Post-viral physical exhaustion

Specialty: General.

• prolonged post-viral fatigue
• post-infectious asthenia
• post-viral residual fatigue

Why it occurs

• Mitochondrial dysfunction and persistent neuroinflammation induced by previous infection (perpetuation of activated microgliosis and secretion of intratetal inflammatory cytokines)
• Secondary post-infectious dysautonomia (post-viral postural orthostatic tachycardia syndrome that causes cerebral hypoperfusion and physical fatigue when standing)
• Subclinical reactivation of other latent viruses (such as Epstein-Barr virus or cytomegalovirus due to transient immunosuppression induced by the initial virus)
• Severe cardiovascular deconditioning accelerated by prolonged immobilization in bed during the acute phase of infection
• Residual organized pneumonitis or low-intensity pulmonary microvascular damage that decreases tissue oxygen reserve.

Initial workup

Complete blood count with platelet count, erythrocyte sedimentation rate (ESR), ultrasensitive C-reactive protein (CRP), transthoracic Doppler echocardiogram, respiratory function tests (spirometry and carbon monoxide diffusion DLCO), and 24-hour Holter.

Standard management

• Coenzyme Q10 combined with L-carnitine — 100 mg and 500 mg orally per day, respectively, to support mitochondrial energy metabolism and cellular repair
• Fludrocortisone — 0.1 mg per day orally if there is residual postural hypotension due to proven dysautonomia
• Paracetamol (500 mg orally every 8 hours if there is residual myalgia that limits the performance of adapted low-impact physical activity).