1101
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Kalkeri R, Goebel S, Sharma GD. SARS-CoV-2 Shedding from Asymptomatic Patients: Contribution of Potential Extrapulmonary Tissue Reservoirs. Am J Trop Med Hyg 2020; 103:18-21. [PMID: 32406369 PMCID: PMC7356473 DOI: 10.4269/ajtmh.20-0279] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/05/2020] [Indexed: 01/08/2023] Open
Abstract
The ongoing pandemic COVID-19, caused by SARS-CoV-2, has already resulted in more than 3 million cases and more than 200,000 deaths globally. Significant clinical presentations of COVID-19 include respiratory symptoms and pneumonia. In a minority of patients, extrapulmonary organs (central nervous system, eyes, heart, and gut) are affected, with detection of viral RNA in bodily secretions (stool, tears, and saliva). Infection of such extrapulmonary organs may serve as a reservoir for SARS-CoV-2, representing a potential source of viral shedding after the cessation of respiratory symptoms in recovered patients or in asymptomatic individuals. It is extremely important to understand this phenomenon, as individuals with intermittent virus shedding could be falsely identified as reinfected and may benefit from ongoing antiviral treatment. The potential of SARS-CoV-2 infection to rapidly disseminate and infect extrapulmonary organs is likely mediated through the nonstructural and accessory proteins of SARS-CoV-2, which act as ligands for host cells, and through evasion of host immune responses. The focus of this perspective is the extrapulmonary tissues affected by SARS-CoV-2 and the potential implications of their involvement for disease pathogenesis and the development of medical countermeasures.
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Affiliation(s)
| | | | - Guru Dutt Sharma
- College of Optometry, Western University of Health Sciences, Pomona, California
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1102
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Werner C, Scullen T, Mathkour M, Zeoli T, Beighley A, Kilgore MD, Carr C, Zweifler RM, Aysenne A, Maulucci CM, Dumont AS, Bui CJ, Keen JR. Neurological Impact of Coronavirus Disease of 2019: Practical Considerations for the Neuroscience Community. World Neurosurg 2020; 139:344-354. [PMID: 32387786 PMCID: PMC7202815 DOI: 10.1016/j.wneu.2020.04.222] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The coronavirus disease of 2019 (COVID-19), which is caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has recently been designated a pandemic by the World Health Organization, affecting 2.7 million individuals globally as of April 25, 2020, with more than 187,000 deaths. An increasing body of evidence has supported central nervous system involvement. METHODS We conducted a review of the reported data for studies concerning COVID-19 pathophysiology, neurological manifestations, and neuroscience provider recommendations and guidelines. RESULTS Central nervous system manifestations range from vague nonfocal complaints to severe neurological impairment associated with encephalitis. It is unclear whether the neurological dysfunction results from direct viral injury or systemic disease. The virus could affect brainstem pathways that lead to indirect respiratory dysfunction, in addition to direct pulmonary injury. Necessary adaptations in patient management, triage, and diagnosis are evolving in light of the ongoing scientific and clinical findings. CONCLUSIONS The present review has consolidated the current body of data regarding the neurological impact of coronaviruses, discussed the reported neurological manifestations of COVID-19, and highlighted the recommendations for patient management. Specific recommendations pertaining to clinical practice for neurologists and neurosurgeons have also been provided.
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Affiliation(s)
- Cassidy Werner
- Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA
| | - Tyler Scullen
- Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA; Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Mansour Mathkour
- Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA; Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Tyler Zeoli
- Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA
| | - Adam Beighley
- Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA
| | - Mitchell D Kilgore
- Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA
| | - Christopher Carr
- Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA
| | - Richard M Zweifler
- Department of Neurology, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Aimee Aysenne
- Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA
| | - Christopher M Maulucci
- Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA; Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA; Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Cuong J Bui
- Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA; Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Joseph R Keen
- Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA; Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA.
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1103
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Al-Olama M, Rashid A, Garozzo D. COVID-19-associated meningoencephalitis complicated with intracranial hemorrhage: a case report. Acta Neurochir (Wien) 2020; 162:1495-1499. [PMID: 32430637 PMCID: PMC7237227 DOI: 10.1007/s00701-020-04402-w] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/10/2020] [Indexed: 12/12/2022]
Abstract
The coronavirus pandemic that started in December 2019 is mainly related to clinical pictures consistent with respiratory symptoms; nevertheless, reports about neurological complications have recently appeared in the medical literature. We describe a case of a 36-year-old coronavirus-positive patient that was admitted on emergency basis; his clinical presentation included neurological symptoms such as drowsiness and mild confusion. Imaging revealed findings consistent with meningoencephalitis complicated by intracerebral hematoma and subdural hematoma. The latter was surgically evacuated after it became chronic and evidence of coronavirus was found in the fluid. Our experience confirms that neurological complications might be a likely event in COVID-19. Although uncommon, the possible occurrence of meningoencephalitis should be kept in mind by physicians involved in the management of COVID-19 patients. Early recognition of brain involvement may provide better prognosis, preventing evolution into intracerebral hemorrhagic events.
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Affiliation(s)
- Mohammad Al-Olama
- Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates.
| | - Anas Rashid
- Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
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1104
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Singal CMS, Jaiswal P, Seth P. SARS-CoV-2, More than a Respiratory Virus: Its Potential Role in Neuropathogenesis. ACS Chem Neurosci 2020; 11:1887-1899. [PMID: 32491829 DOI: 10.1021/acschemneuro.0c00251] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The coronavirus disease-19 (COVID-19) pandemic has emerged as one of the major outbreaks to be mentioned in history in coming times. Like severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a respiratory virus infecting the lungs with fever, dry cough, and acute pneumonia being the major symptoms. It infects epithelial cells expressing angiotensin converting enzyme 2 (ACE2) receptor, which is crucial for viral entry. Based on evolving clinical evidence, it is now unfitting to label SARS-CoV-2 as just a respiratory virus, as lately there are various reports that substantiate its pathogenicity in other organs of the body, including brain. In this review, we discuss the epidemiology of SARS-CoV-2 in comparison to SARS and MERS along with possibilities of viral entry into central nervous system (CNS) tissues. The review provides detailed information about the virulence, epidemiology, and insights into molecular pathways involved in the infectivity of the SARS-CoV-2 virus, along with an in-depth view of current concepts about the neurological significance of the SARS-CoV-2 virus and its neuropathological competence. The review also touches upon our current understanding of placental transmission of SARS-CoV-2, an important aspect of vertical transmission. Furthermore, the review provides a current update on strategies that have been used, are being used, or are under trial for treating the disease.
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Affiliation(s)
| | - Paritosh Jaiswal
- Cellular and Molecular Neuroscience, National Brain Research Centre, Manesar, Gurgaon, Haryana 122052, India
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1105
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Hughes D, Saw R, Perera NKP, Mooney M, Wallett A, Cooke J, Coatsworth N, Broderick C. The Australian Institute of Sport framework for rebooting sport in a COVID-19 environment. J Sci Med Sport 2020; 23:639-663. [PMID: 32451268 PMCID: PMC7200343 DOI: 10.1016/j.jsams.2020.05.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Sport makes an important contribution to the physical, psychological and emotional well-being of Australians. The economic contribution of sport is equivalent to 2-3% of Gross Domestic Product (GDP). The COVID-19 pandemic has had devastating effects on communities globally, leading to significant restrictions on all sectors of society, including sport. Resumption of sport can significantly contribute to the re-establishment of normality in Australian society. The Australian Institute of Sport (AIS), in consultation with sport partners (National Institute Network (NIN) Directors, NIN Chief Medical Officers (CMOs), National Sporting Organisation (NSO) Presidents, NSO Performance Directors and NSO CMOs), has developed a framework to inform the resumption of sport. National Principles for Resumption of Sport were used as a guide in the development of 'the AIS Framework for Rebooting Sport in a COVID-19 Environment' (the AIS Framework); and based on current best evidence, and guidelines from the Australian Federal Government, extrapolated into the sporting context by specialists in sport and exercise medicine, infectious diseases and public health. The principles outlined in this document apply to high performance/professional, community and individual passive (non-contact) sport. The AIS Framework is a timely tool of minimum baseline of standards, for 'how' reintroduction of sport activity will occur in a cautious and methodical manner, based on the best available evidence to optimise athlete and community safety. Decisions regarding the timing of resumption (the 'when') of sporting activity must be made in close consultation with Federal, State/Territory and/or Local Public Health Authorities. The priority at all times must be to preserve public health, minimising the risk of community transmission.
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Affiliation(s)
- David Hughes
- Sports Medicine, Australian Institute of Sport, Bruce ACT, Australia; University of Canberra Research Institute for Sport and Exercise (UCRISE), University of Canberra, Bruce ACT, Australia.
| | - Richard Saw
- Sports Medicine, Australian Institute of Sport, Bruce ACT, Australia
| | - Nirmala Kanthi Panagodage Perera
- Sports Medicine, Australian Institute of Sport, Bruce ACT, Australia; Sport Without Injury ProgrammE (SWIPE), Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences (HMV), Linköping University, Linköping, Sweden
| | - Mathew Mooney
- Sports Medicine, Australian Institute of Sport, Bruce ACT, Australia; University of Canberra Research Institute for Sport and Exercise (UCRISE), University of Canberra, Bruce ACT, Australia
| | - Alice Wallett
- Sports Medicine, Australian Institute of Sport, Bruce ACT, Australia; University of Canberra Research Institute for Sport and Exercise (UCRISE), University of Canberra, Bruce ACT, Australia
| | - Jennifer Cooke
- Sports Medicine, Australian Institute of Sport, Bruce ACT, Australia
| | - Nick Coatsworth
- Department of Health, Australian Government, Canberra, ACT, Australia
| | - Carolyn Broderick
- School of Medical Sciences, University of New South Wales, NSW, Australia; Children's Hospital Institute of Sports Medicine, Sydney Children's Hospital Network, Westmead NSW, Australia
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1106
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Avula A, Nalleballe K, Narula N, Sapozhnikov S, Dandu V, Toom S, Glaser A, Elsayegh D. COVID-19 presenting as stroke. Brain Behav Immun 2020; 87:115-119. [PMID: 32360439 PMCID: PMC7187846 DOI: 10.1016/j.bbi.2020.04.077] [Citation(s) in RCA: 367] [Impact Index Per Article: 91.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 04/26/2020] [Accepted: 04/27/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Acute stroke remains a medical emergency even during the COVID-19 pandemic. Most patients with COVID-19 infection present with constitutional and respiratory symptoms; while others present with atypical gastrointestinal, cardiovascular, or neurological manifestations. Here we present a series of four patients with COVID-19 that presented with acute stroke. METHODS We searched the hospital databases for patients that presented with acute stroke and concomitant features of suspected COVID-19 infection. All patients who had radiographic evidence of stroke and PCR-confirmed COVID-19 infection were included in the study. Patients admitted to the hospital with PCR- confirmed COVID-19 disease whose hospital course was complicated with acute stroke while inpatient were excluded from the study. Retrospective patient data were obtained from electronic medical records. Informed consent was obtained. RESULTS We identified four patients who presented with radiographic confirmation of acute stroke and PCR-confirmed SARS-CoV-2 infection. We elucidate the clinical characteristics, imaging findings, and the clinical course. CONCLUSIONS Timely assessment and hyperacute treatment is the key to minimize mortality and morbidity of patients with acute stroke. Stroke teams should be wary of the fact that COVID-19 patients can present with cerebrovascular accidents and should dawn appropriate personal protective equipment in every suspected patient. Further studies are urgently needed to improve current understandings of neurological pathology in the setting of COVID-19 infection.
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Affiliation(s)
- Akshay Avula
- Department of Pulmonary Critical Care Medicine, Northwell Health - Staten Island University Hospital, NY, United States.
| | - Krishna Nalleballe
- Department of Neurology, University of Arkansas for Medical Sciences, AR, United States
| | - Naureen Narula
- Department of Pulmonary Critical Care Medicine, Northwell Health - Staten Island University Hospital, NY, United States
| | - Steven Sapozhnikov
- Department of Medicine, Northwell Health - Staten Island University Hospital, NY, United States
| | - Vasuki Dandu
- Department of Neurology, University of Arkansas for Medical Sciences, AR, United States
| | - Sudhamshi Toom
- Department of Hematology and Oncology, Maimonides Medical Center, NY, United States
| | - Allison Glaser
- Department of Infectious Disease - Northwell Health - Staten Island University Hospital, NY, United States
| | - Dany Elsayegh
- Department of Pulmonary Critical Care Medicine, Northwell Health - Staten Island University Hospital, NY, United States
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1107
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Beach SR, Praschan NC, Hogan C, Dotson S, Merideth F, Kontos N, Fricchione GL, Smith FA. Delirium in COVID-19: A case series and exploration of potential mechanisms for central nervous system involvement. Gen Hosp Psychiatry 2020; 65:47-53. [PMID: 32470824 PMCID: PMC7242189 DOI: 10.1016/j.genhosppsych.2020.05.008] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/13/2020] [Accepted: 05/17/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Neuropsychiatric manifestations of the coronavirus disease 2019 (COVID-19) have been described, including anosmia, ageusia, headache, paresthesia, encephalitis and encephalopathy. Little is known about the mechanisms by which the virus causes central nervous system (CNS) symptoms, and therefore little guidance is available regarding potential workup or management options. CASES We present a series of four consecutive cases, seen by our psychiatry consultation service over a one-week period, each of which manifested delirium as a result of infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). DISCUSSION The four cases highlighted here all occurred in older patients with premorbid evidence of cognitive decline. Unique features seen in multiple cases included rigidity, alogia, abulia, and elevated inflammatory markers. In all four cases, a change in mental status was the presenting symptom, and three of the four cases lacked significant respiratory symptoms. In addition to discussing unique features of the cases, we discuss possible pathophysiologic explanations for COVID-19 delirium. CONCLUSIONS Delirium should be recognized as a potential feature of infection with SARS-CoV-2 and may be the only presenting symptom. Based on the high rates of delirium demonstrated in prior studies, hospitals should consider adding mental status changes to the list of testing criteria. Further research is needed to determine if delirium in COVID-19 represents a primary encephalopathy heralding invasion of the CNS by the virus, or a secondary encephalopathy related to systemic inflammatory response or other factors.
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Affiliation(s)
- Scott R Beach
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America.
| | - Nathan C Praschan
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Charlotte Hogan
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Samuel Dotson
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Flannery Merideth
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Nicholas Kontos
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Gregory L Fricchione
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Felicia A Smith
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
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1108
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Devana SK, Chaudhary K, Sharma AP, Singh SK. Changing urological practice during COVID-19. Indian J Urol 2020; 36:153-158. [PMID: 33082628 PMCID: PMC7531373 DOI: 10.4103/iju.iju_269_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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1109
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Brun G, Hak JF, Coze S, Kaphan E, Carvelli J, Girard N, Stellmann JP. COVID-19-White matter and globus pallidum lesions: Demyelination or small-vessel vasculitis? NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:e777. [PMID: 32444427 PMCID: PMC7286652 DOI: 10.1212/nxi.0000000000000777] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/02/2020] [Indexed: 12/28/2022]
Affiliation(s)
- Gilles Brun
- From the APHM (G.B., J.-F.H., S.C., N.G., J.-P.S.), Neuroradiology Department, La Timone University Hospital; APHM (E.K.), Department of Neurology, La Timone University Hospital; APHM (J.C.), Intensive Care Unit, La Timone University Hospital; Aix-Marseille University (N.G.), UMR CNRS 7339; and APHM (J.-P.S.), La Timone University Hospital, CEMEREM, Marseille, France.
| | - Jean-François Hak
- From the APHM (G.B., J.-F.H., S.C., N.G., J.-P.S.), Neuroradiology Department, La Timone University Hospital; APHM (E.K.), Department of Neurology, La Timone University Hospital; APHM (J.C.), Intensive Care Unit, La Timone University Hospital; Aix-Marseille University (N.G.), UMR CNRS 7339; and APHM (J.-P.S.), La Timone University Hospital, CEMEREM, Marseille, France
| | - Stéphanie Coze
- From the APHM (G.B., J.-F.H., S.C., N.G., J.-P.S.), Neuroradiology Department, La Timone University Hospital; APHM (E.K.), Department of Neurology, La Timone University Hospital; APHM (J.C.), Intensive Care Unit, La Timone University Hospital; Aix-Marseille University (N.G.), UMR CNRS 7339; and APHM (J.-P.S.), La Timone University Hospital, CEMEREM, Marseille, France
| | - Elsa Kaphan
- From the APHM (G.B., J.-F.H., S.C., N.G., J.-P.S.), Neuroradiology Department, La Timone University Hospital; APHM (E.K.), Department of Neurology, La Timone University Hospital; APHM (J.C.), Intensive Care Unit, La Timone University Hospital; Aix-Marseille University (N.G.), UMR CNRS 7339; and APHM (J.-P.S.), La Timone University Hospital, CEMEREM, Marseille, France
| | - Julien Carvelli
- From the APHM (G.B., J.-F.H., S.C., N.G., J.-P.S.), Neuroradiology Department, La Timone University Hospital; APHM (E.K.), Department of Neurology, La Timone University Hospital; APHM (J.C.), Intensive Care Unit, La Timone University Hospital; Aix-Marseille University (N.G.), UMR CNRS 7339; and APHM (J.-P.S.), La Timone University Hospital, CEMEREM, Marseille, France
| | - Nadine Girard
- From the APHM (G.B., J.-F.H., S.C., N.G., J.-P.S.), Neuroradiology Department, La Timone University Hospital; APHM (E.K.), Department of Neurology, La Timone University Hospital; APHM (J.C.), Intensive Care Unit, La Timone University Hospital; Aix-Marseille University (N.G.), UMR CNRS 7339; and APHM (J.-P.S.), La Timone University Hospital, CEMEREM, Marseille, France
| | - Jan-Patrick Stellmann
- From the APHM (G.B., J.-F.H., S.C., N.G., J.-P.S.), Neuroradiology Department, La Timone University Hospital; APHM (E.K.), Department of Neurology, La Timone University Hospital; APHM (J.C.), Intensive Care Unit, La Timone University Hospital; Aix-Marseille University (N.G.), UMR CNRS 7339; and APHM (J.-P.S.), La Timone University Hospital, CEMEREM, Marseille, France
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1110
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Ahmad I, Rathore FA. Neurological manifestations and complications of COVID-19: A literature review. J Clin Neurosci 2020; 77:8-12. [PMID: 32409215 PMCID: PMC7200361 DOI: 10.1016/j.jocn.2020.05.017] [Citation(s) in RCA: 298] [Impact Index Per Article: 74.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/04/2020] [Indexed: 02/08/2023]
Abstract
The Coronavirus disease due to SARS-CoV-2 emerged in Wuhan city, China in December 2019 and rapidly spread to more than 200 countries as a global health pandemic. There are more than 3.5 million confirmed cases and around 165,000 to 243,000 fatalities. The primary manifestation is respiratory and cardiac but neurological features are also being reported in the literature as case reports and case series. The most common reported symptoms to include headache and dizziness followed by encephalopathy and delirium. Among the complications noted are Cerebrovascular accident, Guillian barre syndrome, acute transverse myelitis, and acute encephalitis. The most common peripheral manifestation was hyposmia. It is further noted that sometimes the neurological manifestations can precede the typical features like fever and cough and later on typical manifestations develop in these patients. Hence a high index of suspicion is required for timely diagnosis and isolation of cases to prevent the spread in neurology wards. We present a narrative review of the neurological manifestations and complications of COVID-19. Our aim is to update the neurologists and physicians working with suspected cases of COVID-19 about the possible neurological presentations and the probable neurological complications resulting from this novel virus infection.
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Affiliation(s)
- Imran Ahmad
- Department of Neurology, Bahria University Medical and Dental College, Karachi, Pakistan
| | - Farooq Azam Rathore
- Department of Rehabilitation Medicine, Bahria University Medical and Dental College, Karachi, Pakistan.
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1111
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Panariello A, Bassetti R, Radice A, Rossotti R, Puoti M, Corradin M, Moreno M, Percudani M. Anti-NMDA receptor encephalitis in a psychiatric Covid-19 patient: A case report. Brain Behav Immun 2020; 87:179-181. [PMID: 32454137 PMCID: PMC7255176 DOI: 10.1016/j.bbi.2020.05.054] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 01/19/2023] Open
Affiliation(s)
- Adelaide Panariello
- Department of Mental Health and Addiction Services, Niguarda Hospital, Milan, Italy
| | - Roberta Bassetti
- Department of Mental Health and Addiction Services, Niguarda Hospital, Milan, Italy
| | - Anna Radice
- Department of Mental Health and Addiction Services, Niguarda Hospital, Milan, Italy
| | | | - Massimo Puoti
- Infectious Diseases Unit, Niguarda Hospital, Milan, Italy
| | | | - Mauro Moreno
- Healthcare Management, Niguarda Hospital, Milan, Italy
| | - Mauro Percudani
- Department of Mental Health and Addiction Services, Niguarda Hospital, Milan, Italy.
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1112
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Wang Y, Shi L, Wang Y, Duan G, Yang H. Cerebrovascular disease is associated with the risk of mortality in coronavirus disease 2019. Neurol Sci 2020; 41:2017-2019. [PMID: 32607850 PMCID: PMC7324486 DOI: 10.1007/s10072-020-04542-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 06/21/2020] [Indexed: 01/18/2023]
Affiliation(s)
- Ying Wang
- Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou, 450001, China
| | - Li Shi
- Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou, 450001, China
| | - Yadong Wang
- Department of Toxicology, Henan Center for Disease Control and Prevention, Zhengzhou, 450016, China
| | - Guangcai Duan
- Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou, 450001, China
| | - Haiyan Yang
- Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou, 450001, China.
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1113
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Parihar J, Tripathi M, Dhamija RK. Seizures and Epilepsy in Times of Corona Virus Disease 2019 Pandemic. J Epilepsy Res 2020; 10:3-7. [PMID: 32983949 PMCID: PMC7494888 DOI: 10.14581/jer.20002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/22/2020] [Accepted: 06/05/2020] [Indexed: 01/08/2023] Open
Abstract
The end of the year 2019 was marked by novel coronavirus (severe acute respiratory syndrome coronavirus-2, SARS-CoV-2) outbreak in China that rapidly spread to the rest of the world. While the involvement of the lower respiratory system causing pneumonia is identified as the primary target of the virus, extra-pulmonary manifestations, especially of the central nervous system, are also being increasingly reported. Previous research on Middle East respiratory syndrome coronavirus and SARS-CoV have shown neurological involvement in human coronavirus infections. While several cases of seizures have been reported in patients with coronavirus disease 2019 (COVID-19) patients, there is no specific data to suggest an association of COVID-19 with epilepsy. Epilepsy patients on immunosuppressive medications may have a higher risk of contracting the viral infection. There can be an indirect relation of COVID-19 to epilepsy as the viral infection is associated with fever in most COVID-19 cases, which can lower seizure threshold. Additionally, inadequate sleep and stress due to ongoing pandemic of coronavirus can be another trigger for seizure precipitation in epilepsy patients. Drug compliance, availability of antiepileptic drugs, and drug interactions with COVID-19 experimental drugs are major concerns in epilepsy patients. Adopting telemedicine services and the use of epilepsy helplines may be important in assisting epilepsy patients and ensuring that treatment continues uninterrupted.
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Affiliation(s)
- Jasmine Parihar
- Department of Neurology, Lady Hardinge Medical College & Associated Hospitals, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajinder K Dhamija
- Department of Neurology, Lady Hardinge Medical College & Associated Hospitals, New Delhi, India
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1114
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Romoli M, Jelcic I, Bernard-Valnet R, García Azorín D, Mancinelli L, Akhvlediani T, Monaco S, Taba P, Sellner J. A systematic review of neurological manifestations of SARS-CoV-2 infection: the devil is hidden in the details. Eur J Neurol 2020; 27:1712-1726. [PMID: 32503088 PMCID: PMC7300895 DOI: 10.1111/ene.14382] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 12/15/2022]
Abstract
Background and purpose We systematically reviewed available evidence for reports of neurological signs and symptoms in patients with COVID‐19 to identify cases with severe acute respiratory syndrome coronavirus (SARS‐CoV)‐2 infection or immune‐mediated reaction in the nervous system. Methods We followed PRISMA guidelines and used the MEDLINE, EMBASE, Google Scholar, MedRxiv and ChinaXiv databases to search for articles on COVID‐19 and nervous system involvement that were published from 1 January to 24 April 2020. Data on design, sample size, neurological assessment and related work‐up were extracted. Biases were assessed with the Newcastle–Ottawa scale. Results We analysed 27 publications on potential neuroinvasive or parainfectious neurological complications of COVID‐19. The reports focused on smell and taste (n = 5) and evaluation of neurological symptoms and signs in cohorts (n = 5). There were cases of Guillain‐Barré syndrome/Miller‐Fisher syndrome/cranial neuropathy (seven cases), meningitis/encephalitis (nine cases) and various other conditions (five cases). The number of patients with examination of cerebrospinal fluid and, in particular, SARS‐CoV‐2 polymerase chain reaction was negligible. Two had a positive SARS‐CoV‐2 polymerase chain reaction examination of cerebrospinal fluid specimen. Study of potential parenchymal involvement with magnetic resonance imaging was rare. Only four reports received a rating of the highest quality standards. Conclusions This systematic review failed to establish comprehensive insights into nervous system manifestations of COVID‐19 beyond immune‐mediated complications in the aftermath of respiratory symptoms. The authors therefore provide guidance for more careful clinical, diagnostic and epidemiological studies to characterize the manifestations and burden of neurological disease caused by SARS‐CoV‐2 on behalf of the Infectious Disease Panel of the European Academy of Neurology.
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Affiliation(s)
- M Romoli
- Neurology Unit, Maurizio Bufalini Hospital, Cesena, Italy.,Neurology Clinic, University of Perugia - S. Maria della Misericordia Hospital, Perugia, Italy
| | - I Jelcic
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University Hospital of Zurich, Zurich, Switzerland
| | - R Bernard-Valnet
- Department of Clinical Neurosciences, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois) and University of Lausanne, Lausanne, Switzerland
| | - D García Azorín
- Department of Neurology, Hospital Clinico de Valladolid, Valladolid, Spain
| | - L Mancinelli
- Neurology Unit, Maurizio Bufalini Hospital, Cesena, Italy
| | - T Akhvlediani
- American MD Program, Faculty of Medicine, Tbilisi State Medical University, Tblisi, Georgia
| | - S Monaco
- Department of Neuroscience, Biomedicine and Movement Sciences, University Hospital of Verona, Verona, Italy
| | - P Taba
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Neurology Clinic, Tartu University Hospital, Tartu, Estonia
| | - J Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria.,Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Department of Neurology, Klinikum rechts der Isar, Technische Universität München, München, Germany
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1115
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Nobile B, Durand M, Olié E, Guillaume S, Molès JP, Haffen E, Courtet P. Clomipramine Could Be Useful in Preventing Neurological Complications of SARS-CoV-2 Infection. J Neuroimmune Pharmacol 2020; 15:347-348. [PMID: 32601885 PMCID: PMC7324075 DOI: 10.1007/s11481-020-09939-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/23/2020] [Indexed: 12/20/2022]
Affiliation(s)
- B Nobile
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France. .,PSNREC, INSERM, CHU de Montpellier, University Montpellier, Montpellier, France.
| | - M Durand
- Pathogenesis and control of chronic infection, INSERM, EFS; CHU Montpellier, Montpellier, University of Montpellier, Montpellier, France
| | - E Olié
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France.,PSNREC, INSERM, CHU de Montpellier, University Montpellier, Montpellier, France.,FondaMental Foundation, Créteil, France
| | - S Guillaume
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France.,PSNREC, INSERM, CHU de Montpellier, University Montpellier, Montpellier, France.,FondaMental Foundation, Créteil, France
| | - J P Molès
- Pathogenesis and control of chronic infection, INSERM, EFS; CHU Montpellier, Montpellier, University of Montpellier, Montpellier, France
| | - E Haffen
- FondaMental Foundation, Créteil, France.,Service de Psychiatrie de l'Adulte, CIC-1431 INSERM, CHU de Besançon, Laboratoire de Neurosciences, Université de Franche-Comté, UBFC, Besançon, France
| | - P Courtet
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France.,PSNREC, INSERM, CHU de Montpellier, University Montpellier, Montpellier, France.,FondaMental Foundation, Créteil, France
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1116
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Novikova LB, Akopian AP, Sharapova KM, Latypova RF. Neurological and mental disorders associated with COVID-19. ACTA ACUST UNITED AC 2020. [DOI: 10.18705/1607-419x-2020-26-3-317-326] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The article presents a narrative review, clinical observations. Special attention is given to the pathogenesis, features of neurological manifestations and mental disorders, neurological complications in coronavirus infection, illustrated by clinical cases. Neurological disorders occur in approximately 36,4 % patients with COVID-19. Currently, severe viral hemorrhagic encephalitis, toxic encephalopathy, acute demyelinating lesions of the peripheral nervous system, stroke, behavioral and emotional disorders have been described. Despite numerous publications on the neurological pathology in COVID-19, pathogenesis, risk factors, and relation between neurological disorders and coronavirus infection remain unclear. There is a need for systematization of the accumulated data on the damage to the nervous system during the COVID-19 epidemic for clinical routine use, further development of the optimal treatment strategy and implementation of effective preventive measures.
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1117
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Belani P, Schefflein J, Kihira S, Rigney B, Delman BN, Mahmoudi K, Mocco J, Majidi S, Yeckley J, Aggarwal A, Lefton D, Doshi AH. COVID-19 Is an Independent Risk Factor for Acute Ischemic Stroke. AJNR Am J Neuroradiol 2020; 41:1361-1364. [PMID: 32586968 DOI: 10.3174/ajnr.a6650] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/17/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Coronavirus disease 2019 (COVID-19) is an active worldwide pandemic with diverse complications. Stroke as a presentation has not been strongly associated with COVID-19. The authors aimed to retrospectively review a link between COVID-19 and acute stroke. MATERIALS AND METHODS We conducted a retrospective case-control study of 41 cases and 82 control subjects matched by age, sex, and risk factors. Cases were patients who underwent stroke alert imaging with confirmed acute stroke on imaging between March 16 and April 5, 2020, at 6 hospitals across New York City. Control subjects were those who underwent stroke alertimaging during the same timeframe without imaging evidence of acute infarction. Data pertaining to diagnosis of COVID-19 infection, patient demographics, and risk factors were collected. A univariate analysis was performed to assess the covariate effect of risk factors and COVID-19 status on stroke imaging with positive findings. RESULTS The mean age for cases and controls was 65.5 ± 15.3 years and 68.8 ± 13.2 years, respectively. Of patients with acute ischemic stroke, 46.3% had COVID-19 infection compared with 18.3% of controls (P = .001). After adjusting for age, sex, and risk factors, COVID-19 infection had a significant independent association with acute ischemic stroke compared with control subjects (OR, 3.9; 95% CI, 1.7-8.9; P = .001). CONCLUSIONS We demonstrated that COVID-19 infection is significantly associated with imaging confirmation of acute ischemic stroke, and patients with COVID-19 should undergo more aggressive monitoring for stroke.
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Affiliation(s)
- P Belani
- From the Departments of Diagnostic, Molecular and Interventional Radiology (P.B., J.S., S.K., B.R., B.N.D., K.M., J.Y., A.A., D.L., A.H.D.)
| | - J Schefflein
- From the Departments of Diagnostic, Molecular and Interventional Radiology (P.B., J.S., S.K., B.R., B.N.D., K.M., J.Y., A.A., D.L., A.H.D.)
| | - S Kihira
- From the Departments of Diagnostic, Molecular and Interventional Radiology (P.B., J.S., S.K., B.R., B.N.D., K.M., J.Y., A.A., D.L., A.H.D.)
| | - B Rigney
- From the Departments of Diagnostic, Molecular and Interventional Radiology (P.B., J.S., S.K., B.R., B.N.D., K.M., J.Y., A.A., D.L., A.H.D.)
| | - B N Delman
- From the Departments of Diagnostic, Molecular and Interventional Radiology (P.B., J.S., S.K., B.R., B.N.D., K.M., J.Y., A.A., D.L., A.H.D.)
| | - K Mahmoudi
- From the Departments of Diagnostic, Molecular and Interventional Radiology (P.B., J.S., S.K., B.R., B.N.D., K.M., J.Y., A.A., D.L., A.H.D.)
| | - J Mocco
- Neurosurgery (J.M., S.M.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - S Majidi
- Neurosurgery (J.M., S.M.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - J Yeckley
- From the Departments of Diagnostic, Molecular and Interventional Radiology (P.B., J.S., S.K., B.R., B.N.D., K.M., J.Y., A.A., D.L., A.H.D.)
| | - A Aggarwal
- From the Departments of Diagnostic, Molecular and Interventional Radiology (P.B., J.S., S.K., B.R., B.N.D., K.M., J.Y., A.A., D.L., A.H.D.)
| | - D Lefton
- From the Departments of Diagnostic, Molecular and Interventional Radiology (P.B., J.S., S.K., B.R., B.N.D., K.M., J.Y., A.A., D.L., A.H.D.)
| | - A H Doshi
- From the Departments of Diagnostic, Molecular and Interventional Radiology (P.B., J.S., S.K., B.R., B.N.D., K.M., J.Y., A.A., D.L., A.H.D.)
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1118
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Azim D, Nasim S, Kumar S, Hussain A, Patel S. Neurological Consequences of 2019-nCoV Infection: A Comprehensive Literature Review. Cureus 2020; 12:e8790. [PMID: 32601577 PMCID: PMC7317136 DOI: 10.7759/cureus.8790] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/24/2020] [Indexed: 01/08/2023] Open
Abstract
First identified in November 2019 in Hubei Province, the coronavirus disease of 2019 (COVID-19) caused by SARS-CoV-2 soon spread worldwide to become a global health pandemic. The COVID-19 preferentially damages the respiratory system that produces symptoms such as fever, cough, and shortness of breath. However, the infection often tends to disseminate to involve various organ systems. Recent evidence indicates that SARS-CoV-2 can cause significant neurological damage and resultant neurological symptoms and complications. Here, we provide a comprehensive and thorough review of original articles, case reports, and case series to delineate the possible mechanisms of nervous system invasion and damage by SARS-CoV-2 and subsequent consequences. We divided the neurological manifestations into three categories: (1) Central Nervous System involvement, (2) Peripheral Nervous System manifestations, and (3) Skeletal Muscle Injury. Headache and dizziness were found to be the most prevalent symptoms followed by impaired consciousness. Among the symptoms indicating peripheral nervous system invasion, anosmia and dysgeusia were commonly reported. Skeletal muscle injury predominantly presents as myalgia. In addition, encephalitis, myelitis, cerebrovascular disease, Guillain-Barre syndrome, and Miller Fischer syndrome were among the commonly noted complications. We also emphasized the association of pre-existing comorbidities with neurological manifestations. The aim of this review is to provide a deeper understanding of the potential neurological implications to help neurologists have a high index of clinical suspicion allowing them to manage the patient appropriately.
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Affiliation(s)
- Dua Azim
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Sundus Nasim
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Sohail Kumar
- Internal Medicine, Dow Medical College and Dr. Ruth K. M. Pfau Civil Hospital, Karachi, PAK
| | - Azhar Hussain
- Healthcare Administration, Franklin University, Columbus, USA
- Medicine, Xavier University School of Medicine, Oranjestad, ABW
| | - Sundip Patel
- Medicine, Windsor University School of Medicine, Cayon, KNA
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1119
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COVID-19-related strokes in adults below 55 years of age: a case series. Neurol Sci 2020; 41:1985-1989. [PMID: 32583169 PMCID: PMC7311861 DOI: 10.1007/s10072-020-04521-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/16/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Coronavirus infection is a novel respiratory disease affecting people across the world. Although the majority of patients present with fever, dyspnea, cough, or myalgia, various signs and symptoms have been reported for this disease. Recently, neurological symptoms have been noticed in patients with COVID-19 with unknown etiology. However, the occurrence of strokes in young and middle aged patients with COVID-19 is not fully explained. METHODS In this series, six patients younger than 55 years of age with diagnosis of stroke and a confirmed diagnosis of COVID-19 were evaluated for symptoms, lab data, imaging findings, and outcomes from March 2020 to the end of April 2020 from all stroke cases in a tertiary academic hospital. Patients older than 55 and all others who had evidence of cardiac abnormalities (arrhythmia/valvular) were excluded. RESULTS Fever, myalgia, cough, and dyspnea were the most common clinical symptoms noted in 66.66% (4/6), 66.66% (4/6), 50% (3/6), and 50% (3/6) of the patients, respectively. The mean ± standard deviation (SD) of National Institutes of Health Stroke Scale (NIHSS) for the patient was 10.16 ± 7.13 (ranged 5-24). The most involved area was middle cerebral artery (MCA) (five in MCA versus one in basal ganglia) and the majority of our patients had a low lung involvement score (mean ± SD: 13.16 ± 6.49 out of 24). Finally, one patient was deceased and rest discharged. CONCLUSION Stroke may be unrelated to age and the extent of lung involvement. However, different factors may play roles in co-occurrence of stroke and COVID-19 and its outcome. Future studies with long-term follow-up and more cases are needed to assess prognostic factors.
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1120
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Weiss C, Carriere M, Fusco L, Capua I, Regla-Nava JA, Pasquali M, Scott JA, Vitale F, Unal MA, Mattevi C, Bedognetti D, Merkoçi A, Tasciotti E, Yilmazer A, Gogotsi Y, Stellacci F, Delogu LG. Toward Nanotechnology-Enabled Approaches against the COVID-19 Pandemic. ACS NANO 2020; 14:6383-6406. [PMID: 32519842 PMCID: PMC7299399 DOI: 10.1021/acsnano.0c03697] [Citation(s) in RCA: 338] [Impact Index Per Article: 84.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The COVID-19 outbreak has fueled a global demand for effective diagnosis and treatment as well as mitigation of the spread of infection, all through large-scale approaches such as specific alternative antiviral methods and classical disinfection protocols. Based on an abundance of engineered materials identifiable by their useful physicochemical properties through versatile chemical functionalization, nanotechnology offers a number of approaches to cope with this emergency. Here, through a multidisciplinary Perspective encompassing diverse fields such as virology, biology, medicine, engineering, chemistry, materials science, and computational science, we outline how nanotechnology-based strategies can support the fight against COVID-19, as well as infectious diseases in general, including future pandemics. Considering what we know so far about the life cycle of the virus, we envision key steps where nanotechnology could counter the disease. First, nanoparticles (NPs) can offer alternative methods to classical disinfection protocols used in healthcare settings, thanks to their intrinsic antipathogenic properties and/or their ability to inactivate viruses, bacteria, fungi, or yeasts either photothermally or via photocatalysis-induced reactive oxygen species (ROS) generation. Nanotechnology tools to inactivate SARS-CoV-2 in patients could also be explored. In this case, nanomaterials could be used to deliver drugs to the pulmonary system to inhibit interaction between angiotensin-converting enzyme 2 (ACE2) receptors and viral S protein. Moreover, the concept of "nanoimmunity by design" can help us to design materials for immune modulation, either stimulating or suppressing the immune response, which would find applications in the context of vaccine development for SARS-CoV-2 or in counteracting the cytokine storm, respectively. In addition to disease prevention and therapeutic potential, nanotechnology has important roles in diagnostics, with potential to support the development of simple, fast, and cost-effective nanotechnology-based assays to monitor the presence of SARS-CoV-2 and related biomarkers. In summary, nanotechnology is critical in counteracting COVID-19 and will be vital when preparing for future pandemics.
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Affiliation(s)
- Carsten Weiss
- Institute of Biological and Chemical
Systems, Biological Information Processing, Karlsruhe
Institute of Technology, Campus North,
Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen,
Germany
| | - Marie Carriere
- Univ. Grenoble
Alpes, CEA, CNRS, IRIG, SyMMES-CIBEST, F-38000
Grenoble, France
| | - Laura Fusco
- Department of Chemical and
Pharmaceutical Sciences, University of
Trieste, 34127 Trieste,
Italy
- Cancer Research Department,
Sidra Medicine, Doha,
Qatar
| | - Ilaria Capua
- One Health Center of Excellence,
University of Florida, Gainesville,
Florida 32611, United States
| | - Jose Angel Regla-Nava
- Division of Inflammation Biology,
La Jolla Institute for Allergy and
Immunology, La Jolla, California 92037,
United States
| | - Matteo Pasquali
- Department of Chemical &
Biomolecular Engineering, Rice University,
Houston, Texas 77251, United States
- Department of Chemistry,
Rice University, Houston, Texas
77251, United States
- Department of Materials Science and
Nanoengineering, Rice University, Houston,
Texas 77251, United States
| | - James A. Scott
- Dalla Lana School of Public Health,
University of Toronto, 223 College
Street, M5T 1R4 Toronto, Ontario, Canada
| | - Flavia Vitale
- Department of Neurology,
Bioengineering, Physical Medicine & Rehabilitation, Center for
Neuroengineering and Therapeutics, University of
Pennsylvania, Philadelphia, Pennsylvania 19104,
United States
- Center for Neurotrauma,
Neurodegeneration, and Restoration, Corporal Michael J.
Crescenz Veterans Affairs Medical Center,
Philadelphia, Pennsylvania 19104, United
States
| | | | - Cecilia Mattevi
- Department of Materials,
Imperial College London, London SW7
2AZ, United Kingdom
| | | | - Arben Merkoçi
- Nanobioelectronics & Biosensors
Group, Catalan Institute of Nanoscience and
Nanotechnology (ICN2), CSIC and BIST, Campus UAB,
08193 Bellaterra, Spain
- ICREA -
Institució Catalana de Recerca i Estudis
Avançats, ES-08010 Barcelona,
Spain
| | - Ennio Tasciotti
- Orthopedics and Sports Medicine,
Houston Methodist Hospital, Houston,
Texas 77030, United States
- Department of Plastic Surgery,
MD Anderson, Houston, Texas 77230,
United States
| | - Açelya Yilmazer
- Stem Cell Institute,
Ankara University, Ankara, 06100
Turkey
- Department of Biomedical Engineering,
Faculty of Engineering, Ankara University,
Ankara, 06100 Turkey
| | - Yury Gogotsi
- A.J. Drexel Nanomaterials Institute,
and Materials Science and Engineering Department, Drexel
University, Philadelphia, Pennsylvania 19104,
United States
| | - Francesco Stellacci
- Institute of Materials,
Ecole Polytechnique Federale de Lausanne
(EPFL), 1015 Lausanne,
Switzerland
- Interfaculty Bioengineering Institute,
Ecole Polytechnique Fédérale de
Lausanne (EPFL), 1015 Lausanne,
Switzerland
| | - Lucia Gemma Delogu
- Department of Biomedical Sciences,
University of Padua, 35122 Padova,
Italy
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1121
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Sun H, Jain A, Leone MJ, Alabsi HS, Brenner L, Ye E, Ge W, Shao YP, Boutros C, Wang R, Tesh R, Magdamo C, Collens SI, Ganglberger W, Bassett IV, Meigs JB, Kalpathy-Cramer J, Li MD, Chu J, Dougan ML, Stratton L, Rosand J, Fischl B, Das S, Mukerji S, Robbins GK, Westover MB. COVID-19 Outpatient Screening: a Prediction Score for Adverse Events. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.06.17.20134262. [PMID: 32607523 PMCID: PMC7325189 DOI: 10.1101/2020.06.17.20134262] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND We sought to develop an automatable score to predict hospitalization, critical illness, or death in patients at risk for COVID-19 presenting for urgent care during the Massachusetts outbreak. METHODS Single-center study of adult outpatients seen in respiratory illness clinics (RICs) or the emergency department (ED), including development (n = 9381, March 7-May 2) and prospective (n = 2205, May 3-14) cohorts. Data was queried from Partners Enterprise Data Warehouse. Outcomes were hospitalization, critical illness or death within 7 days. We developed the COVID-19 Acuity Score (CoVA) using automatically extracted data from the electronic medical record and learning-to-rank ordinal logistic regression modeling. Calibration was assessed using predicted-to-observed event ratio (E/O). Discrimination was assessed by C-statistics (AUC). RESULTS In the development cohort, 27.3%, 7.2%, and 1.1% of patients experienced hospitalization, critical illness, or death, respectively; and in the prospective cohort, 26.1%, 6.3%, and 0.5%. CoVA showed excellent performance in the development cohort (concurrent validation) for hospitalization (E/O: 1.00, AUC: 0.80); for critical illness (E/O: 1.00, AUC: 0.82); and for death (E/O: 1.00, AUC: 0.87). Performance in the prospective cohort (prospective validation) was similar for hospitalization (E/O: 1.01, AUC: 0.76); for critical illness (E/O 1.03, AUC: 0.79); and for death (E/O: 1.63, AUC=0.93). Among 30 predictors, the top five were age, diastolic blood pressure, blood oxygen saturation, COVID-19 testing status, and respiratory rate. CONCLUSIONS CoVA is a prospectively validated automatable score to assessing risk for adverse outcomes related to COVID-19 infection in the outpatient setting.
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Affiliation(s)
- Haoqi Sun
- Department of Neurology, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Clinical Data AI Center (CDAC), Massachusetts General Hospital, Boston, MA
| | - Aayushee Jain
- Department of Neurology, Massachusetts General Hospital, Boston, MA
- Clinical Data AI Center (CDAC), Massachusetts General Hospital, Boston, MA
| | - Michael J Leone
- Department of Neurology, Massachusetts General Hospital, Boston, MA
- Clinical Data AI Center (CDAC), Massachusetts General Hospital, Boston, MA
| | - Haitham S Alabsi
- Department of Neurology, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Laura Brenner
- Harvard Medical School, Boston, MA
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Elissa Ye
- Department of Neurology, Massachusetts General Hospital, Boston, MA
- Clinical Data AI Center (CDAC), Massachusetts General Hospital, Boston, MA
| | - Wendong Ge
- Department of Neurology, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Clinical Data AI Center (CDAC), Massachusetts General Hospital, Boston, MA
| | - Yu-Ping Shao
- Department of Neurology, Massachusetts General Hospital, Boston, MA
- Clinical Data AI Center (CDAC), Massachusetts General Hospital, Boston, MA
| | | | - Ruopeng Wang
- Department of Radiology, Massachusetts General Hospital, Boston, MA
- Athinoula A. Martinos Center for Biomedical Imaging, Boston, MA
| | - Ryan Tesh
- Department of Neurology, Massachusetts General Hospital, Boston, MA
- Clinical Data AI Center (CDAC), Massachusetts General Hospital, Boston, MA
| | - Colin Magdamo
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Sarah I Collens
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Wolfgang Ganglberger
- Department of Neurology, Massachusetts General Hospital, Boston, MA
- Clinical Data AI Center (CDAC), Massachusetts General Hospital, Boston, MA
| | - Ingrid V Bassett
- Harvard Medical School, Boston, MA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA
| | - James B Meigs
- Harvard Medical School, Boston, MA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Jayashree Kalpathy-Cramer
- Harvard Medical School, Boston, MA
- Department of Radiology, Massachusetts General Hospital, Boston, MA
- Athinoula A. Martinos Center for Biomedical Imaging, Boston, MA
| | - Matthew D Li
- Harvard Medical School, Boston, MA
- Department of Radiology, Massachusetts General Hospital, Boston, MA
- Athinoula A. Martinos Center for Biomedical Imaging, Boston, MA
| | - Jacqueline Chu
- Harvard Medical School, Boston, MA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
- MGH Chelsea HealthCare Center, Chelsea, MA
| | - Michael L Dougan
- Harvard Medical School, Boston, MA
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA
| | - Lawrence Stratton
- Department of Neurology, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Jonathan Rosand
- Department of Neurology, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Bruce Fischl
- Harvard Medical School, Boston, MA
- Department of Radiology, Massachusetts General Hospital, Boston, MA
- Athinoula A. Martinos Center for Biomedical Imaging, Boston, MA
- MIT HST/CSAIL, Cambridge, MA
| | - Sudeshna Das
- Department of Neurology, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Shibani Mukerji
- Department of Neurology, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Gregory K Robbins
- Harvard Medical School, Boston, MA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA
| | - M Brandon Westover
- Department of Neurology, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Clinical Data AI Center (CDAC), Massachusetts General Hospital, Boston, MA
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1122
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Spina Tensini F, Spina Tensini T, Franklin GL, Teive HAG. May Parkinson's disease be a protective factor against CNS involvement by SARS-CoV2? Parkinsonism Relat Disord 2020; 77:20. [PMID: 32575004 PMCID: PMC7299859 DOI: 10.1016/j.parkreldis.2020.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/08/2020] [Accepted: 06/14/2020] [Indexed: 12/12/2022]
Affiliation(s)
- F Spina Tensini
- Complexo Hospital de Clínicas da UFPR, Departamento de Clínica Médica, Unidade de Neurologia e Psiquiatria, Setor de Distúrbios do Movimento, Curitiba, PR, Brazil.
| | | | - G L Franklin
- Complexo Hospital de Clínicas da UFPR, Departamento de Clínica Médica, Unidade de Neurologia e Psiquiatria, Setor de Distúrbios do Movimento, Curitiba, PR, Brazil
| | - H A G Teive
- Complexo Hospital de Clínicas da UFPR, Departamento de Clínica Médica, Unidade de Neurologia e Psiquiatria, Setor de Distúrbios do Movimento, Curitiba, PR, Brazil
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1123
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Farhadian S, Glick LR, Vogels CBF, Thomas J, Chiarella J, Casanovas-Massana A, Zhou J, Odio C, Vijayakumar P, Geng B, Fournier J, Bermejo S, Fauver JR, Alpert T, Wyllie AL, Turcotte C, Steinle M, Paczkowski P, Dela Cruz C, Wilen C, Ko AI, MacKay S, Grubaugh ND, Spudich S, Barakat LA. Acute encephalopathy with elevated CSF inflammatory markers as the initial presentation of COVID-19. BMC Neurol 2020; 20:248. [PMID: 32552792 PMCID: PMC7301053 DOI: 10.1186/s12883-020-01812-2] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/01/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND COVID-19 is caused by the severe acute respiratory syndrome virus SARS-CoV-2. It is widely recognized as a respiratory pathogen, but neurologic complications can be the presenting manifestation in a subset of infected patients. CASE PRESENTATION We describe a 78-year old immunocompromised woman who presented with altered mental status after witnessed seizure-like activity at home. She was found to have SARS-CoV-2 infection and associated neuroinflammation. In this case, we undertake the first detailed analysis of cerebrospinal fluid (CSF) cytokines during COVID-19 infection and find a unique pattern of inflammation in CSF, but no evidence of viral neuroinvasion. CONCLUSION Our findings suggest that neurologic symptoms such as encephalopathy and seizures may be the initial presentation of COVID-19. Central nervous system inflammation may associate with neurologic manifestations of disease.
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Affiliation(s)
- Shelli Farhadian
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, 06510, USA.
- Department of Neurology, Yale School of Medicine, New Haven, CT, 06510, USA.
| | - Laura R Glick
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Chantal B F Vogels
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA
| | - Jared Thomas
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Jennifer Chiarella
- Department of Neurology, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Arnau Casanovas-Massana
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA
| | | | - Camila Odio
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Pavithra Vijayakumar
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Bertie Geng
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06510, USA
| | - John Fournier
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Santos Bermejo
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Joseph R Fauver
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA
| | - Tara Alpert
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA
| | - Anne L Wyllie
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA
| | | | | | | | - Charles Dela Cruz
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Craig Wilen
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Albert I Ko
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, 06510, USA
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA
| | | | - Nathan D Grubaugh
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA
| | - Serena Spudich
- Department of Neurology, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Lydia Aoun Barakat
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, 06510, USA
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1124
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Ehrenreich H, Weissenborn K, Begemann M, Busch M, Vieta E, Miskowiak KW. Erythropoietin as candidate for supportive treatment of severe COVID-19. Mol Med 2020; 26:58. [PMID: 32546125 PMCID: PMC7297268 DOI: 10.1186/s10020-020-00186-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/08/2020] [Indexed: 02/07/2023] Open
Abstract
In light of the present therapeutic situation in COVID-19, any measure to improve course and outcome of seriously affected individuals is of utmost importance. We recap here evidence that supports the use of human recombinant erythropoietin (EPO) for ameliorating course and outcome of seriously ill COVID-19 patients. This brief expert review grounds on available subject-relevant literature searched until May 14, 2020, including Medline, Google Scholar, and preprint servers. We delineate in brief sections, each introduced by a summary of respective COVID-19 references, how EPO may target a number of the gravest sequelae of these patients. EPO is expected to: (1) improve respiration at several levels including lung, brainstem, spinal cord and respiratory muscles; (2) counteract overshooting inflammation caused by cytokine storm/ inflammasome; (3) act neuroprotective and neuroregenerative in brain and peripheral nervous system. Based on this accumulating experimental and clinical evidence, we finally provide the research design for a double-blind placebo-controlled randomized clinical trial including severely affected patients, which is planned to start shortly.
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Affiliation(s)
- Hannelore Ehrenreich
- Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany.
| | | | - Martin Begemann
- Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
- Department of Psychiatry & Psychotherapy, University Medical Center, Göttingen, Germany
| | - Markus Busch
- Center of Internal Medicine, Hannover Medical School, Hannover, Germany
| | - Eduard Vieta
- Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Kamilla W Miskowiak
- Psychiatric Centre Copenhagen, University Hospital, Rigshospitalet, Copenhagen, Denmark.
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1125
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DosSantos MF, Devalle S, Aran V, Capra D, Roque NR, Coelho-Aguiar JDM, Spohr TCLDSE, Subilhaga JG, Pereira CM, D'Andrea Meira I, Niemeyer Soares Filho P, Moura-Neto V. Neuromechanisms of SARS-CoV-2: A Review. Front Neuroanat 2020; 14:37. [PMID: 32612515 PMCID: PMC7308495 DOI: 10.3389/fnana.2020.00037] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/03/2020] [Indexed: 12/14/2022] Open
Abstract
Recent studies have suggested the neuroinvasive potential of severe acute respiratory coronavirus 2 (SARS-CoV-2). Notably, neuroinvasiveness might be involved in the pathophysiology of coronavirus disease 2019 (COVID-19). Some studies have demonstrated that synapse-connected routes may enable coronaviruses to access the central nervous system (CNS). However, evidence related to the presence of SARS-CoV-2 in the CNS, its direct impact on the CNS, and the contribution to symptoms suffered, remain sparse. Here, we review the current literature that indicates that SARS-CoV-2 can invade the nervous system. We also describe the neural circuits that are potentially affected by the virus and their possible role in the progress of COVID-19. In addition, we propose several strategies to understand, diagnose, and treat the neurological symptoms of COVID-19.
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Affiliation(s)
- Marcos F. DosSantos
- Laboratório de Morfogênese Celular, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Programa de Pós-Graduação em Medicina (Radiologia), Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Programa de Pós-Graduação em Neurociência Translacional, Instituto Nacional de Neurociência Translacional (INNT-UFRJ), Rio de Janeiro, Brazil
| | - Sylvie Devalle
- Laboratório de Biomedicina do Cérebro, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria de Estado de Saúde, Rio de Janeiro, Brazil
| | - Veronica Aran
- Laboratório de Biomedicina do Cérebro, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria de Estado de Saúde, Rio de Janeiro, Brazil
| | - Daniela Capra
- Laboratório de Morfogênese Celular, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Programa de Pós-Graduação em Neurociência Translacional, Instituto Nacional de Neurociência Translacional (INNT-UFRJ), Rio de Janeiro, Brazil
- Laboratório de Biomedicina do Cérebro, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria de Estado de Saúde, Rio de Janeiro, Brazil
| | - Natália Roberta Roque
- Laboratório de Biomedicina do Cérebro, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria de Estado de Saúde, Rio de Janeiro, Brazil
| | - Juliana de Mattos Coelho-Aguiar
- Laboratório de Morfogênese Celular, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tânia Cristina Leite de Sampaio e Spohr
- Laboratório de Biomedicina do Cérebro, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria de Estado de Saúde, Rio de Janeiro, Brazil
- Programa de Pós-Graduação em Anatomia Patológica, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Janice Gonçalves Subilhaga
- Setor de Pneumologia, Serviço de Clínica Médica, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | - Cláudia Maria Pereira
- Programa de Pós-Graduação em Biomedicina Translacional e Odontologia Clínica e Experimental, Universidade do Grande Rio (Unigranrio), Duque de Caxias, Brazil
| | - Isabella D'Andrea Meira
- Departamento de Neurologia, Universidade Federal Fluminense, Niterói, Brazil
- Programa de Epilepsia do Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria de Estado de Saúde, Rio de Janeiro, Brazil
- Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria de Estado de Saúde, Rio de Janeiro, Brazil
| | | | - Vivaldo Moura-Neto
- Laboratório de Morfogênese Celular, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Programa de Pós-Graduação em Neurociência Translacional, Instituto Nacional de Neurociência Translacional (INNT-UFRJ), Rio de Janeiro, Brazil
- Laboratório de Biomedicina do Cérebro, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria de Estado de Saúde, Rio de Janeiro, Brazil
- Programa de Pós-Graduação em Anatomia Patológica, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria de Estado de Saúde, Rio de Janeiro, Brazil
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1126
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Exum E, Hull BL, Lee ACW, Gumieny A, Villarreal C, Longnecker D. Applying Telehealth Technologies and Strategies to Provide Acute Care Consultation and Treatment of Patients With Confirmed or Possible COVID-19. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2020; 11:10.1097/JAT.0000000000000143. [PMID: 34192091 PMCID: PMC7297073 DOI: 10.1097/jat.0000000000000143] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE The COVID-19 pandemic continues to grow, with 19% of total confirmed patients classified as severe or critical experiencing complications such as dyspnea, hypoxia, acute respiratory distress syndrome, or multiorgan failure. These complications require rehabilitative care. Considering the contagious nature of COVID-19 and the necessity to decrease the volume of health care professionals entering confirmed COVID-19 patient rooms and becoming a potential disease vector, can audiovisual technologies employed by telehealth and telerehabilitation help? CASE DESCRIPTION This case discusses the Baylor Scott and White Institute for Rehab (BSWIR) Physical Medicine and Rehabilitation (PMR) department COVID-19 acute care therapy team's creation of a telehealth strategy to provide early rehabilitative intervention without increasing the odds of disease transmission. OUTCOMES The COVID-19 therapy team created a simple process for identifying and triaging care for patients with possible or confirmed COVID-19. These patients were evaluated and treated by the dedicated team using telehealth strategies. A structured risk-benefit analysis was used to determine when in-room care was indicated. DISCUSSION Acute care physical therapy, occupational therapy, and speech-language pathology telehealth strategies can add value by mitigating COVID-19-related harm and influencing recovery, while not unnecessarily becoming additional disease vectors consuming personal protective equipment. COVID-19 is not only an aggressive respiratory illness similar to acute respiratory distress syndrome but also highly contagious and a risk for health care providers. Telehealth strategies allow therapists to intervene early, opening the possibility to maximize recovery and prevent harm or decompensation. Telehealth strategies can be more prevention-focused while the patient is experiencing relatively good health with goals to maximize strength and endurance before the disease process evolves to critical illness. As COVID-19 progresses, therapy can help mitigate potential complications associated with prolonged intensive care unit stay and ventilator management.
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Affiliation(s)
- Emelia Exum
- Department of Physical Medicine & Rehabilitation, Baylor University Medical Center, 3500 Gaston Ave, Dallas, TX 75246 (USA) Baylor Scott & White Institute for Rehabilitation, Dallas, Texas
- Department of Physical Medicine & Rehabilitation, Baylor University Medical Center, Dallas, Texas Baylor Scott & White Institute for Rehabilitation, Dallas, Texas
- Mount Saint Mary's University, Los Angeles, California
- Department of Physical Medicine & Rehabilitation, Baylor University Medical Center, Dallas, Texas Baylor Scott & White Institute for Rehabilitation, Dallas, Texas
- Department of Physical Medicine & Rehabilitation, Baylor University Medical Center, Dallas, Texas Baylor Scott & White Institute for Rehabilitation, Dallas, Texas
- Department of Physical Medicine & Rehabilitation, Baylor University Medical Center, Dallas, Texas Baylor Scott & White Institute for Rehabilitation, Dallas, Texas
| | - Brian L Hull
- Department of Physical Medicine & Rehabilitation, Baylor University Medical Center, 3500 Gaston Ave, Dallas, TX 75246 (USA) Baylor Scott & White Institute for Rehabilitation, Dallas, Texas
- Department of Physical Medicine & Rehabilitation, Baylor University Medical Center, Dallas, Texas Baylor Scott & White Institute for Rehabilitation, Dallas, Texas
- Mount Saint Mary's University, Los Angeles, California
- Department of Physical Medicine & Rehabilitation, Baylor University Medical Center, Dallas, Texas Baylor Scott & White Institute for Rehabilitation, Dallas, Texas
- Department of Physical Medicine & Rehabilitation, Baylor University Medical Center, Dallas, Texas Baylor Scott & White Institute for Rehabilitation, Dallas, Texas
- Department of Physical Medicine & Rehabilitation, Baylor University Medical Center, Dallas, Texas Baylor Scott & White Institute for Rehabilitation, Dallas, Texas
| | - Alan Chong W Lee
- Department of Physical Medicine & Rehabilitation, Baylor University Medical Center, 3500 Gaston Ave, Dallas, TX 75246 (USA) Baylor Scott & White Institute for Rehabilitation, Dallas, Texas
- Department of Physical Medicine & Rehabilitation, Baylor University Medical Center, Dallas, Texas Baylor Scott & White Institute for Rehabilitation, Dallas, Texas
- Mount Saint Mary's University, Los Angeles, California
- Department of Physical Medicine & Rehabilitation, Baylor University Medical Center, Dallas, Texas Baylor Scott & White Institute for Rehabilitation, Dallas, Texas
- Department of Physical Medicine & Rehabilitation, Baylor University Medical Center, Dallas, Texas Baylor Scott & White Institute for Rehabilitation, Dallas, Texas
- Department of Physical Medicine & Rehabilitation, Baylor University Medical Center, Dallas, Texas Baylor Scott & White Institute for Rehabilitation, Dallas, Texas
| | - Annie Gumieny
- Department of Physical Medicine & Rehabilitation, Baylor University Medical Center, 3500 Gaston Ave, Dallas, TX 75246 (USA) Baylor Scott & White Institute for Rehabilitation, Dallas, Texas
- Department of Physical Medicine & Rehabilitation, Baylor University Medical Center, Dallas, Texas Baylor Scott & White Institute for Rehabilitation, Dallas, Texas
- Mount Saint Mary's University, Los Angeles, California
- Department of Physical Medicine & Rehabilitation, Baylor University Medical Center, Dallas, Texas Baylor Scott & White Institute for Rehabilitation, Dallas, Texas
- Department of Physical Medicine & Rehabilitation, Baylor University Medical Center, Dallas, Texas Baylor Scott & White Institute for Rehabilitation, Dallas, Texas
- Department of Physical Medicine & Rehabilitation, Baylor University Medical Center, Dallas, Texas Baylor Scott & White Institute for Rehabilitation, Dallas, Texas
| | - Christopher Villarreal
- Department of Physical Medicine & Rehabilitation, Baylor University Medical Center, 3500 Gaston Ave, Dallas, TX 75246 (USA) Baylor Scott & White Institute for Rehabilitation, Dallas, Texas
- Department of Physical Medicine & Rehabilitation, Baylor University Medical Center, Dallas, Texas Baylor Scott & White Institute for Rehabilitation, Dallas, Texas
- Mount Saint Mary's University, Los Angeles, California
- Department of Physical Medicine & Rehabilitation, Baylor University Medical Center, Dallas, Texas Baylor Scott & White Institute for Rehabilitation, Dallas, Texas
- Department of Physical Medicine & Rehabilitation, Baylor University Medical Center, Dallas, Texas Baylor Scott & White Institute for Rehabilitation, Dallas, Texas
- Department of Physical Medicine & Rehabilitation, Baylor University Medical Center, Dallas, Texas Baylor Scott & White Institute for Rehabilitation, Dallas, Texas
| | - Diane Longnecker
- Department of Physical Medicine & Rehabilitation, Baylor University Medical Center, 3500 Gaston Ave, Dallas, TX 75246 (USA) Baylor Scott & White Institute for Rehabilitation, Dallas, Texas
- Department of Physical Medicine & Rehabilitation, Baylor University Medical Center, Dallas, Texas Baylor Scott & White Institute for Rehabilitation, Dallas, Texas
- Mount Saint Mary's University, Los Angeles, California
- Department of Physical Medicine & Rehabilitation, Baylor University Medical Center, Dallas, Texas Baylor Scott & White Institute for Rehabilitation, Dallas, Texas
- Department of Physical Medicine & Rehabilitation, Baylor University Medical Center, Dallas, Texas Baylor Scott & White Institute for Rehabilitation, Dallas, Texas
- Department of Physical Medicine & Rehabilitation, Baylor University Medical Center, Dallas, Texas Baylor Scott & White Institute for Rehabilitation, Dallas, Texas
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1127
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Orsucci D, Ienco EC, Nocita G, Napolitano A, Vista M. Neurological features of COVID-19 and their treatment: a review. Drugs Context 2020; 9:2020-5-1. [PMID: 32587625 PMCID: PMC7295105 DOI: 10.7573/dic.2020-5-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/29/2020] [Accepted: 05/29/2020] [Indexed: 12/13/2022] Open
Abstract
Severe acute respiratory syndrome-correlated new coronavirus (SARS-Cov-2) infection may result in neurological signs and symptoms through different mechanisms. Although direct infection of the central nervous system is uncertain or very rare and the para-infectious complications (e.g. inflammatory neuropathies) are rare, delirium and septic encephalopathy are common in severely ill patients. Smell dysfunction and headache are very common in mild cases, especially in younger people and females. Muscle pain is common in both mild and severe cases, and in the most compromised patients, it is accompanied by increased creatine kinase levels and by a likely true myopathic damage. Ischemic stroke has been reported as a possible complication of the hypercoagulability associated with severe SARS-Cov-2 infection, but further studies are needed. Most of the neurological manifestations may occur early in the illness. Therefore, during the pandemic period, neurologists need to be involved, alert, and prepared. Neurological practice will not be the same until a vaccine is available.
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Affiliation(s)
| | | | | | | | - Marco Vista
- Unit of Neurology, San Luca Hospital, Lucca, Italy
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1128
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Saini AG, Suthar R. COVID-19 Pandemic: The Concerns of Pediatric Neurologists. Ann Indian Acad Neurol 2020; 23:358-359. [PMID: 32606530 PMCID: PMC7313594 DOI: 10.4103/aian.aian_407_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/09/2020] [Accepted: 05/10/2020] [Indexed: 12/18/2022] Open
Affiliation(s)
- Arushi G Saini
- Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Renu Suthar
- Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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1129
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Focal EEG changes indicating critical illness associated cerebral microbleeds in a Covid-19 patient. Clin Neurophysiol Pract 2020; 5:125-129. [PMID: 32607454 PMCID: PMC7286251 DOI: 10.1016/j.cnp.2020.05.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/25/2020] [Accepted: 05/29/2020] [Indexed: 01/05/2023] Open
Abstract
First reported case of Critical Illness-Associated Cerebral Microbleeds in Covid-19. EEG plays a crucial role in Covid-19 patients in the ICU. Acute neurological complications should be explored systematically.
Objectives We describe a patient suffering from Covid19-related acute respiratory distress syndrome (ARDS), highlighting the diagnostic role of the EEG in ICU. History A Covid-19 patient undergoing mechanical ventilation due to related acute respiratory distress syndrome (ARDS), presented altered mental status in the ICU. Video-EEG revealed a focal monomorphic theta slowing in bilateral frontal-central regions. Concordant with the EEG localization, MRI showed abundant microbleeds located in bilateral white matter junction, various regions of corpus callosum and internal capsule, suggestive of Critical Illness-Associated Cerebral Microbleeds. CSF analysis excluded the presence of encephalitis, SARS-Cov2 RNA-PCR in CSF was negative. Clinical and biological picture was suggestive of cytokine release syndrome. Conclusion This is the first reported case of Critical Illness-Associated Cerebral Microbleeds in the context of Covid-19. Knowledge of Covid-19 is still partial and acute neurological complications should be explored systematically. In our case, EEG helped to rule out non-convulsive status epilepticus, but revealed focal dysfunction, justifying further investigations. EEG plays a crucial role in these patients, allowing investigating the presence of focal or diffuse cerebral dysfunction. This is particularly helpful for Covid-19 patients in the ICU, where the neurological examination is challenging by the severity of the respiratory illness.
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1130
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Alexander R, Ravi A, Barclay H, Sawhney I, Chester V, Malcolm V, Brolly K, Mukherji K, Zia A, Tharian R, Howell A, Lane T, Cooper V, Langdon PE. Guidance for the Treatment and Management of COVID-19 Among People with Intellectual Disabilities. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2020; 17:256-269. [PMID: 32837529 PMCID: PMC7307021 DOI: 10.1111/jppi.12352] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/04/2020] [Accepted: 05/14/2020] [Indexed: 01/19/2023]
Abstract
The current COVID‐19 pandemic is a pressing world crisis and people with intellectual disabilities (IDs) are vulnerable due to disparity in healthcare provision and physical and mental health multimorbidity. While most people will develop mild symptoms upon contracting severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2), some will develop serious complications. The aim of this study is to present guidelines for the care and treatment of people with IDs during the COVID‐19 pandemic for both community teams providing care to people with IDs and inpatient psychiatric settings. The guidelines cover specific issues associated with hospital passports, individual COVID‐19 care plans, the important role of families and carers, capacity to make decisions, issues associated with social distancing, ceiling of care/treatment escalation plans, mental health and challenging behavior, and caring for someone suspected of contracting or who has contracted SARS‐CoV‐2 within community or inpatient psychiatric settings. We have proposed that the included conditions recommended by Public Health England to categorize someone as high risk of severe illness due to COVID‐19 should also include mental health and challenging behavior. There are specific issues associated with providing care to people with IDs and appropriate action must be taken by care providers to ensure that disparity of healthcare is addressed during the COVID‐19 pandemic. We recognize that our guidance is focused upon healthcare delivery in England and invite others to augment our guidance for use in other jurisdictions.
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Affiliation(s)
- Regi Alexander
- Little Plumstead Hospital, Hertfordshire Partnership University NHS Foundation Trust Norwich UK.,University of Hertfordshire Hatfield United Kingdom
| | - Ambiga Ravi
- Bowlers Green, Hertfordshire Partnership University NHS Foundation Trust Hatfield UK
| | - Helene Barclay
- Little Plumstead Hospital, Hertfordshire Partnership University NHS Foundation Trust Norwich UK
| | - Indermeet Sawhney
- Lexden Hospital, Hertfordshire Partnership University NHS Foundation Trust Colchester UK
| | - Verity Chester
- Little Plumstead Hospital, Hertfordshire Partnership University NHS Foundation Trust Norwich UK
| | - Vicki Malcolm
- Little Plumstead Hospital, Hertfordshire Partnership University NHS Foundation Trust Norwich UK
| | - Kate Brolly
- Little Plumstead Hospital, Hertfordshire Partnership University NHS Foundation Trust Norwich UK
| | - Kamalika Mukherji
- Hertfordshire Partnership University NHS Foundation Trust Hatfield UK
| | - Asif Zia
- Hertfordshire Partnership University NHS Foundation Trust Hatfield UK
| | - Reena Tharian
- Hellesdon Hospital, Norfolk and Suffolk NHS Foundation Trust Norwich UK
| | - Andreana Howell
- ReseArch in DevelopmentAl NeuropsychiaTry (RADiANT) Norwich UK
| | - Tadhgh Lane
- ReseArch in DevelopmentAl NeuropsychiaTry (RADiANT) Norwich UK
| | | | - Peter E Langdon
- Centre for Educational Development, Appraisal and Research (CEDAR) University of Warwick Coventry UK.,Worcestershire Health and Care NHS Trust Worcester UK.,Coventry and Warwickshire Partnership NHS Trust, Coventry UK
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1131
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Sancho-Saldaña A, Lambea-Gil Á, Liesa JLC, Caballo MRB, Garay MH, Celada DR, Serrano-Ponz M. Guillain-Barré syndrome associated with leptomeningeal enhancement following SARS-CoV-2 infection. Clin Med (Lond) 2020; 20:e93-e94. [PMID: 32518103 DOI: 10.7861/clinmed.2020-0213] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Patients with coronavirus disease 2019 (COVID-19) typically present with respiratory symptoms, but little is known about the disease's potential neurological complications.We report a case of Guillain-Barré syndrome (GBS) following a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, in association with leptomeningeal enhancement. CASE PRESENTATION A 56-year-old woman presented with recent unsteadiness and paraesthesia in both hands. Fifteen days earlier, she complained of fever, dry cough and shortness of breath. Her chest X-ray showed a lobar consolidation and PCR was positive for SARS-CoV-2; she was admitted due to mild COVID-19 pneumonia.In the first 48 hours of hospitalisation, she started to experience lumbar pain and weakness of the proximal lower extremities, progressing to bilateral facial nerve palsy, oropharyngeal weakness and severe proximal tetraparesis with cervical flexion 2/5 on the MRC scale. Full spine magnetic resonance imaging (MRI) showed a brainstem and cervical leptomeningeal enhancement. Analysis of cerebrospinal fluid (CSF) revealed albumin-cytological dissociation. Microbiological studies on CSF, including SARS-CoV-2, were negative. Nerve conduction studies were consistent with demyelinating neuropathy. She was treated with intravenous immunoglobulin, with significant neurological improvement noted over the next 2 weeks. CONCLUSION Leptomeningeal enhancement is an atypical feature in GBS, but could be a marker of its association with SARS-CoV-2 infection.
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1132
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MadaniNeishaboori A, Moshrefiaraghi D, Mohamed Ali K, Toloui A, Yousefifard M, Hosseini M. Central Nervous System Complications in COVID-19 Patients; a Systematic Review and Meta-Analysis based on Current Evidence. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2020; 8:e62. [PMID: 33134959 PMCID: PMC7587989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Several studies have confirmed neurological involvements, such as acute cerebrovascular disease and impaired consciousness in COVID-19. In the present study, our aim is to investigate the current evidence regarding central nervous system (CNS) complications in patients with confirmed COVID-19. METHODS An extensive search was conducted in electronic databases including Medline (using PubMed), Embase, Scopus, and Web of Science, in addition to the manual search in Google and Google scholar search engines, for articles published from 2019 until April 21st, 2020. Inclusion criteria was articles that were reviewed and reported the incidence of neurological outcomes in patients with confirmed COVID-19 disease. RESULTS The initial search yielded 638 records, from which 7 articles were included. Overall, the incidence of CNS complications was calculated to be 6.27% (95% CI: 3.32 to 9.98). The incidence of the most common CNS complications, encephalopathy and acute cerebrovascular disease, were 9.14% (95%CI: 2.20 to 19.81) and 2.59% (95% CI: 1.31 to 4.25), respectively. CONCLUSION CNS complications do exist in COVID-19 patients, encephalopathy being the most concerning one. The heterogeneity in the existing literature causes an uncertainty in reporting the definite prevalence rate for each complication. Thus, further studies are needed for scientists to reach a more accurate estimate of the prevalence of these complications in COVID-19 patients. However, healthcare providers should consider the possibility of CNS involvements in patients with SARS-CoV-2 infection.
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Affiliation(s)
| | | | | | - Amirmohammad Toloui
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Yousefifard
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Hosseini
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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1133
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Eldeeb MA, Hussain FS, Siddiqi ZA. COVID-19 infection may increase the risk of parkinsonism - Remember the Spanish flu? Cytokine Growth Factor Rev 2020; 54:6-7. [PMID: 32563553 PMCID: PMC7276126 DOI: 10.1016/j.cytogfr.2020.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/05/2020] [Indexed: 01/14/2023]
Affiliation(s)
- Mohamed A Eldeeb
- Department of Neurology and Neurosurgery, Montreal Neurological Institute McGill University, Montreal, Quebec, Canada.
| | - Faraz S Hussain
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Zaeem A Siddiqi
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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1135
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Abassi Z, Knaney Y, Karram T, Heyman SN. The Lung Macrophage in SARS-CoV-2 Infection: A Friend or a Foe? Front Immunol 2020; 11:1312. [PMID: 32582222 PMCID: PMC7291598 DOI: 10.3389/fimmu.2020.01312] [Citation(s) in RCA: 118] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/26/2020] [Indexed: 12/15/2022] Open
Abstract
Respiratory, circulatory, and renal failure are among the gravest features of COVID-19 and are associated with a very high mortality rate. A common denominator of all affected organs is the expression of angiotensin-converting enzyme 2 (ACE2), a protease responsible for the conversion of Angiotensin 1-8 (Ang II) to Angiotensin 1-7 (Ang 1-7). Ang 1-7 acts on these tissues and in other target organs via Mas receptor (MasR), where it exerts beneficial effects, including vasodilation and suppression of inflammation and fibrosis, along an attenuation of cardiac and vascular remodeling. Unfortunately, ACE2 also serves as the binding receptor of SARS viral spike glycoprotein, enabling its attachment to host cells, with subsequent viral internalization and replication. Although numerous reports have linked the devastating organ injuries to viral homing and attachment to organ-specific cells widely expressing ACE2, little attention has been given to ACE-2 expressed by the immune system. Herein we outline potential adverse effects of SARS-CoV2 on macrophages and dendritic cells, key cells of the immune system expressing ACE2. Specifically, we propose a new hypothesis that, while macrophages play an important role in antiviral defense mechanisms, in the case of SARS-CoV, they may also serve as a Trojan horse, enabling viral anchoring specifically within the pulmonary parenchyma. It is tempting to assume that diverse expression of ACE2 in macrophages among individuals might govern the severity of SARS-CoV-2 infection. Moreover, reallocation of viral-containing macrophages migrating out of the lung to other tissues is theoretically plausible in the context of viral spread with the involvement of other organs.
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Affiliation(s)
- Zaid Abassi
- Department of Physiology and Biophysics, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Laboratory Medicine, Rambam Health Care Campus, Haifa, Israel
| | - Yara Knaney
- Department of Physiology and Biophysics, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Tony Karram
- Department of Vascular Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Samuel N Heyman
- Department of Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
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1136
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Wiebers DO, Feigin VL. What the COVID-19 Crisis Is Telling Humanity. Neuroepidemiology 2020; 54:283-286. [PMID: 32498068 PMCID: PMC7316645 DOI: 10.1159/000508654] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/14/2020] [Indexed: 01/05/2023] Open
Affiliation(s)
- David O Wiebers
- Emeritus Professor of Neurology, Consultant Emeritus, Departments of Neurology and Health Sciences Research, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA,
| | - Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand
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1137
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Jasti M, Nalleballe K, Dandu V, Onteddu S. A review of pathophysiology and neuropsychiatric manifestations of COVID-19. J Neurol 2020; 268:2007-2012. [PMID: 32494854 PMCID: PMC7268182 DOI: 10.1007/s00415-020-09950-w] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The outbreak of coronavirus disease 2019 (COVID-19) has become one of the most serious pandemics of the recent times. Since this pandemic began, there have been numerous reports about the COVID-19 involvement of the nervous system. There have been reports of both direct and indirect involvement of the central and peripheral nervous system by the virus. OBJECTIVE To review the neuropsychiatric manifestations along with corresponding pathophysiologic mechanisms of nervous system involvement by the COVID-19. BACKGROUND Since the beginning of the disease in humans in the later part of 2019, the coronavirus disease 2019 (COVID-19) pandemic has rapidly spread across the world with over 2,719,000 reported cases in over 200 countries [World Health Organization. Coronavirus disease 2019 (COVID-19) situation report-96.,]. While patients typically present with fever, shortness of breath, sore throat, and cough, neurologic manifestations have been reported, as well. These include the ones with both direct and indirect involvement of the nervous system. The reported manifestations include anosmia, ageusia, central respiratory failure, stroke, acute inflammatory demyelinating polyneuropathy (AIDP), acute necrotizing hemorrhagic encephalopathy, toxic-metabolic encephalopathy, headache, myalgia, myelitis, ataxia, and various neuropsychiatric manifestations. These data were derived from the published clinical data in various journals and case reports. CONCLUSION The neurological manifestations of the COVID-19 are varied and the data about this continue to evolve as the pandemic continues to progress.
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Affiliation(s)
- Madhu Jasti
- Department of Neurology, University of Maryland Baltimore Washington Medical center, Glen Burnie, USA.
| | - Krishna Nalleballe
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Vasuki Dandu
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Sanjeeva Onteddu
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, USA
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1138
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Färber K, Stäbler P, Getzinger T, Uhlig T. [Suspected sepsis in a 10-week-old infant and SARS-CoV-2 detection in cerebrospinal fluid and pharynx]. Monatsschr Kinderheilkd 2020; 169:312-316. [PMID: 32836394 PMCID: PMC7267754 DOI: 10.1007/s00112-020-00942-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A young male infant was referred to the emergency department with apparent acute sepsis. The laboratory results were compatible with a viral infection except for a slightly elevated procalcitonin level. Due to the clinical severity intravenous antibiotic treatment was started immediately. Cerebrospinal fluid and urine testing initially showed no infection focus but then SARS-CoV‑2 was detected in the lower pharynx and cerebrospinal fluid. The clinical condition of the infant rapidly improved but whether this was due to symptomatic or antibiotic treatment remained unknown. There is still a considerable lack of experience regarding diagnostics and treatment of pediatric SARS-CoV-2 infections.
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Affiliation(s)
- Katharina Färber
- Kinder- und Jugendmedizin, RoMed Klinikum Rosenheim, Pettenkoferstraße 10, 83022 Rosenheim, Deutschland
| | - Paul Stäbler
- Kinder- und Jugendmedizin, RoMed Klinikum Rosenheim, Pettenkoferstraße 10, 83022 Rosenheim, Deutschland
| | - Thekla Getzinger
- Kinder- und Jugendmedizin, RoMed Klinikum Rosenheim, Pettenkoferstraße 10, 83022 Rosenheim, Deutschland
| | - Torsten Uhlig
- Kinder- und Jugendmedizin, RoMed Klinikum Rosenheim, Pettenkoferstraße 10, 83022 Rosenheim, Deutschland
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1139
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Benameur K, Agarwal A, Auld SC, Butters MP, Webster AS, Ozturk T, Howell JC, Bassit LC, Velasquez A, Schinazi RF, Mullins ME, Hu WT. Encephalopathy and Encephalitis Associated with Cerebrospinal Fluid Cytokine Alterations and Coronavirus Disease, Atlanta, Georgia, USA, 2020. Emerg Infect Dis 2020; 26:2016-2021. [PMID: 32487282 PMCID: PMC7454059 DOI: 10.3201/eid2609.202122] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
There are few detailed investigations of neurologic complications in severe acute respiratory syndrome coronavirus 2 infection. We describe 3 patients with laboratory-confirmed coronavirus disease who had encephalopathy and encephalitis develop. Neuroimaging showed nonenhancing unilateral, bilateral, and midline changes not readily attributable to vascular causes. All 3 patients had increased cerebrospinal fluid (CSF) levels of anti-S1 IgM. One patient who died also had increased levels of anti-envelope protein IgM. CSF analysis also showed markedly increased levels of interleukin (IL)-6, IL-8, and IL-10, but severe acute respiratory syndrome coronavirus 2 was not identified in any CSF sample. These changes provide evidence of CSF periinfectious/postinfectious inflammatory changes during coronavirus disease with neurologic complications.
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1140
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Niazkar HR, Zibaee B, Nasimi A, Bahri N. The neurological manifestations of COVID-19: a review article. Neurol Sci 2020; 41:1667-1671. [PMID: 32483687 PMCID: PMC7262683 DOI: 10.1007/s10072-020-04486-3] [Citation(s) in RCA: 172] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/21/2020] [Indexed: 12/28/2022]
Abstract
Results Various neurological manifestations have been reported in the literature associated with COVID-19, which in the current study are classified into Central Nervous System (CNS) related manifestations including headache, dizziness, impaired consciousness, acute cerebrovascular disease, epilepsy, and Peripheral Nervous System (PNS) related manifestations such as hyposmia/anosmia, hypogeusia/ageusia, muscle pain, and Guillain-Barre syndrome. Conclusion During the current context of COVID-19 pandemic, physicians should be aware of wide spectrum of neurological COVID-19 sign and symptoms for early diagnosis and isolation of patients. In this regard, COVID-19 has been associated with many neurological manifestations such as confusion, anosmia, and ageusia. Also, various evidences support the possible CNS roles in the COVID-19 pathophysiology. In this regard, further investigation of CNS involvement of SARS-COV-2 is suggested.
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Affiliation(s)
- Hamid Reza Niazkar
- Student Research Committee, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Behdad Zibaee
- Student Research Committee, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Ali Nasimi
- Student Research Committee, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Narjes Bahri
- Department of Midwifery, Faculty of Medicine, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran.
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1141
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Özdağ Acarli AN, Samanci B, Ekizoğlu E, Çakar A, Şirin NG, Gündüz T, Parman Y, Baykan B. Coronavirus Disease 2019 (COVID-19) From the Point of View of Neurologists: Observation of Neurological Findings and Symptoms During the Combat Against a Pandemic. Noro Psikiyatr Ars 2020; 57:154-159. [PMID: 32550783 PMCID: PMC7285636 DOI: 10.29399/npa.26148] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 04/29/2020] [Indexed: 01/08/2023] Open
Abstract
Some respiratory viruses have long been known to cause neurological involvement. A novel coronavirus, leading to severe acute respiratory syndrome, also called coronavirus disease 19 (COVID-19), seems to be a new member of neuroinvasive viruses. While severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) keeps on spreading around the world rapidly, reports about the neurological manifestations associated with SARS-CoV-2, increases day by day. It is reported that a variety of symptoms and syndromes such as headache, dizziness, confusion, ataxia, epilepsy, ischemic stroke, neuropathic pain and myopathy are common especially in more severe COVID-19 patients. It is also suggested that the development of neurological complications is strongly associated with a poor outcome. On the other hand, hyposmia can be the unique symptom in COVID-19 carriers and this can serve as a marker for identifying the otherwise asymptomatically infected patients. It is thought that SARS-CoV-2 may cause neurological symptoms through direct or indirect mechanisms. Nevertheless, neuroinvasion capability of SARS-CoV2 is confirmed by the presence of the virus, in the cerebrospinal fluid of a COVID-19 patient with encephalitis, and this is proven by gene sequencing. In conclusion, during the COVID-19 pandemic, it is crucial to be aware of the possible neurological complications of the disease. Therefore, in this review, we aimed to report neurological manifestations associated with SARS-CoV-2 and possible underlying pathophysiological mechanisms. Due to the high homology of SARS-CoV-2 with other human coronaviruses such as SARS-CoV or Middle East Respiratory Syndrome (MERS)-CoV, reviewing the neurological involvement also associated with these coronaviruses will provide an idea about the long-term complications of COVID-19.
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Affiliation(s)
- Ayşe Nur Özdağ Acarli
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Bedia Samanci
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Esme Ekizoğlu
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Arman Çakar
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Nermin Görkem Şirin
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Tuncay Gündüz
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Yeşim Parman
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Betül Baykan
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
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1142
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Plaze M, Attali D, Petit AC, Blatzer M, Simon-Loriere E, Vinckier F, Cachia A, Chrétien F, Gaillard R. Repurposing chlorpromazine to treat COVID-19: The reCoVery study. L'ENCEPHALE 2020; 46:169-172. [PMID: 32425222 PMCID: PMC7229964 DOI: 10.1016/j.encep.2020.05.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/11/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The ongoing COVID-19 pandemic has caused approximately 2,350,000 infections worldwide and killed more than 160,000 individuals. In Sainte-Anne Hospital (GHU PARIS Psychiatrie & Neuroscience, Paris, France) we have observed a lower incidence of symptomatic forms of COVID-19 among patients than among our clinical staff. This observation led us to hypothesize that psychotropic drugs could have a prophylactic action against SARS-CoV-2 and protect patients from the symptomatic and virulent forms of this infection, since several of these psychotropic drugs have documented antiviral properties. Chlorpromazine (CPZ), a phenothiazine derivative, is also known for its antiviral activity via the inhibition of clathrin-mediated endocytosis. Recentin vitro studies have reported that CPZ exhibits anti-MERS-CoV and anti-SARS-CoV-1 activity. METHODS In this context, the ReCoVery study aims to repurpose CPZ, a molecule with an excellent tolerance profile and a very high biodistribution in the saliva, lungs and brain. We hypothesize that CPZ could reduce the unfavorable course of COVID-19 infection among patients requiring respiratory support without the need for ICU care, and that it could also reduce the contagiousness of SARS-CoV-2. For this purpose, we plan a pilot, multicenter, randomized, single blind, controlled, phase III therapeutic trial (standard treatment vs. CPZ+standard treatment). CONCLUSION This repurposing of CPZ for its anti-SARS-CoV-2 activity could offer an alternative, rapid strategy to alleviate infection severity. This repurposing strategy also avoids numerous developmental and experimental steps, and could save precious time to rapidly establish an anti-COVID-19 therapy with well-known, limited and easily managed side effects.
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Affiliation(s)
- M Plaze
- GHU PARIS Psychiatrie & Neurosciences, site Sainte-Anne, Service Hospitalo-Universitaire, Pôle Hospitalo-Universitaire Paris 15, Paris, France; Université de Paris, Paris, France.
| | - D Attali
- GHU PARIS Psychiatrie & Neurosciences, site Sainte-Anne, Service Hospitalo-Universitaire, Pôle Hospitalo-Universitaire Paris 15, Paris, France; Université de Paris, Paris, France; Physics for Medicine Paris, Inserm, ESPCI Paris, CNRS, PSL Research University, Univ Paris Diderot, Sorbonne Paris Cite, Paris, France
| | - A-C Petit
- GHU PARIS Psychiatrie & Neurosciences, site Sainte-Anne, Service Hospitalo-Universitaire, Pôle Hospitalo-Universitaire Paris 15, Paris, France; Institut Pasteur, Experimental Neuropathology Unit, Paris, France
| | - M Blatzer
- Institut Pasteur, Experimental Neuropathology Unit, Paris, France
| | - E Simon-Loriere
- Institut Pasteur, G5 Evolutionary Genomics of RNA Viruses, Paris, France
| | - F Vinckier
- GHU PARIS Psychiatrie & Neurosciences, site Sainte-Anne, Service Hospitalo-Universitaire, Pôle Hospitalo-Universitaire Paris 15, Paris, France; Université de Paris, Paris, France
| | - A Cachia
- Université de Paris, Institut de Psychiatrie et Neurosciences de Paris, INSERM, Paris, France; Université de Paris, Laboratoire de Psychologie du développement et de l'Éducation de l'Enfant, CNRS, Paris, France
| | - F Chrétien
- Institut Pasteur, Experimental Neuropathology Unit, Paris, France; GHU PARIS Psychiatrie & Neurosciences, site Sainte-Anne, Service de Neuropathologie, Paris, France
| | - R Gaillard
- GHU PARIS Psychiatrie & Neurosciences, site Sainte-Anne, Service Hospitalo-Universitaire, Pôle Hospitalo-Universitaire Paris 15, Paris, France; Université de Paris, Paris, France; Institut Pasteur, Experimental Neuropathology Unit, Paris, France
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1143
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Plaze M, Attali D, Petit AC, Blatzer M, Simon-Loriere E, Vinckier F, Cachia A, Chrétien F, Gaillard R. [Repurposing of chlorpromazine in COVID-19 treatment: the reCoVery study]. L'ENCEPHALE 2020; 46:S35-S39. [PMID: 32387014 PMCID: PMC7188634 DOI: 10.1016/j.encep.2020.04.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/27/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The ongoing COVID-19 pandemic comprises a total of more than 2,350,000 cases and 160,000 deaths. The interest in anti-coronavirus drug development has been limited so far and effective methods to prevent or treat coronavirus infections in humans are still lacking. Urgent action is needed to fight this fatal coronavirus infection by reducing the number of infected people along with the infection contagiousness and severity. Since the beginning of the COVID-19 outbreak several weeks ago, we observe in GHU PARIS Psychiatrie & Neurosciences (Sainte-Anne hospital, Paris, France) a lower prevalence of symptomatic and severe forms of COVID-19 infections in psychiatric patients (∼4%) compared to health care professionals (∼14%). Similar observations have been noted in other psychiatric units in France and abroad. Our hypothesis is that psychiatric patients could be protected from severe forms of COVID-19 by their psychotropic treatments. Chlorpromazine (CPZ) is a phenothiazine derivative widely used in clinical routine in the treatment of acute and chronic psychoses. This first antipsychotic medication has been discovered in 1952 by Jean Delay and Pierre Deniker at Sainte-Anne hospital. In addition, to its antipsychotic effects, several in vitro studies have also demonstrated a CPZ antiviral activity via the inhibition of clathrin-mediated endocytosis. Recently, independent studies revealed that CPZ is an anti-MERS-CoV and an anti-SARS-CoV-1 drug. In comparison to other antiviral drugs, the main advantages of CPZ lie in its biodistribution: (i) preclinical and clinical studies have reported a high CPZ concentration in the lungs (20-200 times higher than in plasma), which is critical because of the respiratory tropism of SARS-CoV-2; (ii) CPZ is highly concentrated in saliva (30-100 times higher than in plasma) and could therefore reduce the contagiousness of COVID-19; (iii) CPZ can cross the blood-brain barrier and could therefore prevent the neurological forms of COVID-19. METHODS Our hypothesis is that CPZ could decrease the unfavorable evolution of COVID-19 infection in oxygen-requiring patients without the need for intensive care, but also reduce the contagiousness of SARS-CoV-2. At this end, we designed a pilot, phase III, multicenter, single blind, randomized controlled clinical trial. Efficacy of CPZ will be assessed according to clinical, biological and radiological criteria. The main objective is to demonstrate a shorter time to response (TTR) to treatment in the CPZ+standard-of-care (CPZ+SOC) group, compared to the SOC group. Response to treatment is defined by a reduction of at least one level of severity on the WHO-Ordinal Scale for Clinical Improvement (WHO-OSCI). The secondary objectives are to demonstrate in the CPZ+SOC group, compared to the SOC group: (A) superior clinical improvement; (B) a greater decrease in the biological markers of viral attack by SARS-CoV-2 (PCR, viral load); (C) a greater decrease in inflammatory markers (e.g. CRP and lymphopenia); (D) a greater decrease in parenchymal involvement (chest CT) on the seventh day post-randomization; (E) to define the optimal dosage of CPZ and its tolerance; (F) to evaluate the biological parameters of response to treatment, in particular the involvement of inflammatory cytokines. Patient recruitment along with the main and secondary objectives are in line with WHO 2020 COVID-19 guidelines. CONCLUSION This repositioning of CPZ as an anti-SARS-CoV-2 drug offers an alternative and rapid strategy to alleviate the virus propagation and the infection severity and lethality. This CPZ repositioning strategy also avoids numerous developmental and experimental steps and can save precious time to rapidly establish an anti-COVID-19 therapy with well-known, limited and easy to manage side effects. Indeed, CPZ is an FDA-approved drug with an excellent tolerance profile, prescribed for around 70 years in psychiatry but also in clinical routine in nausea and vomiting of pregnancy, in advanced cancer and also to treat headaches in various neurological conditions. The broad spectrum of CPZ treatment - including antipsychotic, anxiolytic, antiemetic, antiviral, immunomodulatory effects along with inhibition of clathrin-mediated endocytosis and modulation of blood-brain barrier - is in line with the historical French commercial name for CPZ, i.e. LARGACTIL, chosen as a reference to its "LARGe ACTion" properties. The discovery of those CPZ properties, as for many other molecules in psychiatry, is both the result of serendipity and careful clinical observations. Using this approach, the field of mental illness could provide innovative therapeutic approaches to fight SARS-CoV-2.
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Affiliation(s)
- M Plaze
- GHU Paris psychiatrie et neurosciences, site Sainte-Anne, service hospitalo-universitaire, pôle hospitalo-universitaire Paris 15, Paris, France; Université de Paris, Paris, France.
| | - D Attali
- GHU Paris psychiatrie et neurosciences, site Sainte-Anne, service hospitalo-universitaire, pôle hospitalo-universitaire Paris 15, Paris, France; Université de Paris, Paris, France; Physics for medicine Paris, Inserm, ESPCI Paris, CNRS, PSL Research university, université Paris Diderot, Sorbonne Paris Cite, Paris, France
| | - A-C Petit
- GHU Paris psychiatrie et neurosciences, site Sainte-Anne, service hospitalo-universitaire, pôle hospitalo-universitaire Paris 15, Paris, France; Institut Pasteur, experimental neuropathology unit, Paris, France
| | - M Blatzer
- Institut Pasteur, experimental neuropathology unit, Paris, France
| | - E Simon-Loriere
- Institut Pasteur, G5 evolutionary genomics of RNA viruses, Paris, France
| | - F Vinckier
- GHU Paris psychiatrie et neurosciences, site Sainte-Anne, service hospitalo-universitaire, pôle hospitalo-universitaire Paris 15, Paris, France; Université de Paris, Paris, France
| | - A Cachia
- Université de Paris, Institut de Psychiatrie et Neurosciences de Paris, INSERM, Paris, France; Université de Paris, Laboratoire de Psychologie du développement et de l'Éducation de l'Enfant, CNRS, Paris, France
| | - F Chrétien
- Institut Pasteur, experimental neuropathology unit, Paris, France; GHU PARIS Psychiatrie et Neurosciences, site Sainte-Anne, service de Neuropathologie, Paris, France
| | - R Gaillard
- GHU Paris psychiatrie et neurosciences, site Sainte-Anne, service hospitalo-universitaire, pôle hospitalo-universitaire Paris 15, Paris, France; Université de Paris, Paris, France; Institut Pasteur, experimental neuropathology unit, Paris, France
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1144
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Yuksel A, Karadogan D, Gurkan CG, Akyil FT, Toreyin ZN, Marim F, Arikan H, Eyuboglu TS, Emiralioglu N, Serifoglu I, Develi E, Celik S, Sertcelik UO, Gursoy TR, Elversli MF, Oncel A, Er B, Firincioglulari A, Gunaydin FE, Ozakinci H, Ozcelik N, Esendagli D, Aydin A, Kose N, Ercelik M, Gulhan PY, Yildiz E, Irmak I, Kara BY, Gurz S, Karakas FG, Akgun M. Unclear Issues Regarding COVID-19. Eurasian J Med 2020; 52:191-196. [PMID: 32612430 PMCID: PMC7311136 DOI: 10.5152/eurasianjmed.2020.20092] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 04/29/2020] [Indexed: 01/08/2023] Open
Abstract
Scientists from all over the world have been intensively working to discover different aspects of Coronavirus disease 2019 (COVID-19) since the first cluster of cases was reported in China. Herein, we aimed to investigate unclear issues related to transmission and pathogenesis of disease as well as accuracy of diagnostic tests and treatment modalities. A literature search on PubMed, Ovid, and EMBASE databases was conducted, and articles pertinent to identified search terms were extracted. A snow-ball search strategy was followed in order to retrieve additional relevant articles. It was reported that viral spread may occur during the asymptomatic phase of infection, and viral load was suggested to be a useful marker to assess disease severity. In contrast to immune response against viral infections, cytotoxic T lymphocytes decline in SARS-CoV-2 infection, which can be partially explained by direct invasion of T lymphocytes or apoptosis activated by SARS-CoV-2. Dysregulation of the urokinase pathway, cleavage of the SARS-CoV-2 Spike protein by FXa and FIIa, and consumption coagulopathy were the proposed mechanisms of the coagulation dysfunction in COVID-19. False-negative rates of reverse transcriptase polymerase chain reaction varied between 3% and 41% across studies. The probability of the positive test was proposed to decrease with the number of days past from symptom onset. Safety issues related to infection spread limit the use of high flow nasal oxygen (HFNO) and continuous positive airway pressure (CPAP) in hypoxic patients. Further studies are required to elucidate the challenging issues, thus enhancing the management of COVID-19 patients.
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Affiliation(s)
- Aycan Yuksel
- Department of Chest Diseases, Ufuk University School of Medicine, Ankara, Turkey
| | - Dilek Karadogan
- Department of Chest Diseases, Recep Tayyip Erdogan University School of Medicine, Rize, Turkey
| | - Canan Gunduz Gurkan
- Department of Chest Diseases, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Fatma Tokgoz Akyil
- Department of Chest Diseases, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Zehra Nur Toreyin
- Department of Occupational Health and Diseases, Adana City Research and Training Hospital, Adana, Turkey
| | - Feride Marim
- Department of Chest Diseases, Kutahya University of Health Sciences School of Medicine, Kutahya, Turkey
| | - Huseyin Arikan
- Yuzuncu Yil University, Dursun Odabas Medical Center, Internal Medicine Intensive Care Unit, Van, Turkey
| | | | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Irem Serifoglu
- Department of Chest Diseases Kirikhan State Hospital, Hatay, Turkey
| | - Elif Develi
- Department of Physiotherapy and Rehabilitation, Yeditepe University Faculty of Health Sciences, Istanbul, Turkey
| | - Selman Celik
- Department of Nursing and Health Services, Yeditepe University Faculty of Health Sciences, Istanbul, Turkey
| | - Umran Ozden Sertcelik
- Department of Chest Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Tugba Ramasli Gursoy
- Department of Pediatric Pulmonology, Gazi University School of Medicine, Ankara, Turkey
| | | | - Asli Oncel
- Department of Chest Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Berrin Er
- Internal Medicine Intensive Care Unit, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ali Firincioglulari
- Department of Chest Diseases, University of Health Sciences, Ankara Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Fatma Esra Gunaydin
- Department of Allergy and Immunology, Uludag University School of Medicine, Bursa, Turkey
| | - Hilal Ozakinci
- Department of Pathology, Ankara University School of Medicine, Ankara, Turkey
| | - Neslihan Ozcelik
- Department of Chest Diseases, Recep Tayyip Erdogan University School of Medicine, Rize, Turkey
| | - Dorina Esendagli
- Department of Chest Diseases, Baskent University School of Medicine, Ankara, Turkey
| | - Asena Aydin
- Department of Chest Diseases, Kestel State Hospital, Bursa, Turkey
| | - Neslihan Kose
- Department of Chest Diseases, Bilecik State Hospital, Bilecik, Turkey
| | - Merve Ercelik
- Department of Chest Diseases, Duzce University School of Medicine, Düzce, Turkey
| | - Pinar Yildiz Gulhan
- Department of Chest Diseases, Duzce University School of Medicine, Düzce, Turkey
| | - Ethem Yildiz
- Department of Chest Diseases, Bingol State Hopital, Bingöl, Turkey
| | - Ilim Irmak
- Department of Chest Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Bilge Yilmaz Kara
- Department of Chest Diseases, Recep Tayyip Erdogan University School of Medicine, Rize, Turkey
| | - Selcuk Gurz
- Department of Thoracic Surgery, Ondokuz Mayis University School of Medicine, Samsun, Turkey
| | - Fatma Gulsum Karakas
- Department of Chest Diseases, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Metin Akgun
- Department of Chest Diseases, Ataturk University School of Medicine, Erzurum, Turkey
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1145
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Wilson MP, Jack AS. Coronavirus disease 2019 (COVID-19) in neurology and neurosurgery: A scoping review of the early literature. Clin Neurol Neurosurg 2020; 193:105866. [PMID: 32389893 PMCID: PMC7179494 DOI: 10.1016/j.clineuro.2020.105866] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 01/15/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is a devastating respiratory illness that has dramatically changed the medical landscape around the world. In parallel with a rise in the number of cases globally, the COVID-19 literature has rapidly expanded with experts around the world disseminating knowledge and collaborating on best practices. To date, the literature has predominantly consisted of case reports, case series, and systemic protocols for dealing with this deadly disease from a plethora of specialties with larger observational and randomized studies only now starting to emerge. This scoping review of MEDLINE, EMBASE, SCOPUS, and the Cochrane Library aims to evaluate and summarize the current status of the COVID-19 literature at it applies to neurology and neurosurgery. Neurological symptomatology, neurological risk factors for poor prognosis, pathophysiology for neuroinvasion, and actions taken by neurological or neurosurgical services to manage the current COVID-19 crisis are reviewed.
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Affiliation(s)
- Mitchell P Wilson
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2B2.41 WMC, 8440-112 Street NW, T6G 2B7, Edmonton, Alberta, Canada.
| | - Andrew S Jack
- Department of Neurosurgery, University of California, San Francisco (UCSF), 400 Parnassus Ave, 94143, San Francisco, California, United States.
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1146
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Sezgin M, Ekizoğlu E, Yeşilot N, Çoban O. Stroke During COVID-19 Pandemic. Noro Psikiyatr Ars 2020; 57:83-84. [PMID: 32550770 PMCID: PMC7285634 DOI: 10.29399/npa.27196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 01/30/2023] Open
Affiliation(s)
- Mine Sezgin
- Istanbul University, Istanbul Medical Faculty, Department of Neurology, Istanbul, Turkey
| | - Esme Ekizoğlu
- Istanbul University, Istanbul Medical Faculty, Department of Neurology, Istanbul, Turkey
| | - Nilüfer Yeşilot
- Istanbul University, Istanbul Medical Faculty, Department of Neurology, Istanbul, Turkey
| | - Oğuzhan Çoban
- Istanbul University, Istanbul Medical Faculty, Department of Neurology, Istanbul, Turkey
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1147
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Neurological manifestations of COVID-19 and other coronaviruses: A systematic review. ACTA ACUST UNITED AC 2020; 37:27-32. [PMID: 32834527 PMCID: PMC7261450 DOI: 10.1016/j.npbr.2020.05.008] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/28/2020] [Indexed: 12/26/2022]
Abstract
COVID-19 is a common pathology that may affect diverse organs, including the central and peripheral nervous system. Coronaviruses have important neurotropic potential and they cause neurological alterations that range from mild to severe. CoV may affect any age group; the main symptoms are headache, dizziness, and altered consciousness. The neurological symptoms caused by CoV (MERS-CoV, SARS-CoV and SARS-CoV2) are similar.
Objective To describe the main neurological manifestations related to coronavirus infection in humans. Methodology A systematic review was conducted regarding clinical studies on cases that had neurological manifestations associated with COVID-19 and other coronaviruses. The search was carried out in the electronic databases PubMed, Scopus, Embase, and LILACS with the following keywords: “coronavirus” or “Sars-CoV-2” or “COVID-19” and “neurologic manifestations” or “neurological symptoms” or “meningitis” or “encephalitis” or “encephalopathy,” following the Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Seven studies were included. Neurological alterations after CoV infection may vary from 17.3% to 36.4% and, in the pediatric age range, encephalitis may be as frequent as respiratory disorders, affecting 11 % and 12 % of patients, respectively. The Investigation included 409 patients diagnosed with CoV infection who presented neurological symptoms, with median age range varying from 3 to 62 years. The main neurological alterations were headache (69; 16.8 %), dizziness (57, 13.9 %), altered consciousness (46; 11.2 %), vomiting (26; 6.3 %), epileptic crises (7; 1.7 %), neuralgia (5; 1.2 %), and ataxia (3; 0.7 %). The main presumed diagnoses were acute viral meningitis/encephalitis in 25 (6.1 %) patients, hypoxic encephalopathy in 23 (5.6 %) patients, acute cerebrovascular disease in 6 (1.4 %) patients, 1 (0.2 %) patient with possible acute disseminated encephalomyelitis, 1 (0.2 %) patient with acute necrotizing hemorrhagic encephalopathy, and 2 (1.4 %) patients with CoV related to Guillain-Barré syndrome. Conclusion Coronaviruses have important neurotropic potential and they cause neurological alterations that range from mild to severe. The main neurological manifestations found were headache, dizziness and altered consciousness.
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Key Words
- ACE2, angiotensin converting enzyme 2
- ADEM, acute disseminated encephalomyelitis
- ANHE, acute necrotizing hemorrhagic encephalopathy
- BBE, Bickerstaff’s encephalitis
- COVID-19
- COVID-19, coronavirus disease 2019
- CoV, coronavirus
- Coronavirus
- DPP4, dipeptidil peptidase 4
- Encephalopathy
- G-CSF, granulocyte colony stimulating factor (G-CSF)
- GBS, Guillain-Barré syndrome
- GM-CSF, granulocyte-macrophage colony-stimulating factor
- HCoV, Human coronavirus
- HCoV-229E, Human coronavirus 229E
- HCoV-OC43, Human coronavirus OC43
- ICU, intensive care unit
- IL, interleukin
- MCP-1, monocyte chemoattractant protein-1
- MERS, Middle East respiratory syndrome
- MERS-CoV, Middle East respiratory syndrome coronavirus
- Neurologic manifestations
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- SARS, severe acute respiratory syndrome
- SARS-CoV-2
- SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
- SARS‐CoV, severe acute respiratory syndrome coronavirus
- βCoV, betacoronavírus
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1148
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Singh S. Coronavirus disease-2019 in pregnancy with neurological manifestations versus pregnancy with eclampsia: Need for liberal testing to rule out the masquerades. Acta Obstet Gynecol Scand 2020; 99:950. [PMID: 32473022 PMCID: PMC7300980 DOI: 10.1111/aogs.13927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 05/21/2020] [Accepted: 05/23/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Sweta Singh
- All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
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1149
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Chiappell F. Putative Natural History of CoViD-19. Bioinformation 2020; 16:398-403. [PMID: 32831521 PMCID: PMC7434958 DOI: 10.6026/97320630016398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 12/22/2022] Open
Abstract
The Severe Acute Respiratory Syndrome Corona Virus2 (SARS-CoV2) is responsible for Corona Virus Disease 2019 (CoViD-19), the pandemic that has afflicted close to two million people worldwide, and has taken the lives of over 120,000 patients since its first report in late December 2019. Per million people globally, the infection rate is close to 250 with a death rate of close to 14 (death rate average global death rate: 6.06%; for comparison, revised estimate of the 1918 influenza pandemic had an average global death rate of 5.4% [1]). About 400,000 SARS-CoV2-positive patients have been declared 'recovered', although it is not clear to date what exactly that entails. To be clear, the natural history of SARS-CoV2 infection and of the patho-physiology of CoViD-19 remains shrouded in relative confusion, in part due to the exceedingly virulent nature of the virus, as manifest by its elevated morbidity and mortality, and the fast accumulation of clinical observations and research evidence. Many pieces of a complex puzzle are emerging all at once and their organization into a coherent and cogent picture of the natural history of CoViD-19 is arduous and still wanting. Here, we discuss the recent findings in the context of the available evidence. We propose a putative prediction model of the natural history of CoViD-19. We highlight putative loci and modes of therapeutic intervention that may become beneficial preventive and treatment modalities for individuals at risk of SARS-CoV2 infection and CoViD-19 patients.
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1150
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SARS-CoV-2 / COVID-19 and its Transmission, Prevention, Treatment and Control - An Update. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2020. [DOI: 10.22207/jpam.14.spl1.32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Coronavirus Disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Virus-2 (SARS-CoV-2), pandemic has caused huge panic, havoc and global threats worldwide. The origin of this virus has been linked to animals, intermediate host is still to be identified, and studies are being carried out that how it got transmitted to humans and acquired rapid human-to-human transmission. Within a short time period of only 05 months, SARS-CoV-2 has spread to 213 countries, and till 28th May, 2020, nearly 5.8 million confirmed cases have been reported while taking lives of 0.36 million persons. Seeing the current situation of rapid increase in COVID-19 cases daily in many countries, this seems to be the deadliest pandemic after the 1918 Spanish Flu. There is currently no specific effective treatment for COVID-19 and also in absence of vaccine the radical cure of the disease is far away. Researchers are pacing high to design and develop effective vaccines, drugs and therapeutics to counter COVID-19, however such efforts, clinical trials, necessary approvals and then to reach the level of bulk production of many millions of doses may still take much time. Prevention and control of COVID-19 outbreaks requires an evidence-based, multi-factorial and effective mitigation strategy to be adopted. The current review discusses on the research advancements, challenges and opportunities in COVID 19 management with a focus on its transmission, prevention, treatment and control.
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