in Covid-19. New England Journal of Medicine. 2020;383(2):120-28.
  56. Wei J, Yang H, Lei P, et al. Analysis of thin-section CT in patients with coronavirus disease (COVID-19) after hospital discharge. Journal of X-ray Science and Technology. 2020;28(3):383-89.
  57. Tanni SE, Fabro AT, de Albuquerque A, et al. Pulmonary fibrosis secondary to COVID-19: a narrative review. Expert review of respiratory medicine. 2021;15(6):791-803.
  58. Alipoor SD, Jamaati H, Tabarsi P, et al. Immunopathogenesis of Pneumonia in COVID-19. Tanaffos. 2020;19(2):79.
  59. Maranatha D, Hasan H, Bakhtiar A, et al. Association of TNF-α, TGF-β1, amphiregulin, IL-2, and EGFR with pulmonary fibrosis in COVID-19. Journal of Infection and Public Health. 2022;15(10):1072-75.
  60. Bharat A, Querrey M, Markov NS, et al. Lung transplantation for patients with severe COVID-19. Science Translational Medicine. 2020;12(574):eabe4282.
  61. Coker R, Laurent G, Jeffery P, et al. Localisation of transforming growth factor β1 and β3 mRNA transcripts in normal and fibrotic human lung. Thorax. 2001;56(7):549.
  62. Solomon JJ, Heyman B, Ko JP, et al. CT of post-acute lung complications of COVID-19. Radiology. 2021;301(2):E383-E95.
  63. Motiejunaite J, Balagny P, Arnoult F, et al. Hyperventilation: a possible explanation for long-lasting exercise intolerance in mild COVID-19 survivors? Frontiers in physiology. 2021;11:1856.
  64. Dani M, Dirksen A, Taraborrelli P, et al. Autonomic dysfunction in ‘long COVID’: rationale, physiology and management strategies. Clinical Medicine. 2021;21(1):e63.
  65. Yong SJ. Persistent brainstem dysfunction in long-COVID: a hypothesis. ACS chemical neuroscience. 2021;12(4):573-80.
  66. Maranatha D, Rahardjo P, Lusman R. Evolution of chest CT scan manifestations in a patient recovered from COVID-19 severe pneumonia with acute respiratory distress syndrome. Respiratory Medicine Case Reports. 2021;32:101342.
  67. Udwadia ZF, Koul PA, Richeldi L. Post-COVID lung fibrosis: The tsunami that will follow the earthquake. Lung India: Official Organ of Indian Chest Society. 2021;38(Suppl 1):S41.
  68. National Institute for Health and Care Excellence. COVID-19 rapid guideline: managing the long-term effects of COVID-19 NICE guideline 2020. Available from:
  69. Greenhalgh T, Knight M. Long COVID: a primer for family physicians. American family physician. 2020;102(12):716-17.
  70. Wang TJ, Chau B, Lui M, et al. Physical Medicine and Rehabilitation and pulmonary rehabilitation for COVID-19. American journal of physical medicine & rehabilitation. 2020
  71. Liu K, Zhang W, Yang Y, et al. Respiratory rehabilitation in elderly patients with COVID-19: A randomized controlled study. Complementary therapies in clinical practice. 2020;39:101166.
  72. Yachou Y, El Idrissi A, Belapasov V, et al. Neuroinvasion, neurotropic, and neuroinflammatory events of SARS-CoV-2: understanding the neurological manifestations in COVID-19 patients. Neurological Sciences. 2020;41:2657-69.
  73. Moriguchi T, Harii N, Goto J, et al. A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. International journal of infectious diseases. 2020;94:55-58.
  74. Lu Y, Li X, Geng D, et al. Cerebral micro-structural changes in COVID-19 patients–an MRI-based 3-month follow-up study. EClinicalMedicine. 2020;25:100484.
  75. Needham EJ, Chou SH-Y, Coles AJ, et al. Neurological implications of COVID-19 infections. Neurocritical care. 2020;32:667-71.
  76. Tomasoni D, Bai F, Castoldi R, et al. Anxiety and depression symptoms after virological clearance of COVID‐19: a cross‐sectional study in Milan, Italy. Journal of medical virology. 2021;93(2):1175-79.
  77. Mazza MG, De Lorenzo R, Conte C, et al. Anxiety and depression in COVID-19 survivors: Role of inflammatory and clinical predictors. Brain, behavior, and immunity. 2020;89:594-600.
  78. Chamberlain SR, Grant JE, Trender W, et al. Post-traumatic stress disorder symptoms in COVID-19 survivors: online population survey. BJPsych open. 2021;7(2):e47.
  79. Taquet M, Luciano S, Geddes JR, et al. Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA. The Lancet Psychiatry. 2021;8(2):130-40.
  80. Fahriani M, Ilmawan M, Fajar JK, et al. Persistence of long COVID symptoms in COVID-19 survivors worldwide and its potential pathogenesis-a systematic review and meta-analysis. Narra J. 2021;1(2):1-7.
  81. Bansal R, Gubbi S, Koch CA. COVID-19 and chronic fatigue syndrome: An endocrine perspective. Journal of Clinical & Translational Endocrinology. 2022;27:100284.
  82. Salamanna F, Veronesi F, Martini L, et al. Post-COVID-19 syndrome: the persistent symptoms at the post-viral stage of the disease. A systematic review of the current data. Frontiers in medicine. 2021:392.
  83. Morgul E, Bener A, Atak M, et al. COVID-19 pandemic and psychological fatigue in Turkey. International Journal of Social Psychiatry. 2021;67(2):128-35.
  84. Brooks SK, Webster RK, Smith LE, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The lancet. 2020;395(10227):912-20.
  85. Wostyn P. COVID-19 and chronic fatigue syndrome: Is the worst yet to come? Medical hypotheses. 2021;146:110469.
  86. Karlsson AC, Humbert M, Buggert M. The known unknowns of T cell immunity to COVID-19. Science Immunology. 2020;5(53):eabe8063.
  87. Ameres M, Brandstetter S, Toncheva AA, et al. Association of neuronal injury blood marker neurofilament light chain with mild-to-moderate COVID-19. Journal of neurology. 2020;267:3476-78.
  88. Guedj E, Million M, Dudouet P, et al. 18 F-FDG brain PET hypometabolism in post-SARS-CoV-2 infection: substrate for persistent/delayed disorders? European journal of nuclear medicine and molecular imaging. 2021;48:592-95.
  89. Delorme C, Paccoud O, Kas A, et al. COVID‐19‐related encephalopathy: a case series with brain FDG‐positron‐emission tomography/computed tomography findings. European journal of neurology. 2020;27(12):2651-57.
  90. Gerwyn M, Maes M. Mechanisms explaining muscle fatigue and muscle pain in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): A review of recent findings. Current rheumatology reports. 2017;19:1-10.
  91. Theoharides TC, Cholevas C, Polyzoidis K, et al. Long‐COVID syndrome‐associated brain fog and chemofog: Luteolin to the rescue. Biofactors. 2021;47(2):232-41.
  92. Sollini M, Morbelli S, Ciccarelli M, et al. Long COVID hallmarks on [18F] FDG-PET/CT: a case-control study. European Journal of Nuclear Medicine and Molecular Imaging. 2021;48:3187-97.
  93. Blazhenets G, Schroeter N, Bormann T, et al. Slow but evident recovery from neocortical dysfunction and cognitive impairment in a series of chronic COVID-19 patients. Journal of Nuclear Medicine. 2021;62(7):910-15.
  94. Vargas G, Geraldo LHM, Salomão NG, et al. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and glial cells: Insights and perspectives. Brain, behavior, & immunity-health. 2020;7:100127.
  95. Murta V, Villarreal A, Ramos AJ. Severe acute respiratory syndrome coronavirus 2 impact on the central nervous system: are astrocytes and microglia main players or merely bystanders? ASN neuro, 2020;12:1759091420954960.
  96. Shaik-Dasthagirisaheb YB, Conti P. The role of mast cells in Alzheimer’s disease. Adv Clin Exp Med. 2016;25(4):781-7.
  97. Kempuraj D, Mentor S, Thangavel R, et al. Mast cells in stress, pain, blood-brain barrier, neuroinflammation and Alzheimer’s disease. Frontiers in cellular neuroscience 2019;13:54.
  98. Hansen DV, Hanson JE, Sheng M. Microglia in Alzheimer’s disease. Journal of Cell Biology. 2018;217(2):459-72.
  99. Zhang X, Dong H, Li N, et al. Activated brain mast cells contribute to postoperative cognitive dysfunction by evoking microglia activation and neuronal apoptosis. Journal of Neuroinflammation. 2016;13(1):1-15.
  100. Fajar JK, Ilmawan M, Mamada S, et al. Global prevalence of persistent neuromuscular symptoms and the possible pathomechanisms in COVID-19 recovered individuals: A systematic review and meta-analysis. Narra J. 2021;1(3):1-8.
  101. Afrin LB, Weinstock LB, Molderings GJ. Covid-19 hyperinflammation and post-Covid-19 illness may be rooted in mast cell activation syndrome. International journal of infectious diseases. 2020;100:327-32.
  102. Kazama I. Stabilizing mast cells by commonly used drugs: a novel therapeutic target to relieve post-COVID syndrome? Drug discoveries & therapeutics. 2020;14(5):259-61.
  103. Weinstock LB, Brook JB, Walters AS, et al. Mast cell activation symptoms are prevalent in Long-COVID. International Journal of Infectious Diseases. 2021;112:217-26.
  104. Glynne P, Tahmasebi N, Gant V, et al. Long COVID following mild SARS-CoV-2 infection: characteristic T cell alterations and response to antihistamines. Journal of Investigative Medicine. 2022;70(1):61-67.
  105. Zheng Y-Y, Ma Y-T, Zhang J-Y, et al. COVID-19 and the cardiovascular system. Nature reviews cardiology. 2020;17(5):259-60.
  106. Yong SJ, Liu S. Proposed subtypes of post‐COVID‐19 syndrome (or long‐COVID) and their respective potential therapies. Reviews in medical virology. 2022;32(4):e2315.
  107. Blitshteyn S, Whitelaw S. Postural orthostatic tachycardia syndrome (POTS) and other autonomic disorders after COVID-19 infection: a case series of 20 patients. Immunologic research. 2021;69(2):205-11.
  108. Shouman K, Vanichkachorn G, Cheshire WP, et al. Autonomic dysfunction following COVID-19 infection: an early experience. Clinical Autonomic Research. 2021;31:385-94.
  109. Rajpal S, Tong MS, Borchers J, et al. Cardiovascular magnetic resonance findings in competitive athletes recovering from COVID-19 infection. JAMA cardiology. 2021;6(1):116-18.
  110. Wallukat G, Hohberger B, Wenzel K, et al. Functional autoantibodies against G-protein coupled receptors in patients with persistent Long-COVID-19 symptoms. Journal of Translational Autoimmunity. 2021;4:100100.
  111. Karas B, Grubb BP, Boehm K, et al. The postural orthostatic tachycardia syndrome: a potentially treatable cause of chronic fatigue, exercise intolerance, and cognitive impairment in adolescents. Pacing and Clinical Electrophysiology. 2000;23(3):344-51.
  112. Raj SR. Postural tachycardia syndrome (POTS). Circulation. 2013;127(23):2336-42.
  113. Goldstein DS. The possible association between COVID-19 and postural tachycardia syndrome. Heart rhythm. 2021;18(4):508-09.
  114. Lopez-Leon S, Wegman-Ostrosky T, Perelman C, et al. More than 50 long-term effects of COVID-19: a systematic review and meta-analysis. Scientific reports. 2021;11(1):16144.
  115. Sheldon RS, Grubb II BP, Olshansky B, et al. 2015 heart rhythm society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. Heart rhythm. 2015;12(6):e41-e63.
  116. Fu Q, Levine BD. Exercise and non-pharmacological treatment of POTS. Autonomic neuroscience. 2018;215:20-27.
  117. Ormiston CK, Świątkiewicz I, Taub PR. Postural orthostatic tachycardia syndrome as a sequela of COVID-19. Heart Rhythm. 2022;19(11):1880-89.
  118. National Institute for Health and Care Excellence. Stable angina: management clinical guideline 2016. Available from: Guidance/CG126.
  119. National Institute for Health and Care Excellence. Atrial fibrillation: diagnosis and management NICE guideline 2021. Available from: https://www.nice.
  120. National Institute for Health and Care Excellence. Acute coronary syndromes NICE guideline 2020. Available from: guidance/ng185.
  121. Raj SR, Black BK, Biaggioni I, et al. Propranolol decreases tachycardia and improves symptoms in the postural tachycardia syndrome: less is more. Circulation. 2009;120:725–34.
  122. Roberts LN, Whyte MB, Georgiou L, et al. Postdischarge venous thromboembolism following hospital admission with COVID-19. Blood, The Journal of the American Society of Hematology. 2020;136(11):1347-50.
  123. Salisbury R, Iotchkova V, Jaafar S, et al. Incidence of symptomatic, image-confirmed venous thromboembolism following hospitalization for COVID-19 with 90-day follow-up. Blood advances. 2020;4(24):6230-39.
  124. Zuin M, Engelen MM, Barco S, et al. Incidence of venous thromboembolic events in COVID-19 patients after hospital discharge: A systematic review and meta-analysis. Thrombosis research. 2022;209:94-98.
  125. Adeghate EA, Eid N, Singh J. Mechanisms of COVID-19-induced heart failure: a short review. Heart failure reviews. 2021;26:363-69.
  126. Becker RC. COVID-19 update: Covid-19-associated coagulopathy. Journal of thrombosis and thrombolysis. 2020;50(1):54-67.
  127. Bikdeli B, Madhavan MV, Jimenez D, et al. COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up: JACC state-of-the-art review. Journal of the American college of cardiology. 2020;75(23):2950-73.
  128. Hull RD, Schellong SM, Tapson VF, et al. Extended-duration venous thromboembolism prophylaxis in acutely ill medical patients with recently reduced mobility: a randomized trial. Annals of internal medicine. 2010;153(1):8-18.
  129. Khoja O, Silva Passadouro B, Mulvey M, et al. Clinical characteristics and mechanisms of musculoskeletal pain in long COVID. Journal of Pain Research. 2022:1729-48.
  130. Perrot S, Cohen M, Barke A, et al. The IASP classification of chronic pain for ICD-11: chronic secondary musculoskeletal pain. Pain. 2019;160(1):77-82.
  131. Fernández-de-Las-Peñas C, Gómez-Mayordomo V, Cuadrado ML, et al. The presence of headache at onset in SARS-CoV-2 infection is associated with long-term post-COVID headache and fatigue: A case-control study. Cephalalgia. 2021;41(13):1332-41.
  132. Karaarslan F, Güneri FD, Kardeş S. Long COVID: rheumatologic/musculoskeletal symptoms in hospitalized COVID-19 survivors at 3 and 6 months. Clinical rheumatology. 2022;41:289-96.
  133. Sykes DL, Holdsworth L, Jawad N, et al. Post-COVID-19 symptom burden: what is long-COVID and how should we manage it?. Lung. 2021;199:113-19.
  134. Graham EL, Clark JR, Orban ZS, et al. Persistent neurologic symptoms and cognitive dysfunction in non‐hospitalized Covid‐19 “long haulers”. Annals of clinical and translational neurology. 2021;8(5):1073-85.
  135. Kim D-Y, Lee J-S, Park S-Y, et al. Systematic review of randomized controlled trials for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). Journal of translational medicine. 2020;18(1):1-12.
  136. Castro‐Marrero J, Sáez‐Francàs N, Santillo D, et al. Treatment and management of chronic fatigue syndrome/myalgic encephalomyelitis: all roads lead to Rome. British journal of pharmacology. 2017;174(5):345-69.
  137. Falk Hvidberg M, Brinth LS, Olesen AV, et al. The health-related quality of life for patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). PloS one. 2015;10(7):e0132421.
  138. Puspita N, Mcgiani HQDQ. Aspects of quality of life impacted on patients with prolonged covid-19 symptoms (long COVID). Periodic Epidemiology Journal/Jurnal Berkala Epidemiologi. 2023;11(3):1-8.
  139. Koc HC, Xiao J, Liu W, et al. Long COVID and its Management. International Journal .of Biological Sciences. 2022;18(12):4768.
  140. Nurek M, Rayner C, Freyer A, et al. Recommendations for the recognition, diagnosis, and management of long COVID: a Delphi study. British Journal of General Practice. 2021;71(712):e815-e25.
  141. Chopra C, Steele C, Thomas M, et al. Managing The long-term effects of COVID-19, 2021.
  142. National Institute for Health and Care Excellence. COVID-19 rapid guideline: managing the long-term effects of COVID-19; 2020.
  143. Naureen Z, Dautaj A, Nodari S, et al. Proposal of a food supplement for the management of post-COVID syndrome. European Review for Medical & Pharmacological Sciences. 2021;25(1):1-8.
  144. Rossetti M, Martucci G, Starchl C, et al. Micronutrients in sepsis and COVID-19: a narrative review on what we have learned and what we want to know in future trials. Medicina.. 2021;57(5):419.
  145. Peterson CT, Rodionov DA, Osterman AL, et al. B vitamins and their role in immune regulation and cancer. Nutrients. 2020;12(11):3380.
  146. Carr AC, Maggini S. Vitamin C and immune function. Nutrients. 2017;9(11):1211-119.

How to Cite

Soegiarto, G., & Djajapranata, K. M. . (2024). Recent update on long COVID syndrome: Immunopathogenesis and clinical consequences. Bali Medical Journal, 13(1), 840–849.




Search Panel

Gatot Soegiarto
Google Scholar
BMJ Journal

Kenneth Martino Djajapranata
Google Scholar
BMJ Journal