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Viruses
Special Issues
Beyond Acute: Navigating Long COVID and Post-Viral Complications
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Beyond Acute: Navigating Long COVID and Post-Viral Complications

A special issue of Viruses (ISSN 1999-4915). This special issue belongs to the section "Human Virology and Viral Diseases".

Deadline for manuscript submissions: 31 August 2025 | Viewed by 2714

Special Issue Editors

Dr. Maggie Bartlett

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Guest Editor
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
Interests: immunity; neurological viral infections
Prof. Dr. Janko Nikolich-Žugich

E-Mail Website
Guest Editor
Department of Immunobiology and the University of Arizona Center on Aging, University of Arizona College of Medicine – Tucson, Tucson, AZ 85724, USA
Interests: COVID-19; Postacute Sequelae of SARS-CoV-2 Infection; basic mechanisms of T-cell function; immunity to infection in older adults; vaccines and biomarkers of declining immunity in the elderly; immune rejuvenation; immune monitoring in chronic conditions of aging and the impact of inflammation and nutritional intervention in aging, immunity and metabolic disorders
Dr. Rubeshan Perumal

E-Mail Website
Guest Editor
Centre for the AIDS Programme of Research in South Africa, Durban 4001, South Africa
Interests: Post COVID-19 lung disease; lung infection and immunity
Prof. Dr. Anders Vahlne

E-Mail Website
Guest Editor
Professor Emeritus in Clinical Virology, Karolinska Institute, 171 77 Solna, Sweden
Interests: long COVID; herpes simplex virus neurobiology and pathogenesis; HIV pathogenesis; virus diagnostics

Special Issue Information

Dear Colleagues,

The special issue on acute viral infection complications delves into post-acute sequelae (PASC) or long COVID, exploring its mechanisms, clinical manifestations, and management. It covers immune-mediated complications, such as autoimmune disorders, triggered by viral mimicry or dysregulated immune responses. The issue also addresses neurological, respiratory, cardiovascular, and pregnancy-related complications arising from viral infections. Through research articles and case studies, it aims to enhance understanding of these complications, informing clinical practice, public health strategies, and ongoing research for better patient outcomes globally.

Dr. Maggie Bartlett
Prof. Dr. Janko Nikolich-Žugich
Dr. Rubeshan Perumal
Prof. Dr. Anders Vahlne
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Viruses is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • long COVID
  • post-viral complications
  • dysregulated immune responses
  • neurological complications
  • respiratory complications
  • cardiovascular complications
  • pregnancy-related complications

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Published Papers (2 papers)

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Research

14 pages, 1459 KiB  
Article
A New Approach to the Etiology of Syncope: Infection as a Cause
by Branislav Milovanovic, Nikola Markovic, Masa Petrovic, Vasko Zugic, Milijana Ostojic, Milica Dragicevic-Antonic and Milovan Bojic
Viruses 2025, 17(3), 427; https://doi.org/10.3390/v17030427 - 15 Mar 2025
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Abstract
Background/Objectives: Syncope is a common clinical occurrence, with neurally mediated and orthostatic types accounting for about 75% of cases. The exact pathophysiological mechanisms remain unclear, with recent evidence suggesting autonomic nervous system damage and a potential infectious etiology. This study aimed to examine [...] Read more.
Background/Objectives: Syncope is a common clinical occurrence, with neurally mediated and orthostatic types accounting for about 75% of cases. The exact pathophysiological mechanisms remain unclear, with recent evidence suggesting autonomic nervous system damage and a potential infectious etiology. This study aimed to examine the role of infection in the development of syncope and orthostatic hypotension (OH). Methods: The cross-sectional study included 806 patients from the Neurocardiological Laboratory of the Institute for Cardiovascular Diseases “Dedinje”. Patients were divided into three groups: unexplained recurrent syncope (n = 506), syncope with OH during the head-up tilt test (HUTT) (n = 235), and OH without a history of syncope (n = 62). All participants underwent the HUTT, and 495 underwent serological testing for various microorganisms. Data were analyzed using chi-squared tests and binary and multinomial logistic regression. Results: The HUTT was positive in 90.6% of patients with syncope and OH, compared with 61.6% with syncope alone (p < 0.001). Serological testing revealed that 57.85% of syncope patients, 62.9% of syncope with OH patients, and 78% of OH patients had positive IgM antibodies to at least one microorganism. Multivariate analysis indicated that IgM antibodies to Coxsackievirus and Epstein–Barr virus were significant predictors of OH. Conclusions: This study demonstrated a potential association between infections and syncope/OH. Further investigation into the role of infectious agents in autonomic dysfunction is warranted to clarify the underlying mechanisms of syncope and OH. Full article
(This article belongs to the Special Issue Beyond Acute: Navigating Long COVID and Post-Viral Complications)
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11 pages, 730 KiB  
Article
Persistence of Long COVID Symptoms Two Years After SARS-CoV-2 Infection: A Prospective Longitudinal Cohort Study
by Gili Joseph, Ili Margalit, Yael Weiss-Ottolenghi, Carmit Rubin, Havi Murad, Raquel C. Gardner, Noam Barda, Elena Ben-Shachar, Victoria Indenbaum, Mayan Gilboa, Sharon Alroy-Preis, Yitshak Kreiss, Yaniv Lustig and Gili Regev-Yochay
Viruses 2024, 16(12), 1955; https://doi.org/10.3390/v16121955 - 20 Dec 2024
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Abstract
Background/Objectives: Millions of individuals worldwide continue to experience symptoms following SARS-CoV-2 infection. This study aimed to assess the prevalence and phenotype of multi-system symptoms attributed to Long COVID—including fatigue, pain, cognitive-emotional disturbances, headache, cardiopulmonary issues, and alterations in taste and smell—that have persisted [...] Read more.
Background/Objectives: Millions of individuals worldwide continue to experience symptoms following SARS-CoV-2 infection. This study aimed to assess the prevalence and phenotype of multi-system symptoms attributed to Long COVID—including fatigue, pain, cognitive-emotional disturbances, headache, cardiopulmonary issues, and alterations in taste and smell—that have persisted for at least two years after acute infection, which we define as “persistent Long COVID”. Additionally, the study aimed to identify clinical features and blood biomarkers associated with persistent Long COVID symptoms. Methods: We sent a detailed long COVID symptoms questionnaire to an existing cohort of 1258 vaccinated adults (age 18–79 years) who had mild infection (e.g., non-hospitalized) SARS-CoV-2 Delta variant 2 years earlier. These individuals had comprehensive datasets, including blood samples, available for further analysis. We estimated prevalence of persistent long COVID two years post-infection using weighted adjustment (Horvitz–Thompson estimator) to overcome reporting bias. Multivariable logistic regression models were used to determine association of clinical features and blood biomarkers (pre-infection SARS-CoV-2 RBD-IgG, SARS-CoV-2 neutralizing antibodies, and pre-infection and post-infection neurofilament light) with prevalence of persistent long COVID. Results: N = 323 participants responded to the survey, of whom N = 74 (23%) reported at least one long COVID symptom that had persisted for two years after the acute infection. Weighted prevalence of persistent long COVID symptoms was 21.5% (95% CI = 16.7–26.3%). Female gender, smoking, and severity of acute COVID-19 infection were significantly associated with persistent Long COVID. The blood biomarkers assessed were not significantly associated with persistent Long COVID. Conclusions: Among vaccinated adults two years after mild infection with Delta variant SARS-CoV-2, persistent symptoms attributed to Long COVID are extremely common, certain subgroups are at higher risk, and further research into biological mechanisms and potential treatment targets is needed. Full article
(This article belongs to the Special Issue Beyond Acute: Navigating Long COVID and Post-Viral Complications)
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