Persistent (>6 months) Neuropsychiatric symptoms in a cohort of SARS- CoV-2 PCR positive patients in Cape Town, South Africa

Van Niekerk, Inette

Persistent (>6 months) Neuropsychiatric symptoms in a cohort of SARS- CoV-2 PCR positive patients in Cape Town, South Africa

Thesis / Dissertation

2024

Publisher

University of Cape Town

Department

Department of Psychiatry and Mental Health

Faculty

Faculty of Health Sciences

Abstract

Background : SARS-CoV-2 is a neurotrophic and pro-inflammatory virus, with several acute and more persistent neuropsychiatric sequelae reported. There are limited data from younger African cohorts and few acute illness biomarkers of persistent neuropsychiatric symptoms. Objectives : To determine the prevalence of neuropsychiatric symptoms in a cohort of South African SARS-CoV-2 PCR positive patients at least six months following infection/hospitalization. Second, to examine the association of neuropsychiatric outcomes with clinical illness severity, systemic inflammation, cardiovascular and renin-angiotensin system (RAS) biomarkers. Methodology: SARS-CoV-2 PCR positive patients were recruited prospectively from Cape Town, South Africa, including hospitalized patients from ancestral, beta and delta-dominant COVID-19 waves (pre-vaccine rollout); and asymptomatic/mild SARS-CoV-2 positive patients. Telephonic interviews were conducted at least six months post infection/hospitalization. Validated measures employed were: WHO Self-Report Questionnaire (SRQ-20), Generalized Anxiety Disorder Scale (GAD-7), Chalder Fatigue Scale (CFS-11) and Telephonic Montreal Cognitive Assessment (T-MoCA). The 96-protein O-link inflammation and cardiovascular panels, RAS fingerprinting, and antibody responses were measured in plasma/serum samples collected at peak severity and recovery (>3 months post infection). Results: Ninety-seven participants completed telephonic interviews. The median (IQR) age was 48 (37-59) years, and 54% were female. More than half of this South African COVID19 cohort had one or more persistent neuropsychiatric symptoms >6 months post vaccine-naïve infection. On the T-MoCA, 44% of participants showed evidence of cognitive and/or memory impairments. There were no significant associations between neuropsychiatric outcomes and illness severity, systemic inflammation, cardiovascular and renin-angiotensin-system (RAS) biomarkers. Conclusion : The high prevalence of persistent neuropsychiatric symptoms in this young African cohort supports ongoing attention to long COVID. Persistent neuropsychiatric outcomes post-COVID are not associated with systemic inflammation or altered renin angiotensin physiology. Psychosocial variables affecting individual responses to the virus may explain the lack of association found on the biological front.

Keywords

Anxiety, biopsychosocial, cognitive impairment

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