A 47 year old Male, known with type II diabetes mellitus, on oral hypoglycemics, previous lumbar spine fusion, developed acute Covid-19 infection confirmed on throat swab PCR, 30 December 2020. He did not report prior asthma or lung pathology
Symptoms
His symptoms included fever, generalised body weakness, extreme fatigue, dry cough, loss of taste and post nasal drip, with nasal congestion and severe shortness of breath with exertion. Lower back pain was also reported worsening with prolonged immobility. His cough, fatigue and nasal congestion persisted despite antibiotics, oxygen saturation above 95 percent with home pulse oximeter, not requiring oxygen therapy.
Treatment
He was treated empirically with Vitamin C, Paracetamol for fever, nasal decongestants, Azithromycin, Zinc and oral fluids as an outpatient.
Examination
Clinical and neurological examination demonstrated nasal speech, with Grade 3 Dyspnea, and no meningism or sinus tenderness. He remained apyrexial
Investigations
Inflammatory markers including CRP mildly elevated at 5.5, White cell count and coagulation screen including D Dimer, normal. ECG and cardiac markers normal. Chest radiograph demonstrated basal pneumonia changes
Photobiomodulation therapy protocol
Photobiomodulation therapy (PBMT) was commenced on day 18 of the illness over the chest, anterior and posteriorly, using Red and Near Infrared light therapy, frequencies ranging from 100 – 1000Hz over 4 days. PBMT was also applied to the carotid arteries at low frequencies of 50Hz and lumbar spine region in view of the lower pain back reported.
Results
Fatigue Assessment Scale (FAS) prior to therapy 34, and upon completion of PBMT reduced to 24, on Day 4, and 20 on Day 7 following photobiomodulation therapy.
The minimum score = 10 and maximum score possible = 50, Higher the score = greater fatigue severity. A total FAS score < 22 indicates no fatigue, a score ≥ 22 indicates fatigue
In addition to his fatigue resolving, his cough, shortness of breath and nasal congestion also resolved. He was able to have an uninterrupted sleep since commencing PBMT. This patient responded dramatically to 4 days of PBMT with resolution of his symptoms, to date.
Discussion
Photobiomodulation therapy has been shown to modulate inflammation in many conditions including rheumatoid and osteoarthritis, auto immune disorders, including lung disorders such as chronic obstructive pulmonary disease (COPD). PBMT has also been documented to be effective in case reports with patients suffering from Covid-19 related illnesses in the acute setting. The mechanisms are highlighted in the diagram attached, with reduction of pro-inflammatory cytokines, enhanced anti inflammatory cytokine release and energy production on the form of ATP via cytochrome C oxidase activation in the mitochondrial membrane.
These symptoms are well characterized as the Post Covid syndrome, including,
– Fatigue – Difficulty breathing – Joint pain – Chest pain
Post Covid Syndrome
Post-COVID syndrome is a new, unique phenomenon, and we’re still learning about it. But we know its symptoms, particularly the extreme fatigue, can have huge downstream effects on a person’s quality of life, impacting family life and work productivity.
It is not known why some peoples recovery is prolonged.
Postulated mechanisms, in Post Covid Syndrome, include
Persistent viraemia (due to weak or absent antibody response)
Relapse or Reinfection,
Inflammatory andother Immune reactions,
Deconditioning, and
Mental factors such as post-traumatic stress may all contribute.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has speculated that long COVID likely is the same as or very similar to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).
ME/CFS can be triggered by other infectious illnesses — such as mononucleosis, Lyme disease, or severe acute respiratory syndrome (SARS), another coronavirus disease.
Before the pandemic, the National Academy of Medicine estimated that as many as 2.5 million people in the US are living with ME/CFS.
For those suffering with these persistent inflammatory based symptoms, consider an alternative, non-invasive, non-thermal approach with Photobiomodulation therapy.
For further information, contact us at the Durban Neuro Laser Clinic
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