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Once life-threatening causes are excluded and acute alterations are treated, the patient should be referred to an appropriate pediatric specialist (e.g., gastroenterologist, surgeon, neurologist, metabolic experts), to avoid inappropriate further ED visits and a delay in the diagnosis and preventive therapy in case of CVS (130)
Research published in PNAS indicates that patients with Long COVID and ME/CFS exhibit signs of elevated oxidative stress and aberrations in ROS clearance pathways, including elevated glutathione levels in peripheral blood lymphocytes and decreased mitochondrial superoxide dismutase
On the contrary, high numbers of invading bacteria exert an overactivation of Toll-like receptors (TLRs), leading to the overexpression of inflammatory cytokines, with consequent epithelial damage and chronic inflammation [10]