SMALL FIBER NEUROPATHY IN THE PATHOGENESIS OF POST-COVID SYNDROME

Abstract

Introduction. Small fiber neuropathy (SNF) is a condition that occurs due to hereditary, metabolic, autoimmune, infectious and other diseases. Data on the possible role of SNF in the pathogenesis of post-Covid syndrome (PCS) are rare. Aim: To review literature on small fiber neuropathy in the pathogenesis of post-Covid syndrome. Summarize the authors’ many years of experience working with patients with post-viral immunological complications. Results. There are several stages in PCS pathogenesis including antigenic mimicry of viral particles with human proteins, activation of
coagulation and neuroglia, and the long-term presence of residual viral particles in certain areas of the central nervous system. Increased production of nonspecific antibodies allows us to consider PCD as an immunological process. The lack of a gold standard for instrumental diagnostics, given the variety of clinical manifestations of PCS, makes diagnosis difficult. Neuropathic pain and autonomic dysfunction in PCS patients combined with normal electroneuromyography (ENMG) indicators can be explained by the presence of SNF in the structure of the pathogenesis of PCS. This hypothesis is confirmed by data from confocal microscopy and skin biopsy with determination of the density of intradermal nerve endings in patients suffering from PCS, as well as by the clinical observations of the authors of the article. Conclusion. Consideration of small fiber neuropathy as an important stage in the pathogenesis of post-Covid syndrome opens new horizons for the diagnosis of post-Covid syndrome.