There is no doubt that COVID-19, and everything it brought, changed all of our lives in drastic

ways. For some people infected with SARS-CoV2, they may still be feeling the physical effects,

even up to one year later. This is what has recently been dubbed “Long-Hauler Syndrome.”

Classically, however, it is known as Post Infection Syndrome.

So, what is it? Some describe it simply as a “blah” feeling, while others describe it as

soul-sucking fatigue. You feel like you are on this hamster wheel — never feeling as bad as when

you were sick, but also never feeling like yourself again. Post Infection Syndrome has been

recognized for decades; however, it has been poorly studied and scarcely mentioned,

oftentimes being diagnosed and treated as other syndromes with similar symptoms.

Top 3 symptoms of Post Infection Syndrome:

Fatigue/Brain fog

Depression

Weakness/Achiness

Many of these symptoms have a clear laboratory track record and can be detected by your

doctor via thorough questioning and lab diagnostics. Worth noting is that fever is not usually

found once the acute infection has passed. In fact, we will commonly find slightly lower than

the patient’s normal temperature in the post-infectious phase.

Clues for Diagnosing Post Infection Syndrome

Developing a timeline of symptoms with your doctor is critical. The first thing to rule out may

seem rather obvious, but I can tell you that it is largely overlooked or dismissed. We must first

determine if the infection has cleared. Most infections will last a couple of days, up to a few

weeks. However, certain pathogens we classify as persistent. Persistent infections can last

months, if not years. Although all classifications of infections (bacteria, fungus, virus, parasite)

can persist past a few weeks, viral and fungal pathogens are most notorious for sticking around

longer.

Cortisol Levels

Once active infection is ruled out, we must then investigate the downregulation of the immune

response. Cortisol is an important part of the story when we discuss Post Infection Syndrome.

As the primary stress hormone, Cortisol serves an immunomodulatory role: in essence, helping

to regulate the immune response or “quiet it down” when needed. Without it, our immune

system would run wild, chewing up gobs of energy and leaving destruction and inflammation in

its wake. Under normal circumstances, cortisol will be released to calm down the immune

response after infection and return it to its resting state. The body then repairs and regains

what was lost and it is ready to fight another pathogen.

Some infections, however, directly affect cortisol release. In these instances, cortisol is released

in such high amounts or for such prolonged periods of time, that this exposure causes the body

to react abruptly. The brain will register the excess amount or prolonged length of cortisol

production as “inappropriate” and attempt to compensate by shutting down cortisol signaling

altogether. The triggering of this feedback mechanism may continue, causing cortisol levels to

drop very low, and resulting in sugar imbalance, fatigue, and blood pressure dysregulation.

Cortisol depletion is a very common finding in patients with Post Infection Syndrome and is

the centerpiece of Long-Hauler Syndrome.

Oxidative Stress

Infections also induce substantial amounts of oxidative stress, requiring a corrective compound

to counteract the damage. Enter: antioxidants. Antioxidants are normally consumed at a

relatively constant rate in the average diet (think colorful vegetables and fruits) and are recycled

when other vitamins and minerals are balanced. There must be enough of these nutrients

on-tap to handle the higher load of oxidation, post-infection.

Anorexia (loss of appetite) is commonly found during an acute infection. For a short period of

time, this may be an advantage. Fasting can improve short-burst immunity and promote cellular

turnover. Not to mention, the lack of food consumption guarantees the patient is not

consuming anything that could halt the immune system (sugar) or put more stress on it, such as

in the case of food sensitivities.

If decreased appetite lingers for too long, however, the patient becomes nutritionally and

calorically depleted — leading to “antioxidant debt” and mineral deficiencies. Increased damage

results from the body not having these resources to repair itself. The patient is then stuck in a

constant state of catch-up.

Cellular Integrity

In prolonged inflammation, fatty substances are used to communicate within the immune

system and the body must find a reservoir to acquire them from. We have a massive store of

these fatty substances in our cellular membranes, so our body will cannibalize the integrity of

our cells to continue the immune/inflammatory process. Cells weaken and are unable to freely

pass essential information across the membrane, eventually bringing about poorly functioning

cells and increased cell die-off. The result: more mess for the body to clean up.

Now what?

A variety of other diagnoses must be ruled out before arriving at a clinical conclusion of Post

Infection Syndrome. Like with any medical condition, we must get to the root cause of the issue

and work our way forward with the right map, rather than aiming at symptoms in the dark. The

best place for patients or clinicians to start is by recording a timeline of when symptoms

occurred and their correlation to the infection. From there, a series of specific tests should be

performed by your doctor, in order to guide accurate decision-making and treatment

recommendations.

Post Infectious Syndrome can be rather complex, and we only scratched the surface here.

However, as we continue to work with patients before, during and after SARS-CoV2 infections,

we are encouraged by some of the positive outcomes we have seen at our clinic!