1
|
Maini DK, Dixit A, Sharma B, Nanda S, Rehani V, Anand R. Journey of Guillain Barre syndrome from the pre-pandemic era to the pandemic era: A 4-year retrospective study. J Family Med Prim Care 2024; 13:2623-2627. [PMID: 39071018 PMCID: PMC11272027 DOI: 10.4103/jfmpc.jfmpc_1558_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 07/30/2024] Open
Abstract
Aims To study demographic and clinical profiles of Guillain Barre syndrome (GBS) in the pre-pandemic and coronavirus disease 2019 (COVID-19) pandemic era and to compare the GBS incidence, severity, and its outcome in the pre-pandemic and pandemic eras. Methodology This is a 4-year retrospective study done in a tertiary care hospital in Delhi, India, between March 2018 and March 2022. Patients were divided into the pre-pandemic era and pandemic era (2 years before and 2 years after March 2020). Results The number of patients (N) was 25 in the pandemic/vaccine era, while N = 49 in the pre-pandemic era. The mean duration of hospitalization was significantly higher (P = 0.03) during the pandemic era (10.68 ± 6.67 days) compared to the pre-pandemic era (7.59 ± 3.55 days). There was no statistical difference in age (P = 0.56), gender (P = 0.70), GBS variants (P = 0.40), clinical spectrum, antecedent infection (P = 0.91), Hughes Disability Score on admission and discharge (P = 0.93 and P = 0.52, respectively), respiratory involvement requiring a ventilator (P = 0.19), and mortality (P = 0.26) in both the eras. Conclusion Our study showed no association of the incidence of GBS with the ongoing COVID-19 pandemic. The mean hospitalization days were significantly increased during COVID-19 in view of associated respiratory involvement. The commonly held hypothesis of the increase in GBS cases during the pandemic/vaccine era has not been observed in our study.
Collapse
Affiliation(s)
- Deepinder Kaur Maini
- Amity Institute of Neuropsychology and Neurosciences, Amity University, Noida, India
- Department of Neurology, BLK Max Super Speciality Hospital, Delhi, India
| | - Anubhuti Dixit
- Amity Institute of Neuropsychology and Neurosciences, Amity University, Noida, India
| | - Bipan Sharma
- Department of Neurology, BLK Max Super Speciality Hospital, Delhi, India
| | - Satyan Nanda
- Department of Neurology, BLK Max Super Speciality Hospital, Delhi, India
| | - Varun Rehani
- Department of Neurology, BLK Max Super Speciality Hospital, Delhi, India
| | - Rajiv Anand
- Department of Neurology, BLK Max Super Speciality Hospital, Delhi, India
| |
Collapse
|
2
|
Brauer T, Paika S, Kotwani R, Khanna D. Neurological Complications of COVID-19 Infection: A Comprehensive Review. Cureus 2024; 16:e65192. [PMID: 39176347 PMCID: PMC11341106 DOI: 10.7759/cureus.65192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 07/19/2024] [Indexed: 08/24/2024] Open
Abstract
The COVID-19 pandemic is well on its way to reaching endemic status across the globe. While the medical community's understanding of the respiratory complications induced by COVID-19 is improving, there is still much to be learned about the neurological manifestations associated with COVID-19 infection. This review aimed to compile relevant, available evidence of COVID-19-induced neurological complications and to provide information for each complication regarding symptomology, progression patterns, demographic risk factors, treatment, and causative mechanism of action when available. Data for this review was collected using a confined search on PubMed using the keywords ["COVID-19" OR "SARS-CoV-2"] AND ["neurological complications" OR "olfactory symptoms" OR "gustatory symptoms" OR "myalgia" OR "headache" OR "dizziness" OR "stroke" OR "seizures" OR "meningoencephalitis" OR "cerebellar ataxia" OR "acute myelitis" OR "Guillain Barré Syndrome" OR "Miller Fisher Syndrome" OR "Posterior Reversible Encephalopathy Syndrome"] between 2019 and 2023. A wide range of neurological manifestations impact a significant percentage of COVID-19 patients, and a deeper understanding of these manifestations is necessary to ensure adequate management. The most common neurological complications identified consist of olfactory and gustatory dysfunctions, myalgia, headache, and dizziness, while the most severe complications include stroke, seizures, meningoencephalitis, Guillain-Barré syndrome, Miller Fisher syndrome, acute myelitis, and posterior reversible encephalopathy syndrome. While this review effectively provides a roadmap of the neurological risks posed to COVID-19 patients, further research is needed to clarify the precise incidence of these complications and to elucidate the mechanisms responsible for their manifestation.
Collapse
Affiliation(s)
- Travis Brauer
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Sulaiman Paika
- Foundational Sciences, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Roshni Kotwani
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Deepesh Khanna
- Foundational Sciences, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| |
Collapse
|
3
|
Kopańko M, Zabłudowska M, Zajkowska M, Gudowska-Sawczuk M, Mucha M, Mroczko B. The Impact of COVID-19 on the Guillain-Barré Syndrome Incidence. Biomedicines 2024; 12:1248. [PMID: 38927455 PMCID: PMC11201746 DOI: 10.3390/biomedicines12061248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/28/2024] [Accepted: 06/01/2024] [Indexed: 06/28/2024] Open
Abstract
Despite the fact that the global COVID-19 pandemic has officially ended, we continue to feel its effects and discover new correlations between SARS-CoV-2 infection and changes in the organism that have occurred in patients. It has been shown that the disease can be associated with a variety of complications, including disorders of the nervous system such as a characteristic loss of smell and taste, as well as less commonly reported incidents such as cranial polyneuropathy or neuromuscular disorders. Nervous system diseases that are suspected to be related to COVID-19 include Guillain-Barré syndrome, which is frequently caused by viruses. During the course of the disease, autoimmunity destroys peripheral nerves, which despite its rare occurrence, can lead to serious consequences, such as symmetrical muscle weakness and deep reflexes, or even their complete abolition. Since the beginning of the pandemic, case reports suggesting a relationship between these two disease entities have been published, and in some countries, the increasing number of Guillain-Barré syndrome cases have also been reported. This suggests that previous contact with SARS-CoV-2 may have had an impact on their occurrence. This article is a review and summary of the literature that raises awareness of the neurological symptoms' prevalence, including Guillain-Barré syndrome, which may be impacted by the commonly occurring COVID-19 disease or vaccination against it. The aim of this review was to better understand the mechanisms of the virus's action on the nervous system, allowing for better detection and the prevention of its complications.
Collapse
Affiliation(s)
- Magdalena Kopańko
- Department of Biochemical Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland (M.G.-S.); (B.M.)
| | - Magdalena Zabłudowska
- Department of Biochemical Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland (M.G.-S.); (B.M.)
| | - Monika Zajkowska
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland
| | - Monika Gudowska-Sawczuk
- Department of Biochemical Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland (M.G.-S.); (B.M.)
| | - Mateusz Mucha
- Department of Oncological Surgery with Specialized Cancer Treatment Units, Maria Sklodowska-Curie Oncology Center, 15-027 Bialystok, Poland
| | - Barbara Mroczko
- Department of Biochemical Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland (M.G.-S.); (B.M.)
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland
| |
Collapse
|
4
|
Lee L, French E, Coelho DH, Manzoor NF, Wilcox AB, Lee AM, Graves A, Anzalone A, Manna A, Saha A, Olex A, Zhou A, Williams AE, Southerland A, Girvin AT, Walden A, Sharathkumar AA, Amor B, Bates B, Hendricks B, Patel B, Alexander C, Bramante C, Ward-Caviness C, Madlock-Brown C, Suver C, Chute C, Dillon C, Wu C, Schmitt C, Takemoto C, Housman D, Gabriel D, Eichmann DA, Mazzotti D, Brown D, Boudreau E, Hill E, Zampino E, Marti EC, Pfaff ER, French E, Koraishy FM, Mariona F, Prior F, Sokos G, Martin G, Lehmann H, Spratt H, Mehta H, Liu H, Sidky H, Awori Hayanga J, Pincavitch J, Clark J, Harper JR, Islam J, Ge J, Gagnier J, Saltz JH, Saltz J, Loomba J, Buse J, Mathew J, Rutter JL, McMurry JA, Guinney J, Starren J, Crowley K, Bradwell KR, Walters KM, Wilkins K, Gersing KR, Cato KD, Murray K, Kostka K, Northington L, Pyles LA, Misquitta L, Cottrell L, Portilla L, Deacy M, Bissell MM, Clark M, Emmett M, Saltz MM, Palchuk MB, Haendel MA, Adams M, Temple-O’Connor M, Kurilla MG, Morris M, Qureshi N, Safdar N, Garbarini N, Sharafeldin N, Sadan O, Francis PA, Burgoon PW, Robinson P, Payne PRO, Fuentes R, Jawa R, Erwin-Cohen R, Patel R, Moffitt RA, Zhu RL, Kamaleswaran R, Hurley R, Miller RT, Pyarajan S, Michael SG, Bozzette S, Mallipattu S, Vedula S, Chapman S, O’Neil ST, Setoguchi S, Hong SS, Johnson S, Bennett TD, Callahan T, Topaloglu U, Sheikh U, Gordon V, Subbian V, Kibbe WA, Hernandez W, Beasley W, Cooper W, Hillegass W, Zhang XT. Increased Incidence of Vestibular Disorders in Patients With SARS-CoV-2. OTOLOGY & NEUROTOLOGY OPEN 2024; 4:e051. [PMID: 38919767 PMCID: PMC11195920 DOI: 10.1097/ono.0000000000000051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/21/2024] [Indexed: 06/27/2024]
Abstract
Objective Determine the incidence of vestibular disorders in patients with SARS-CoV-2 compared to the control population. Study Design Retrospective. Setting Clinical data in the National COVID Cohort Collaborative database (N3C). Methods Deidentified patient data from the National COVID Cohort Collaborative database (N3C) were queried based on variant peak prevalence (untyped, alpha, delta, omicron 21K, and omicron 23A) from covariants.org to retrospectively analyze the incidence of vestibular disorders in patients with SARS-CoV-2 compared to control population, consisting of patients without documented evidence of COVID infection during the same period. Results Patients testing positive for COVID-19 were significantly more likely to have a vestibular disorder compared to the control population. Compared to control patients, the odds ratio of vestibular disorders was significantly elevated in patients with untyped (odds ratio [OR], 2.39; confidence intervals [CI], 2.29-2.50; P < 0.001), alpha (OR, 3.63; CI, 3.48-3.78; P < 0.001), delta (OR, 3.03; CI, 2.94-3.12; P < 0.001), omicron 21K variant (OR, 2.97; CI, 2.90-3.04; P < 0.001), and omicron 23A variant (OR, 8.80; CI, 8.35-9.27; P < 0.001). Conclusions The incidence of vestibular disorders differed between COVID-19 variants and was significantly elevated in COVID-19-positive patients compared to the control population. These findings have implications for patient counseling and further research is needed to discern the long-term effects of these findings.
Collapse
Affiliation(s)
- Lawrance Lee
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Evan French
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Daniel H. Coelho
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Nauman F. Manzoor
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - on behalf of the N3C consortium.
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Adam B. Wilcox
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Adam M. Lee
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Alexis Graves
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Alfred Anzalone
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Amin Manna
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Amit Saha
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Amy Olex
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Andrea Zhou
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Andrew E. Williams
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Andrew Southerland
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Andrew T. Girvin
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Anita Walden
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Anjali A. Sharathkumar
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Benjamin Amor
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Benjamin Bates
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Brian Hendricks
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Brijesh Patel
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Caleb Alexander
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Carolyn Bramante
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Cavin Ward-Caviness
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Charisse Madlock-Brown
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Christine Suver
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Christopher Chute
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Christopher Dillon
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Chunlei Wu
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Clare Schmitt
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Cliff Takemoto
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Dan Housman
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Davera Gabriel
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - David A. Eichmann
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Diego Mazzotti
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Don Brown
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Eilis Boudreau
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Elaine Hill
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Elizabeth Zampino
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Emily Carlson Marti
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Emily R. Pfaff
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Evan French
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Farrukh M Koraishy
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Federico Mariona
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Fred Prior
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - George Sokos
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Greg Martin
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Harold Lehmann
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Heidi Spratt
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Hemalkumar Mehta
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Hongfang Liu
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Hythem Sidky
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - J.W. Awori Hayanga
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Jami Pincavitch
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Jaylyn Clark
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Jeremy Richard Harper
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Jessica Islam
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Jin Ge
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Joel Gagnier
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Joel H. Saltz
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Joel Saltz
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Johanna Loomba
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - John Buse
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Jomol Mathew
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Joni L. Rutter
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Julie A. McMurry
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Justin Guinney
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Justin Starren
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Karen Crowley
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Katie Rebecca Bradwell
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Kellie M. Walters
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Ken Wilkins
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Kenneth R. Gersing
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Kenrick Dwain Cato
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Kimberly Murray
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Kristin Kostka
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Lavance Northington
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Lee Allan Pyles
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Leonie Misquitta
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Lesley Cottrell
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Lili Portilla
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Mariam Deacy
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Mark M. Bissell
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Marshall Clark
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Mary Emmett
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Mary Morrison Saltz
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Matvey B. Palchuk
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Melissa A. Haendel
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Meredith Adams
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Meredith Temple-O’Connor
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Michael G. Kurilla
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Michele Morris
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Nabeel Qureshi
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Nasia Safdar
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Nicole Garbarini
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Noha Sharafeldin
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Ofer Sadan
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Patricia A. Francis
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Penny Wung Burgoon
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Peter Robinson
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Philip R. O. Payne
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Rafael Fuentes
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Randeep Jawa
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Rebecca Erwin-Cohen
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Rena Patel
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Richard A. Moffitt
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Richard L. Zhu
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Rishi Kamaleswaran
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Robert Hurley
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Robert T. Miller
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Saiju Pyarajan
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Sam G. Michael
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Samuel Bozzette
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Sandeep Mallipattu
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Satyanarayana Vedula
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Scott Chapman
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Shawn T. O’Neil
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Soko Setoguchi
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Stephanie S. Hong
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Steve Johnson
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Tellen D. Bennett
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Tiffany Callahan
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Umit Topaloglu
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Usman Sheikh
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Valery Gordon
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Vignesh Subbian
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Warren A. Kibbe
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Wenndy Hernandez
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Will Beasley
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Will Cooper
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - William Hillegass
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Xiaohan Tanner Zhang
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| |
Collapse
|
5
|
Jagst M, Pottkämper L, Gömer A, Pitarokoili K, Steinmann E. Neuroinvasion and neurotropism of severe acute respiratory syndrome coronavirus 2 infection. Curr Opin Microbiol 2024; 79:102474. [PMID: 38615394 DOI: 10.1016/j.mib.2024.102474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/16/2024]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019, contributes to neurological pathologies in nearly 30% of patients, extending beyond respiratory symptoms. These manifestations encompass disorders of both the peripheral and central nervous systems, causing among others cerebrovascular issues and psychiatric manifestations during the acute and/or post-acute infection phases. Despite ongoing research, uncertainties persist about the precise mechanism the virus uses to infiltrate the central nervous system and the involved entry portals. This review discusses the potential entry routes, including hematogenous and anterograde transport. Furthermore, we explore variations in neurotropism, neurovirulence, and neurological manifestations among pandemic-associated variants of concern. In conclusion, SARS-CoV-2 can infect numerous cells within the peripheral and central nervous system, provoke inflammatory responses, and induce neuropathological changes.
Collapse
Affiliation(s)
- Michelle Jagst
- Department of Molecular and Medical Virology, Ruhr University Bochum, Bochum, Germany; Institute of Virology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Lilli Pottkämper
- Department of Molecular and Medical Virology, Ruhr University Bochum, Bochum, Germany
| | - André Gömer
- Department of Molecular and Medical Virology, Ruhr University Bochum, Bochum, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Eike Steinmann
- Department of Molecular and Medical Virology, Ruhr University Bochum, Bochum, Germany; German Centre for Infection Research (DZIF), External Partner Site, Bochum, Germany.
| |
Collapse
|
6
|
Taftaf A, Vera Cruz CA, Al-Qasmi H, Al-Qasmi M. Bilateral Facial Paralysis in an Atypical Clinical Onset of COVID-Associated Guillain-Barre Syndrome. Cureus 2024; 16:e63498. [PMID: 39081416 PMCID: PMC11287485 DOI: 10.7759/cureus.63498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2024] [Indexed: 08/02/2024] Open
Abstract
Coronavirus disease (COVID-19) has been associated with a diverse range of extrapulmonary manifestations since its global outbreak in 2019. One of its rare complications is Guillain-Barre Syndrome (GBS), a post-infectious neurological disorder that manifests with a characteristic ascending limb paralysis. Here, we describe the atypical case of a 42-year-old African American male who developed bilateral facial paralysis within five weeks of testing positive for COVID-19. Initial diagnostic imaging and blood studies were negative for acute pathology. Albuminocytological dissociation found in a subsequent analysis of the patient's cerebrospinal fluid and his appropriate therapeutic response to intravenous immunoglobulin (IVIg) indicated GBS as the most likely diagnosis.
Collapse
Affiliation(s)
- Ahmad Taftaf
- Internal Medicine, Hurley Medical Center, Flint, USA
| | | | | | | |
Collapse
|
7
|
Li Y, Zhao R, Li L, Xue H, Meng H, Li G, Liang F, Zhang H, Ma J, Pang X, Wang J, Chang X, Guo J, Zhang W. Relative frequencies and clinical features of Guillain-Barré Syndrome before and during the COVID-19 pandemic in North China. BMC Infect Dis 2024; 24:541. [PMID: 38816802 PMCID: PMC11138026 DOI: 10.1186/s12879-024-09401-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/13/2024] [Indexed: 06/01/2024] Open
Abstract
OBJECTIVE Most studies investigated the relationship between COVID-19 and Guillain-Barré syndrome (GBS) by comparing the incidence of GBS before and during the pandemic of COVID-19. However, the findings were inconsistent, probably owing to varying degrees of the lockdown policy. The quarantine requirements and travel restrictions in China were lifted around December 7, 2022. This study aimed to explore whether the relative frequency of GBS increased during the major outbreak in the absence of COVID-19-mandated social restrictions in China. METHODS GBS patients admitted to the First Hospital, Shanxi Medical University, from December 7, 2022 to February 20, 2023, and from June, 2017 to August, 2019 were included. The relative frequencies of GBS in hospitalized patients during different periods were compared. The patients with and without SARS-CoV-2 infection within six weeks prior to GBS onset formed the COVID-GBS group and non-COVID-GBS group, respectively. RESULTS The relative frequency of GBS among hospitalized patients during the major outbreak of COVID-19 (13/14,408) was significantly higher than that before the COVID-19 epidemic (29/160,669, P < 0.001). More COVID-GBS patients (11/13) presented AIDP subtype than non-COVID-GBS cases (10/27, P = 0.003). The mean interval between onset of infective symptoms and GBS was longer in COVID-GBS (21.54 ± 11.56 days) than in non-COVID-GBS (5.76 ± 3.18 days, P < 0.001). CONCLUSIONS COVID-19 significantly increased the incidence of GBS. Most COVID-GBS patients fell into the category of AIDP, responded well to IVIg, and had a favorable prognosis.
Collapse
Affiliation(s)
- Yaqian Li
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Rongjuan Zhao
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Ling Li
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Huiru Xue
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Huaxing Meng
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Guanxi Li
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Feng Liang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Huiqiu Zhang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Jing Ma
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Xiaomin Pang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Juan Wang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xueli Chang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Junhong Guo
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Wei Zhang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China.
| |
Collapse
|
8
|
Blackbourn L, Hamid U, Tokala J, Blume G. A case report of thrombocytopenic COVID-19 and Miller-Fisher syndrome on a concurrent chronic immune neuropathy. Medicine (Baltimore) 2024; 103:e38304. [PMID: 38788032 PMCID: PMC11124588 DOI: 10.1097/md.0000000000038304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024] Open
Abstract
RATIONALE Miller-Fisher syndrome (MFS) is a rare subtype of Guillain-Barre syndrome with classic features of ataxia, areflexia, and ophthalmoplegia that can be caused by a preceding infection including COVID-19. We present a current, asymptomatic thrombocytopenic COVID-19 infection as a cause of MFS in a 60-year-old male with a concurrent chronic immune neuropathy. PATIENT CONCERNS A 60-year-old male presenting with acute symptoms of MFS including ataxia, areflexia, and ophthalmoplegia on a chronic immune neuropathy for at least 1 year and concurrent asymptomatic COVID-19 positive infection. DIAGNOSIS MFS suspected secondary to a current thrombocytopenic COVID-19 infection. INTERVENTIONS Five days of intravenous immune globulin with continued monthly intravenous immune globulin as an outpatient, follow-up long-term in a neuromuscular clinic, electromyography as an outpatient, and continued physical therapy. OUTCOMES The patient significantly improved after initial treatment. LESSONS The full effect of COVID-19 on the various Guillain-Barre syndrome subtypes is unknown, although it clearly can be a cause of the various variants including being caused by a current, asymptomatic infection.
Collapse
Affiliation(s)
- Lisle Blackbourn
- Department of Neurology, University of Illinois College of Medicine Peoria, Peoria, IL, USA
- OSF Illinois Neurological Institute, Peoria, IL, USA
| | - Umair Hamid
- Department of Neurology, University of Illinois College of Medicine Peoria, Peoria, IL, USA
- OSF Illinois Neurological Institute, Peoria, IL, USA
| | - Janaki Tokala
- Department of Neurology, University of Illinois College of Medicine Peoria, Peoria, IL, USA
- OSF Illinois Neurological Institute, Peoria, IL, USA
| | - Gregory Blume
- Department of Neurology, University of Illinois College of Medicine Peoria, Peoria, IL, USA
- OSF Illinois Neurological Institute, Peoria, IL, USA
| |
Collapse
|
9
|
Golzardi M, Hromić-Jahjefendić A, Šutković J, Aydin O, Ünal-Aydın P, Bećirević T, Redwan EM, Rubio-Casillas A, Uversky VN. The Aftermath of COVID-19: Exploring the Long-Term Effects on Organ Systems. Biomedicines 2024; 12:913. [PMID: 38672267 PMCID: PMC11048001 DOI: 10.3390/biomedicines12040913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/12/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Post-acute sequelae of SARS-CoV-2 infection (PASC) is a complicated disease that affects millions of people all over the world. Previous studies have shown that PASC impacts 10% of SARS-CoV-2 infected patients of which 50-70% are hospitalised. It has also been shown that 10-12% of those vaccinated against COVID-19 were affected by PASC and its complications. The severity and the later development of PASC symptoms are positively associated with the early intensity of the infection. RESULTS The generated health complications caused by PASC involve a vast variety of organ systems. Patients affected by PASC have been diagnosed with neuropsychiatric and neurological symptoms. The cardiovascular system also has been involved and several diseases such as myocarditis, pericarditis, and coronary artery diseases were reported. Chronic hematological problems such as thrombotic endothelialitis and hypercoagulability were described as conditions that could increase the risk of clotting disorders and coagulopathy in PASC patients. Chest pain, breathlessness, and cough in PASC patients were associated with the respiratory system in long-COVID causing respiratory distress syndrome. The observed immune complications were notable, involving several diseases. The renal system also was impacted, which resulted in raising the risk of diseases such as thrombotic issues, fibrosis, and sepsis. Endocrine gland malfunction can lead to diabetes, thyroiditis, and male infertility. Symptoms such as diarrhea, nausea, loss of appetite, and taste were also among reported observations due to several gastrointestinal disorders. Skin abnormalities might be an indication of infection and long-term implications such as persistent cutaneous complaints linked to PASC. CONCLUSIONS Long-COVID is a multidimensional syndrome with considerable public health implications, affecting several physiological systems and demanding thorough medical therapy, and more study to address its underlying causes and long-term effects is needed.
Collapse
Affiliation(s)
- Maryam Golzardi
- Department of Genetics and Bioengineering, Faculty of Engineering and Natural Sciences, International University of Sarajevo, Hrasnicka Cesta 15, 71000 Sarajevo, Bosnia and Herzegovina; (M.G.); (J.Š.)
| | - Altijana Hromić-Jahjefendić
- Department of Genetics and Bioengineering, Faculty of Engineering and Natural Sciences, International University of Sarajevo, Hrasnicka Cesta 15, 71000 Sarajevo, Bosnia and Herzegovina; (M.G.); (J.Š.)
| | - Jasmin Šutković
- Department of Genetics and Bioengineering, Faculty of Engineering and Natural Sciences, International University of Sarajevo, Hrasnicka Cesta 15, 71000 Sarajevo, Bosnia and Herzegovina; (M.G.); (J.Š.)
| | - Orkun Aydin
- Department of Psychology, Faculty of Arts and Social Sciences, International University of Sarajevo, Hrasnicka Cesta 15, 71000 Sarajevo, Bosnia and Herzegovina; (O.A.); (P.Ü.-A.)
| | - Pinar Ünal-Aydın
- Department of Psychology, Faculty of Arts and Social Sciences, International University of Sarajevo, Hrasnicka Cesta 15, 71000 Sarajevo, Bosnia and Herzegovina; (O.A.); (P.Ü.-A.)
| | - Tea Bećirević
- Atrijum Polyclinic, 71000 Sarajevo, Bosnia and Herzegovina;
| | - Elrashdy M. Redwan
- Department of Biological Science, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
- Centre of Excellence in Bionanoscience Research, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Therapeutic and Protective Proteins Laboratory, Protein Research Department, Genetic Engineering and Biotechnology Research Institute, City of Scientific Research and Technological Applications (SRTA-City), New Borg EL-Arab, Alexandria 21934, Egypt
| | - Alberto Rubio-Casillas
- Autlan Regional Hospital, Health Secretariat, Autlan 48900, Jalisco, Mexico;
- Biology Laboratory, Autlan Regional Preparatory School, University of Guadalajara, Autlan 48900, Jalisco, Mexico
| | - Vladimir N. Uversky
- Department of Molecular Medicine and USF Health Byrd Alzheimer’s Research Institute, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
| |
Collapse
|
10
|
Tasdemir V, Sirin NG, Cakar A, Culha A, Soysal A, Elmali AD, Gunduz A, Arslan B, Yalcin D, Atakli D, Orhan EK, Sanli E, Tuzun E, Gozke E, Gursoy E, Savrun FK, Uslu FI, Aysal F, Durmus H, Bulbul H, Ertas FI, Uluc K, Tutkavul K, Baysal L, Baslo MB, Kiziltan M, Mercan M, Pazarci N, Uzun N, Akan O, Cokar O, Koytak PK, Sürmeli R, Gunaydin S, Ayas S, Baslo SA, Yayla V, Yilmaz V, Parman Y, Matur Z, Acar ZU, Oge AE. Electrodiagnostic methods to verify Guillain-Barré syndrome subtypes in Istanbul: A prospective multicenter study. J Peripher Nerv Syst 2024; 29:72-81. [PMID: 38291679 DOI: 10.1111/jns.12612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND AND AIMS This study aimed to identify the clinical characteristics and electrodiagnostic subtypes of Guillain-Barré syndrome (GBS) in Istanbul. METHODS Patients with GBS were prospectively recruited between April 2019 and March 2022 and two electrodiagnostic examinations were performed on each patient. The criteria of Ho et al., Hadden et al., Rajabally et al., and Uncini et al. were compared for the differentiation of demyelinating and axonal subtypes, and their relations with anti-ganglioside antibodies were analyzed. RESULTS One hundred seventy-seven patients were included, 69 before the coronavirus disease 2019 pandemic (April 2019-February 2020) and 108 during the pandemic (March 2020-March 2022), without substantial changes in monthly frequencies. As compared with the criteria of Uncini et al., demyelinating GBS subtype diagnosis was more frequent according to the Ho et al. and Hadden et al. criteria (95/162, 58.6% vs. 110/174, 63.2% and 121/174, 69.5%, respectively), and less frequent according to Rajabally et al.'s criteria (76/174, 43.7%). Fourteen patients' diagnoses made using Rajabally et al.'s criteria were shifted to the other subtype with the second electrodiagnostic examination. Of the 106 analyzed patients, 22 had immunoglobulin G anti-ganglioside antibodies (14 with the axonal subtype). They had less frequent sensory symptoms (54.5% vs. 83.1%, p = 0.009), a more frequent history of previous gastroenteritis (54.5% vs. 22.9%, p = 0.007), and a more severe disease as compared with those without antibodies. INTERPRETATION Serial electrodiagnostic examinations are more helpful for accurate subtype diagnosis of GBS because of the dynamic pathophysiology of the disease. We observed no significant increase in GBS frequency during the pandemic in this metropolis.
Collapse
Affiliation(s)
- Volkan Tasdemir
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Nermin Gorkem Sirin
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Arman Cakar
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Ayla Culha
- Haseki Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Aysun Soysal
- Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Ayse Deniz Elmali
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Aysegul Gunduz
- Cerrahpasa Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Beyza Arslan
- Department of Neurology and Clinical Neurophysiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Destina Yalcin
- Umraniye Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Dilek Atakli
- Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Elif Kocasoy Orhan
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Elif Sanli
- Aziz Sancar Institute of Experimental Medicine, Department of Neuroscience, Istanbul University, Istanbul, Turkey
| | - Erdem Tuzun
- Aziz Sancar Institute of Experimental Medicine, Department of Neuroscience, Istanbul University, Istanbul, Turkey
| | - Eren Gozke
- Fatih Sultan Mehmet Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Esra Gursoy
- Faculty of Medicine Hospital, Department of Neurology, Bezmialem Vakif University, Istanbul, Turkey
| | - Feray Karaali Savrun
- Cerrahpasa Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ferda Ilgen Uslu
- Faculty of Medicine Hospital, Department of Neurology, Bezmialem Vakif University, Istanbul, Turkey
| | - Fikret Aysal
- Faculty of Medicine, Department of Neurology, Medipol University, Istanbul, Turkey
| | - Hacer Durmus
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Hafsa Bulbul
- Department of Neurology and Clinical Neurophysiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - F Inci Ertas
- Sisli Hamidiye Etfal Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Kayihan Uluc
- Department of Neurology and Clinical Neurophysiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Kemal Tutkavul
- Haydarpaşa Numune Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Leyla Baysal
- Prof. Dr. Cemil Taşçıoğlu City Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Baris Baslo
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Meral Kiziltan
- Cerrahpasa Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Metin Mercan
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Nevin Pazarci
- Umraniye Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Nurten Uzun
- Cerrahpasa Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Onur Akan
- Prof. Dr. Cemil Taşçıoğlu City Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Ozlem Cokar
- Haseki Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Pinar Kahraman Koytak
- Department of Neurology and Clinical Neurophysiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Reyhan Sürmeli
- Umraniye Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Sefer Gunaydin
- Haseki Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Selahattin Ayas
- Cerrahpasa Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sezin Alpaydin Baslo
- Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Vildan Yayla
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Vuslat Yilmaz
- Aziz Sancar Institute of Experimental Medicine, Department of Neuroscience, Istanbul University, Istanbul, Turkey
| | - Yesim Parman
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Zeliha Matur
- Faculty of Medicine Hospital, Department of Neurology, Bezmialem Vakif University, Istanbul, Turkey
| | - Zeynep Unlusoy Acar
- Haseki Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Ali Emre Oge
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| |
Collapse
|
11
|
Bromberg MB. What Is in the Literature. J Clin Neuromuscul Dis 2024; 25:157-162. [PMID: 38441937 DOI: 10.1097/cnd.0000000000000473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
ABSTRACT This issue of What is in the Literature focuses on the Guillain-Barré syndrome. Guillain-Barré syndrome is a monophasic illness, and there is new information about precipitating factors, changes in nerve conduction studies over time, potential biomarkers, optimal treatment, and features in uncommon patient populations.
Collapse
Affiliation(s)
- Mark B Bromberg
- Department of Neurology, University of Utah, Salt Lake City, UT
| |
Collapse
|
12
|
Massa F, Vigo T, Bellucci M, Giunti D, Emanuela MM, Visigalli D, Capodivento G, Cerne D, Assini A, Boni S, Rizzi D, Narciso E, Grisanti GS, Coco E, Uccelli A, Schenone A, Franciotta D, Benedetti L. COVID-19-associated serum and cerebrospinal fluid cytokines in post- versus para-infectious SARS-CoV-2-related Guillain-Barré syndrome. Neurol Sci 2024; 45:849-859. [PMID: 38169013 DOI: 10.1007/s10072-023-07279-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Guillain-Barré syndrome associated with Coronavirus-2-related severe acute respiratory syndrome (COV-GBS) occurs as para- or post-infectious forms, depending on the timing of disease onset. In these two forms, we aimed to compare the cerebrospinal fluid (CSF) and serum proinflammatory cytokine profiles to evaluate differences that could possibly have co-pathogenic relevance. MATERIALS AND METHODS We studied a retrospective cohort of 26 patients with either post-COV-GBS (n = 15), with disease onset occurring > 7 days after SARS-CoV-2 infection, or para-COV-GBS (n = 11), with disease onset 7 days or less. TNF-α, IL-6, and IL-8 were measured in the serum with SimplePlex™ Ella™ immunoassay. In addition to the para-/post-COV-GBS patients, serum levels of these cytokines were determined in those with non-COVID-associated-GBS (NC-GBS; n = 43), paucisymptomatic SARS-CoV-2 infection without GBS (COVID, n = 20), and in healthy volunteers (HV; n = 12). CSF cytokine levels were measured in patients with para-/post-COV-GBS, in those with NC-GBS (n = 29), or with Alzheimer's disease (AD; n = 24). RESULTS Serum/CSF cytokine levels did not differ in para- vs post-COV-GBS. We found that SARS-CoV-2 infection raises the serum levels of TNF-α, IL-6, and IL-8, as well as an increase of IL-6 (in serum and CSF) and IL-8 (in CSF) in either NC-GBS or COV-GBS than controls. CSF and serum cytokine levels resulted independent one with another. CONCLUSIONS The change of cytokines linked to SARS-CoV-2 in COV-GBS appears to be driven by viral infection, although it has unique characteristics in GBS as such and does not account for cases with para- or post-infectious onset.
Collapse
Affiliation(s)
- Federico Massa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Largo Paolo Daneo 3, 16132, Genova, Italy.
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genova, Italy.
| | - Tiziana Vigo
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genova, Italy
| | - Margherita Bellucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Largo Paolo Daneo 3, 16132, Genova, Italy
| | - Debora Giunti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Largo Paolo Daneo 3, 16132, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genova, Italy
| | | | - Davide Visigalli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Largo Paolo Daneo 3, 16132, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genova, Italy
| | - Giovanna Capodivento
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Largo Paolo Daneo 3, 16132, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genova, Italy
| | - Denise Cerne
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Largo Paolo Daneo 3, 16132, Genova, Italy
| | - Andrea Assini
- Neurology Unit, Galliera Hospital, Via Mura Delle Cappuccine 14, 1628, Genova, Italy
| | - Silvia Boni
- Department of Infectious Diseases, Galliera Hospital, Via Mura Delle Cappuccine 14, 1628, Genoa, Italy
| | - Domenica Rizzi
- Neurology Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genova, Italy
| | - Eleonora Narciso
- Department of Neurology, ASL3 Genovese, Corso Onofrio Scassi 1, 16149, Genova, Italy
| | - Giuseppe Stefano Grisanti
- Department of Neurology, Santa Corona Hospital, Viale XXV Aprile 38, 17027, Pietra Ligure, Savona, Italy
| | - Elena Coco
- Department of Neurology, Santa Corona Hospital, Viale XXV Aprile 38, 17027, Pietra Ligure, Savona, Italy
| | - Antonio Uccelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Largo Paolo Daneo 3, 16132, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genova, Italy
| | - Angelo Schenone
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Largo Paolo Daneo 3, 16132, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genova, Italy
| | | | - Luana Benedetti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Largo Paolo Daneo 3, 16132, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genova, Italy
| |
Collapse
|
13
|
Rao S, Gross RS, Mohandas S, Stein CR, Case A, Dreyer B, Pajor NM, Bunnell HT, Warburton D, Berg E, Overdevest JB, Gorelik M, Milner J, Saxena S, Jhaveri R, Wood JC, Rhee KE, Letts R, Maughan C, Guthe N, Castro-Baucom L, Stockwell MS. Postacute Sequelae of SARS-CoV-2 in Children. Pediatrics 2024; 153:e2023062570. [PMID: 38321938 PMCID: PMC10904902 DOI: 10.1542/peds.2023-062570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 02/08/2024] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has caused significant medical, social, and economic impacts globally, both in the short and long term. Although most individuals recover within a few days or weeks from an acute infection, some experience longer lasting effects. Data regarding the postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection (PASC) in children, or long COVID, are only just emerging in the literature. These symptoms and conditions may reflect persistent symptoms from acute infection (eg, cough, headaches, fatigue, and loss of taste and smell), new symptoms like dizziness, or exacerbation of underlying conditions. Children may develop conditions de novo, including postural orthostatic tachycardia syndrome, myalgic encephalomyelitis/chronic fatigue syndrome, autoimmune conditions and multisystem inflammatory syndrome in children. This state-of-the-art narrative review provides a summary of our current knowledge about PASC in children, including prevalence, epidemiology, risk factors, clinical characteristics, underlying mechanisms, and functional outcomes, as well as a conceptual framework for PASC based on the current National Institutes of Health definition. We highlight the pediatric components of the National Institutes of Health-funded Researching COVID to Enhance Recovery Initiative, which seeks to characterize the natural history, mechanisms, and long-term health effects of PASC in children and young adults to inform future treatment and prevention efforts. These initiatives include electronic health record cohorts, which offer rapid assessments at scale with geographical and demographic diversity, as well as longitudinal prospective observational cohorts, to estimate disease burden, illness trajectory, pathobiology, and clinical manifestations and outcomes.
Collapse
Affiliation(s)
- Suchitra Rao
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado
| | - Rachel S. Gross
- Departments of Pediatrics
- Population Health, NYU Grossman School of Medicine, New York, New York
| | - Sindhu Mohandas
- Division of Infectious Diseases
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Cheryl R. Stein
- Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, New York
| | - Abigail Case
- Department of Pediatrics and Rehabilitation Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Benard Dreyer
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Nathan M. Pajor
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - H. Timothy Bunnell
- Biomedical Research Informatics Center, Nemours Children’s Health, Nemours Children’s Hospital, Delaware, Wilmington, Delaware
| | - David Warburton
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Elizabeth Berg
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Jonathan B. Overdevest
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Mark Gorelik
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Joshua Milner
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Sejal Saxena
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Ravi Jhaveri
- Division of Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - John C. Wood
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Kyung E. Rhee
- Department of Pediatrics, University of California, San Diego, School of Medicine, San Diego, California
| | - Rebecca Letts
- Population Health, NYU Grossman School of Medicine, New York, New York
| | - Christine Maughan
- Population Health, NYU Grossman School of Medicine, New York, New York
| | - Nick Guthe
- Population Health, NYU Grossman School of Medicine, New York, New York
| | | | - Melissa S. Stockwell
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York
| |
Collapse
|
14
|
Liu S, Zhang WW, Jia L, Zhang HL. Guillain-Barré syndrome: immunopathogenesis and therapeutic targets. Expert Opin Ther Targets 2024; 28:131-143. [PMID: 38470316 DOI: 10.1080/14728222.2024.2330435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 03/10/2024] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Guillain-Barré syndrome (GBS) is a group of acute immune-mediated disorders in the peripheral nervous system. Both infectious and noninfectious factors are associated with GBS, which may act as triggers of autoimmune responses leading to neural damage and dysfunction. AREAS COVERED Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its vaccines as well as flaviviruses have been associated with GBS, although a robust conclusion has yet to be reached. Immunomodulatory treatments, including intravenous immunoglobulins (IVIg) and plasma exchange (PE), have long been the first-line therapies for GBS. Depending on GBS subtype and severity at initial presentation, the efficacy of IVIg and PE can be variable. Several new therapies showing benefits to experimental animals merit further investigation before translation into clinical practice. We review the state-of-the-art knowledge on the immunopathogenesis of GBS in the context of coronavirus disease 2019 (COVID-19). Immunomodulatory therapies in GBS, including IVIg, PE, corticosteroids, and potential therapies, are summarized. EXPERT OPINION The association with SARS-CoV-2 remains uncertain, with geographical differences that are difficult to explain. Evidence and guidelines are lacking for the decision-making of initiating immunomodulatory therapies in mildly affected patients or patients with regional subtypes of GBS.
Collapse
Affiliation(s)
- Shan Liu
- Department of Nuclear Medicine, Second Hospital of Jilin University, Changchun, China
| | - Wei Wei Zhang
- Department of Neurology, First Hospital of Jilin University, Jilin University, Changchun, China
| | - Linpei Jia
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hong-Liang Zhang
- Department of Life Sciences, National Natural Science Foundation of China, Beijing, China
| |
Collapse
|
15
|
Vogrig A, Tartaglia S, Dentoni M, Fabris M, Bax F, Belluzzo M, Verriello L, Bagatto D, Gastaldi M, Tocco P, Zoccarato M, Zuliani L, Pilotto A, Padovani A, Villagrán-García M, Davy V, Gigli GL, Honnorat J, Valente M. Central nervous system immune-related disorders after SARS-CoV-2 vaccination: a multicenter study. Front Immunol 2024; 15:1344184. [PMID: 38375477 PMCID: PMC10876052 DOI: 10.3389/fimmu.2024.1344184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/09/2024] [Indexed: 02/21/2024] Open
Abstract
Background COVID-19 vaccines have been approved due to their excellent safety and efficacy data and their use has also permitted to reduce neurological complications of SARS-CoV-2. However, clinical trials were underpowered to detect rare adverse events. Herein, the aim was to characterize the clinical spectrum and immunological features of central nervous system (CNS) immune-related events following SARS-CoV-2 vaccination. Methods Multicenter, retrospective, cohort study (December 1, 2020-April 30, 2022). Inclusion criteria were (1) de novo CNS disorders developing after SARS-CoV-2 vaccination (probable causal relationship as per 2021 Butler criteria) (2); evidence for an immune-mediated etiology, as per (i) 2016 Graus criteria for autoimmune encephalitis (AE); (ii) 2015 Wingerchuk criteria for neuromyelitis optica spectrum disorders; (iii) criteria for myelitis. Results Nineteen patients were included from 7 tertiary referral hospitals across Italy and France (one of them being a national referral center for AE), over almost 1 year and half of vaccination campaign. Vaccines administered were mRNA-based (63%) and adenovirus-vectored (37%). The median time between vaccination and symptoms onset was 14 days (range: 2-41 days). CSF was inflammatory in 74%; autoantibodies were detected in 5%. CSF cytokine analysis (n=3) revealed increased CXCL-10 (IP-10), suggesting robust T-cell activation. The patients had AE (58%), myelitis (21%), acute disseminated encephalomyelitis (ADEM) (16%), and brainstem encephalitis (5%). All patients but 2 received immunomodulatory treatment. At last follow-up (median 130 days; range: 32-540), only one patient (5%) had a mRS>2. Conclusion CNS adverse events of COVID-19 vaccination appear to be very rare even at reference centers and consist mostly of antibody-negative AE, myelitis, and ADEM developing approximately 2 weeks after vaccination. Most patients improve following immunomodulatory treatment.
Collapse
Affiliation(s)
- Alberto Vogrig
- Department of Medicine (DMED), University of Udine, Udine, Italy
- Clinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Sara Tartaglia
- Department of Medicine (DMED), University of Udine, Udine, Italy
- Clinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Marta Dentoni
- Department of Medicine (DMED), University of Udine, Udine, Italy
- Clinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Martina Fabris
- Institute of Clinical Pathology, Department of Laboratory Medicine, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Francesco Bax
- Clinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Marco Belluzzo
- Neurology Unit, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Lorenzo Verriello
- Neurology Unit, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Daniele Bagatto
- Department of Diagnostic Imaging, Unit of Neuroradiology, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Matteo Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - Pierluigi Tocco
- Neurology and Stroke Unit, “Spirito Santo” Hospital of Pescara, Pescara, Italy
| | - Marco Zoccarato
- UOC Neurologia O.S.A. - Azienda Ospedale Università di Padova, Padua, Italy
| | - Luigi Zuliani
- Neurology Unit, AULSS8 Berica, San Bortolo Hospital, Vicenza, Italy
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Neurology Unit, Department of Continuity of Care and Frailty, ASST Spedali Civili Brescia University Hospital, Brescia, Italy
- Laboratory of Digital Neurology and Biosensors, University of Brescia, Brescia, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Neurology Unit, Department of Continuity of Care and Frailty, ASST Spedali Civili Brescia University Hospital, Brescia, Italy
- Laboratory of Digital Neurology and Biosensors, University of Brescia, Brescia, Italy
| | - Macarena Villagrán-García
- French Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France
| | - Vincent Davy
- Department of Neurology, Hôpital Pitié Salpétrière, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Gian Luigi Gigli
- Department of Medicine (DMED), University of Udine, Udine, Italy
- Clinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Jérôme Honnorat
- French Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France
| | - Mariarosaria Valente
- Department of Medicine (DMED), University of Udine, Udine, Italy
- Clinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| |
Collapse
|
16
|
Censi S, Bisaccia G, Gallina S, Tomassini V, Uncini A. Guillain-Barré syndrome and SARS-CoV-2 infection: a systematic review and meta-analysis on a debated issue and evidence for the 'Italian factor'. Eur J Neurol 2024; 31:e16094. [PMID: 37823707 PMCID: PMC11235836 DOI: 10.1111/ene.16094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/07/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND AND PURPOSE The association between Guillain-Barré syndrome (GBS) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is debated. This study reappraises, after three pandemic years, the epidemiological data and the features of GBS in SARS-CoV-2 patients. METHODS A systematic review and meta-analysis of case reports/series and cohort studies published between 1 January 2020 and 19 April 2023 was performed. RESULTS In all, 209 case reports/series (304 patients) and 26 cohort studies were included. The risk of GBS in northern Italy during the first pandemic wave was 2.85 times increased (95% confidence interval [CI] 1.54; 5.25) whereas in some countries the risk during the first pandemic year was 0.17 times reduced (risk ratio 0.83, 95% CI 0.75; 0.93). The incidence of GBS in SARS-CoV-2 Italian hospitalized cohorts was 8.55 per 1000 (95% CI 5.33; 12.49) with an estimated incidence of 0.13 GBS per 1000 in the SARS-CoV-2 infected population. In European cohorts the pooled rate of GBS with SARS-CoV-2 infection was 61.3% of the total. GBS patients with SARS-CoV-2 infection showed more frequently, but not differently from non-infected patients, the classical clinical presentation and the demyelinating subtype. Cranial nerves were more frequently involved in SARS-CoV-2 infected patients. CONCLUSIONS An increased risk of GBS occurred in northern Italy during early COVID-19 pandemic. The recognition of the 'Italian factor' reconciles contrasting results of the epidemiological studies. The slightly reduced GBS risk in other countries and the relatively high frequency of GBS associated with SARS-CoV-2 infection can be explained by the adopted health measures that decreased the circulation of other GBS infective antecedents.
Collapse
Affiliation(s)
- Stefano Censi
- Department of Neuroscience, Imaging and Clinical Sciences; Institute for Advanced Biomedical Technologies (ITAB)‘G. d'Annunzio’ University of Chieti‐PescaraChietiItaly
| | - Giandomenico Bisaccia
- Department of Neuroscience, Imaging and Clinical Sciences; Institute for Advanced Biomedical Technologies (ITAB)‘G. d'Annunzio’ University of Chieti‐PescaraChietiItaly
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences; Institute for Advanced Biomedical Technologies (ITAB)‘G. d'Annunzio’ University of Chieti‐PescaraChietiItaly
| | - Valentina Tomassini
- Department of Neuroscience, Imaging and Clinical Sciences; Institute for Advanced Biomedical Technologies (ITAB)‘G. d'Annunzio’ University of Chieti‐PescaraChietiItaly
- Clinical NeurologySS. Annunziata University HospitalChietiItaly
| | - Antonino Uncini
- Department of Neuroscience, Imaging and Clinical Sciences; Institute for Advanced Biomedical Technologies (ITAB)‘G. d'Annunzio’ University of Chieti‐PescaraChietiItaly
| |
Collapse
|
17
|
Hadhiah K, Alhashim A, Al-Dandan HA, Alhassan E, Alqarni AM, Memish AAA, Alabdali M. Guillain-Barré syndrome post-SARS-CoV-2 vaccine: a systematic review and data analysis on its clinical, laboratory, electrophysiological, and radiological features. Front Neurol 2024; 15:1332364. [PMID: 38352138 PMCID: PMC10863047 DOI: 10.3389/fneur.2024.1332364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/08/2024] [Indexed: 02/16/2024] Open
Abstract
Introduction Guillain-Barré syndrome (GBS) is a rare disease that affects almost 0.8-1.9 cases per 100,000 people worldwide every year. This is the most prevalent cause of subacute flaccid paralyzing illness today. It is a subacute inflammatory demyelinating polyradiculoneuropathy; the typical scenario involves ascending symmetrical flaccid paralysis, but in some circumstances, sensory, autonomic, and cranial neuropathy may also be involved. Several vaccines have been found to have complications since the previous century. Numerous case reports of GBS in the literature have been reported following COVID-19 vaccines in recent times. Objective This study aimed to conduct a comprehensive examination of GBS cases that have been reported after COVID-19 vaccines; to analyze the descriptive statistical analysis of data gathered regarding clinical, laboratory, electrophysiological, and radiological characteristics; to discuss, based on the available evidence, whether the disease has a preference for a particular vaccine type; and to speculate on the potential pathogenesis. Methodology This review has been carried out by recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Result Reviewing 60 case reports illustrated that most of them are from the USA (18.1%) and the majority of affected individuals were males (60%). The results favored the association between vector-based SARS-CoV-2 vaccine, particularly AstraZeneca vaccine, and the GBS. The mean of symptoms onset is 11.4 days. The results of diagnostic tests such as LP are consistent mostly with albumin-cytological dissociation (81.81%), where brain and spine MRI was unremarkable in 59.52%. Regarding electrodiagnostic tests, AIDP is the most common variant (61.81%). The management was not consistent among the case reports. However, IVIG is the most frequent way of treating these patients (68.33%). The functional outcome was documented in 47 patients; 65% improved with medical management. Conclusion This study aimed to conduct a systematic review of reported cases of GBS following COVID-19 vaccines and descriptive statistical analysis of collected data on clinical, laboratory, electrophysiological, and radiological features, to discuss, based on available results, whether the disease has a predilection to a specific vaccine type and to speculate the potential pathogenesis.
Collapse
Affiliation(s)
| | - Ali Alhashim
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | | | | | | | | |
Collapse
|
18
|
Boyarchuk O, Volianska L. Autoimmunity and long COVID in children. Reumatologia 2024; 61:492-501. [PMID: 38322108 PMCID: PMC10839920 DOI: 10.5114/reum/176464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 12/06/2023] [Indexed: 02/08/2024] Open
Abstract
Numerous hypotheses regarding the pathogenetic mechanisms of long COVID have been proposed. Immune dysregulation and autoimmunity are among the leading hypotheses. In this article, we present two clinical cases of long COVID. The first case demonstrates the phenotype of long COVID with pain and musculoskeletal symptoms, which is often associated with autoimmunity and mimics systemic connective tissue diseases. In the second case, a high titer of antinuclear antibodies was observed after SARS-CoV-2 infection, but the clinical symptoms were limited to fever and headache. Only a comprehensive evaluation of clinical symptoms and thorough objective examination can confirm or exclude autoimmune diseases after a previous SARS-CoV-2 infection. A systematic search in the PubMed Medline database was carried out for studies focusing on immune dysregulation, autoimmunity, and its association with the clinical phenotype of long COVID. The question of the role of autoimmunity in the development of long COVID and the management approaches are discussed.
Collapse
Affiliation(s)
- Oksana Boyarchuk
- Department of Children's Diseases and Pediatric Surgery, I. Horbachevsky Ternopil National Medical University, Ukraine
| | - Liubov Volianska
- Department of Children's Diseases and Pediatric Surgery, I. Horbachevsky Ternopil National Medical University, Ukraine
| |
Collapse
|
19
|
Cappelletti G, Colombrita C, Limanaqi F, Invernizzi S, Garziano M, Vanetti C, Moscheni C, Santangelo S, Zecchini S, Trabattoni D, Silani V, Clerici M, Ratti A, Biasin M. Human motor neurons derived from induced pluripotent stem cells are susceptible to SARS-CoV-2 infection. Front Cell Neurosci 2023; 17:1285836. [PMID: 38116398 PMCID: PMC10728732 DOI: 10.3389/fncel.2023.1285836] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/17/2023] [Indexed: 12/21/2023] Open
Abstract
Introduction COVID-19 typically causes Q7 respiratory disorders, but a high proportion of patients also reports neurological and neuromuscular symptoms during and after SARSCoV-2 infection. Despite a number of studies documenting SARS-CoV-2 infection of various neuronal cell populations, the impact of SARS-CoV-2 exposure on motor neuronal cells specifically has not been investigated so far. Methods Thus, by using human iPSC-derived motor neurons (iPSC-MNs) we assessed: (i) the expression of SARS-CoV-2 main receptors; (ii) iPSC-MN infectability by SARS-CoV-2; and (iii) the effect of SARS-CoV-2 exposure on iPSC-MN transcriptome. Results Gene expression profiling and immunofluorescence (IF) analysis of the main host cell receptors recognized by SARS-CoV-2 revealed that all of them are expressed in iPSC-MNs, with CD147 and NRP1 being the most represented ones. By analyzing SARS-CoV-2 N1 and N2 gene expression over time, we observed that human iPSC-MNs were productively infected by SARS-CoV-2 in the absence of cytopathic effect. Supernatants collected from SARS-CoV-2-infected iPSC-MNs were able to re-infect VeroE6 cells. Image analyses of SARS-CoV-2 nucleocapsid proteins by IF confirmed iPSC-MN infectability. Furthermore, SARS-CoV-2 infection in iPSCMNs significantly altered the expression of genes (IL-6, ANG, S1PR1, BCL2, BAX, Casp8, HLA-A, ERAP1, CD147, MX1) associated with cell survival and metabolism, as well as antiviral and inflammatory response. Discussion These results suggest for the very first time that SARS-CoV-2 can productively infect human iPSC-derived MNs probably by binding CD147 and NRP1 receptors. Such information will be important to unveil the biological bases of neuromuscular disorders characterizing SARS-CoV-2 infection and the so called long-COVID symptoms.
Collapse
Affiliation(s)
- Gioia Cappelletti
- Laboratory of Immune-Biology, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Claudia Colombrita
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Fiona Limanaqi
- Laboratory of Immune-Biology, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
- Laboratory of Immunology, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Sabrina Invernizzi
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Micaela Garziano
- Laboratory of Immune-Biology, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
- Laboratory of Immunology, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Claudia Vanetti
- Laboratory of Immune-Biology, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Claudia Moscheni
- Laboratory of Immune-Biology, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Serena Santangelo
- Department of Medical Biotechnology and Translational Medicine, Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy
| | - Silvia Zecchini
- Laboratory of Immune-Biology, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Daria Trabattoni
- Laboratory of Immune-Biology, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, “Dino Ferrari” Center, University of Milan, Milan, Italy
| | - Mario Clerici
- Laboratory of Immunology, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Don C. Gnocchi Foundation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Foundation, Milan, Italy
| | - Antonia Ratti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy
| | - Mara Biasin
- Laboratory of Immune-Biology, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| |
Collapse
|
20
|
Liu T, Gao J, Liu M. The clinical significance of systemic immune-inflammation index and platelet/neutrophil to lymphocyte ratio in Guillain-Barré syndrome. Clin Neurol Neurosurg 2023; 235:108015. [PMID: 37898029 DOI: 10.1016/j.clineuro.2023.108015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/08/2023] [Accepted: 10/14/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE Systemic immune-inflammation index (SII) and platelet/neutrophil to lymphocyte ratio (P/NLR) are two novel hematological inflammatory indices, this study invested the role of SII and P/NLR in Guillain-Barré syndrome (GBS). METHODS A total of 115 GBS patients and 120 healthy controls were enrolled in this retrospective study, SII and P/NLR were calculated from the value of complete blood counts. The Hughes Functional Grading Scale (HFGS) score on admission and at discharge was used to evaluate the severity and short-term outcome of GBS. The level of SII and P/NLR was compared between GBS patients and healthy controls, and the correlation between SII, P/NLR, and GBS's severity as well as poor short-term outcome was analyzed. RESULTS Increased SII (p < 0.001) and decreased P/NLR (p < 0.001) were observed in patients with GBS and the level of SII (p = 0.689) and P/NLR (p = 0.879) was not different between GBS subtypes. Patients with severe GBS and poor short-term outcomes had higher levels of SII and lower levels of P/NLR (p < 0.05), SII was positively correlated and P/NLR was negatively correlated with the HFGS score on admission and at discharge (p < 0.05). To predict severe GBS, the optimal cutoff value of SII was 620.87 (AUC0.633, sensitivity 60.8 % and specificity 60.9 %, p = 0.014), the optimal cutoff value of P/NLR was 53.11 (AUC0.635, sensitivity 45.1 %, specificity 82.8 %, p = 0.013). The SII level of 620.87 was found to be optimal predictive cutoff value for the poor short-term outcome of GBS (AUC 0.728, sensitivity of 82.6 %, specificity of 59.8 %, p = 0.001), the P/NLR level of 62.80 was found to be optimal predictive cutoff value for the poor short-term outcome of GBS (AUC 0.669, sensitivity 60.9 %, specificity 71.7 %, p = 0.012). Both SII>620.87 (p = 0.005) and P/NLR<53.11 (p = 0.002) were independent risk factors for severe GBS, and SII>620.87 (p = 0.035) was independently associated with the poor short-term outcome of GBS. CONCLUSION SII and P/NLR may be useful biomarkers to reflect GBS patients' severity and short-term outcome.
Collapse
Affiliation(s)
- Tao Liu
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao 266000, China; Institute of Cerebrovascular Diseases, The Affiliated Hospital of Qingdao University, Qingdao 266000, China.
| | - Jing Gao
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Min Liu
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
| |
Collapse
|
21
|
Kim HJ, Jeong S, Song J, Park SJ, Oh YH, Jung J, Choi NK, Park SM. Risk of Bell's palsy following SARS-CoV-2 infection: a nationwide cohort study. Clin Microbiol Infect 2023; 29:1581-1586. [PMID: 37611865 DOI: 10.1016/j.cmi.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVES Despite some evidence of an increased risk of neurologic symptoms following viral vector COVID-19 vaccine administration, it is unclear whether SARS-CoV-2 infection is associated with Bell's palsy (BP), especially over a long enough follow-up period. METHODS The study population of this nationwide population-based study was derived from the South Korean population, including 11 593 365 and 36 565 099 participants with and without COVID-19, respectively. The Fine and Gray's regression model was utilized to calculate the adjusted subdistribution hazard ratio (aSHR), considering death as a competing risk, to assess the association between SARS-CoV-2 infection and the risk of BP. All participants were followed up from 1 December 2021, until the incident BP, SARS-CoV-2 infection, death, or 31 March 2022. Subgroup analyses were conducted based on participants' vaccination status (completion of the primary series vs. unvaccinated). RESULTS COVID-19 was associated with an increased risk of BP in all participants (aSHR, 1.24; CI, 1.19-1.29). However, the size of the COVID-19-related BP risk was significantly lower among those who completed the primary series of the COVID-19 vaccine (aSHR, 1.20; 95% CI, 1.15-1.25) compared to those who were unvaccinated (aSHR, 1.84; 95% CI, 1.59-2.12; p for interaction: <0.001). The severity of COVID-19 exhibited a gradual escalation in BP risk for both vaccinated and unvaccinated individuals. DISCUSSION While both unvaccinated individuals and those who completed the primary series of the COVID-19 vaccine may be at an increased risk of developing BP due to COVID-19, the risk appears to be lower among those who completed the vaccination.
Collapse
Affiliation(s)
- Hye Jun Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Seogsong Jeong
- Department of Biomedical Informatics, CHA University School of Medicine, Seongnam, South Korea
| | - Jihun Song
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Sun Jae Park
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Yun Hwan Oh
- Department of Family Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, South Korea
| | - Jaehun Jung
- Department of Preventive Medicine, Gachon University College of Medicine, Incheon, South Korea
| | - Nam-Kyong Choi
- Department of Health Convergence College of Science and Industry Convergence, Ewha Womans University, Seoul, South Korea
| | - Sang Min Park
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea; Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea.
| |
Collapse
|
22
|
Bishara H, Arbel A, Barnett-Griness O, Bloch S, Cohen S, Najjar-Debbiny R, Gronich N, Auriel E, Saliba W. Association Between Guillain-Barré Syndrome and COVID-19 Infection and Vaccination: A Population-Based Nested Case-Control Study. Neurology 2023; 101:e2035-e2042. [PMID: 37852786 PMCID: PMC10662985 DOI: 10.1212/wnl.0000000000207900] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/15/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Existing data regarding occurrence of Guillain-Barré syndrome (GBS) after coronavirus disease 2019 (COVID-19) infection and vaccination are inconclusive. We aimed to assess the association between GBS and both severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and COVID-19 vaccine. METHODS We conducted a nested case-control study in a cohort of 3,193,951 patients aged 16 years or older, without a diagnosis of prior GBS, from the largest health care provider in Israel. Participants were followed from January 1, 2021, until June 30, 2022, for the occurrence of GBS. Ten randomly selected controls were matched to each case of GBS on age and sex. We assessed both SARS-CoV-2 infection and COVID-19 vaccine administration in the prior 6 weeks in cases and controls. RESULTS Overall, 76 patients were diagnosed with GBS during follow-up and were matched to 760 controls. A positive test for SARS-CoV-2 was detected in 9 (11.8%) cases and 18 (2.4%) controls. An administration of COVID-19 vaccine was detected in 8 (10.5%) cases (all Pfizer-BioNTech [BNT162b2] vaccine) and 136 (17.9%) controls (134 Pfizer-BioNTech vaccine). Multivariable conditional logistic regression models showed that the odds ratio for GBS associated with SARS-CoV-2 infection and COVID-19 vaccine administration was 6.30 (95% CI 2.55-15.56) and 0.41 (95% CI 0.17-0.96), respectively. The results were similar when exposure to SARS-CoV-2 infection or COVID-19 vaccine administration was ascertained in the prior 4 and 8 weeks, although did not reach statistical significance for COVID-19 vaccine at 4 weeks. DISCUSSION Our study suggests that SARS-CoV-2 infection is associated with increased risk of GBS, whereas Pfizer-BioNTech COVID-19 vaccine is associated with decreased risk of GBS.
Collapse
Affiliation(s)
- Haya Bishara
- From the Department of Neurology (H.B., S.B.), and Department of Internal Medicine B (A.A., S.C.), Lady Davis Carmel Medical Center; Ruth and Bruce Rappaport Faculty of Medicine (A.A., S.B., S.C., R.N.-D., N.G., W.S.), Technion-Israel Institute of Technology; Statistical Unit (O.B.-G., W.S.), Department of Community Medicine and Epidemiology (O.B.-G., N.G.), and Infection Control and Prevention Unit (R.N.-D.), Lady Davis Carmel Medical Center, Haifa; Sackler Faculty of Medicine (E.A.), Tel Aviv University; Department of Neurology (E.A.), Rabin Medical Center, Petach Tikva; and Translational Epidemiology Unit and Research Authority (W.S.), Lady Davis Carmel Medical Center, Haifa, Israel
| | - Anat Arbel
- From the Department of Neurology (H.B., S.B.), and Department of Internal Medicine B (A.A., S.C.), Lady Davis Carmel Medical Center; Ruth and Bruce Rappaport Faculty of Medicine (A.A., S.B., S.C., R.N.-D., N.G., W.S.), Technion-Israel Institute of Technology; Statistical Unit (O.B.-G., W.S.), Department of Community Medicine and Epidemiology (O.B.-G., N.G.), and Infection Control and Prevention Unit (R.N.-D.), Lady Davis Carmel Medical Center, Haifa; Sackler Faculty of Medicine (E.A.), Tel Aviv University; Department of Neurology (E.A.), Rabin Medical Center, Petach Tikva; and Translational Epidemiology Unit and Research Authority (W.S.), Lady Davis Carmel Medical Center, Haifa, Israel.
| | - Ofra Barnett-Griness
- From the Department of Neurology (H.B., S.B.), and Department of Internal Medicine B (A.A., S.C.), Lady Davis Carmel Medical Center; Ruth and Bruce Rappaport Faculty of Medicine (A.A., S.B., S.C., R.N.-D., N.G., W.S.), Technion-Israel Institute of Technology; Statistical Unit (O.B.-G., W.S.), Department of Community Medicine and Epidemiology (O.B.-G., N.G.), and Infection Control and Prevention Unit (R.N.-D.), Lady Davis Carmel Medical Center, Haifa; Sackler Faculty of Medicine (E.A.), Tel Aviv University; Department of Neurology (E.A.), Rabin Medical Center, Petach Tikva; and Translational Epidemiology Unit and Research Authority (W.S.), Lady Davis Carmel Medical Center, Haifa, Israel
| | - Sivan Bloch
- From the Department of Neurology (H.B., S.B.), and Department of Internal Medicine B (A.A., S.C.), Lady Davis Carmel Medical Center; Ruth and Bruce Rappaport Faculty of Medicine (A.A., S.B., S.C., R.N.-D., N.G., W.S.), Technion-Israel Institute of Technology; Statistical Unit (O.B.-G., W.S.), Department of Community Medicine and Epidemiology (O.B.-G., N.G.), and Infection Control and Prevention Unit (R.N.-D.), Lady Davis Carmel Medical Center, Haifa; Sackler Faculty of Medicine (E.A.), Tel Aviv University; Department of Neurology (E.A.), Rabin Medical Center, Petach Tikva; and Translational Epidemiology Unit and Research Authority (W.S.), Lady Davis Carmel Medical Center, Haifa, Israel
| | - Shai Cohen
- From the Department of Neurology (H.B., S.B.), and Department of Internal Medicine B (A.A., S.C.), Lady Davis Carmel Medical Center; Ruth and Bruce Rappaport Faculty of Medicine (A.A., S.B., S.C., R.N.-D., N.G., W.S.), Technion-Israel Institute of Technology; Statistical Unit (O.B.-G., W.S.), Department of Community Medicine and Epidemiology (O.B.-G., N.G.), and Infection Control and Prevention Unit (R.N.-D.), Lady Davis Carmel Medical Center, Haifa; Sackler Faculty of Medicine (E.A.), Tel Aviv University; Department of Neurology (E.A.), Rabin Medical Center, Petach Tikva; and Translational Epidemiology Unit and Research Authority (W.S.), Lady Davis Carmel Medical Center, Haifa, Israel
| | - Ronza Najjar-Debbiny
- From the Department of Neurology (H.B., S.B.), and Department of Internal Medicine B (A.A., S.C.), Lady Davis Carmel Medical Center; Ruth and Bruce Rappaport Faculty of Medicine (A.A., S.B., S.C., R.N.-D., N.G., W.S.), Technion-Israel Institute of Technology; Statistical Unit (O.B.-G., W.S.), Department of Community Medicine and Epidemiology (O.B.-G., N.G.), and Infection Control and Prevention Unit (R.N.-D.), Lady Davis Carmel Medical Center, Haifa; Sackler Faculty of Medicine (E.A.), Tel Aviv University; Department of Neurology (E.A.), Rabin Medical Center, Petach Tikva; and Translational Epidemiology Unit and Research Authority (W.S.), Lady Davis Carmel Medical Center, Haifa, Israel
| | - Naomi Gronich
- From the Department of Neurology (H.B., S.B.), and Department of Internal Medicine B (A.A., S.C.), Lady Davis Carmel Medical Center; Ruth and Bruce Rappaport Faculty of Medicine (A.A., S.B., S.C., R.N.-D., N.G., W.S.), Technion-Israel Institute of Technology; Statistical Unit (O.B.-G., W.S.), Department of Community Medicine and Epidemiology (O.B.-G., N.G.), and Infection Control and Prevention Unit (R.N.-D.), Lady Davis Carmel Medical Center, Haifa; Sackler Faculty of Medicine (E.A.), Tel Aviv University; Department of Neurology (E.A.), Rabin Medical Center, Petach Tikva; and Translational Epidemiology Unit and Research Authority (W.S.), Lady Davis Carmel Medical Center, Haifa, Israel
| | - Eitan Auriel
- From the Department of Neurology (H.B., S.B.), and Department of Internal Medicine B (A.A., S.C.), Lady Davis Carmel Medical Center; Ruth and Bruce Rappaport Faculty of Medicine (A.A., S.B., S.C., R.N.-D., N.G., W.S.), Technion-Israel Institute of Technology; Statistical Unit (O.B.-G., W.S.), Department of Community Medicine and Epidemiology (O.B.-G., N.G.), and Infection Control and Prevention Unit (R.N.-D.), Lady Davis Carmel Medical Center, Haifa; Sackler Faculty of Medicine (E.A.), Tel Aviv University; Department of Neurology (E.A.), Rabin Medical Center, Petach Tikva; and Translational Epidemiology Unit and Research Authority (W.S.), Lady Davis Carmel Medical Center, Haifa, Israel
| | - Walid Saliba
- From the Department of Neurology (H.B., S.B.), and Department of Internal Medicine B (A.A., S.C.), Lady Davis Carmel Medical Center; Ruth and Bruce Rappaport Faculty of Medicine (A.A., S.B., S.C., R.N.-D., N.G., W.S.), Technion-Israel Institute of Technology; Statistical Unit (O.B.-G., W.S.), Department of Community Medicine and Epidemiology (O.B.-G., N.G.), and Infection Control and Prevention Unit (R.N.-D.), Lady Davis Carmel Medical Center, Haifa; Sackler Faculty of Medicine (E.A.), Tel Aviv University; Department of Neurology (E.A.), Rabin Medical Center, Petach Tikva; and Translational Epidemiology Unit and Research Authority (W.S.), Lady Davis Carmel Medical Center, Haifa, Israel
| |
Collapse
|
23
|
Dunkić N, Nazlić M, Dunkić V, Bilić I. Analysis of Post-COVID-19 Guillain-Barré Syndrome over a Period of One Year in the University Hospital of Split (Croatia). Neurol Int 2023; 15:1359-1370. [PMID: 37987459 PMCID: PMC10661271 DOI: 10.3390/neurolint15040086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/22/2023] Open
Abstract
The virus SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) is capable of attacking the nervous system in several ways and leading to neurological diseases such as GBS (Guillain-Barré syndrome) through the resulting neurotropism and immune response. The aim of this study is to show the relationship between Coronavirus disease (COVID-19) and GBS and to better understand the clinical symptoms to prevent poor outcomes. Data from 15 patients were extracted from the Department of Neurology, University Hospital of Split, Croatia, for the year 2021. The age of the patients ranged from 26 to 89 years, of whom 27% were women. Sixty seven percent of all GBS patients recovered from COVID-19 infection, whereas post-vaccinal polyradiculoneuritis was detected in 6%. Forty four percent of the patients who developed GBS had a severe form of COVID-19 infection. Forty percent of patients were treated with intravenous immunoglobulins (IVIG), followed by therapeutic plasma exchange (PLEX) in 27%. After the therapy, improvement was observed in 13 patients, while two patients died. The results suggest that SARS-CoV-2 triggers GBS because it follows a similar pattern of infection as the other viral and bacterial agents that contribute to the onset of GBS. There is no evidence that prior infection with COVID-19 worsens the clinical presentation of GBS.
Collapse
Affiliation(s)
- Niko Dunkić
- Practice of General Medicine, A.G. Matoša 2, 21000 Split, Croatia;
| | - Marija Nazlić
- Faculty of Science, University of Split, Ruđera Boškovića 33, 21000 Split, Croatia; (M.N.); (V.D.)
| | - Valerija Dunkić
- Faculty of Science, University of Split, Ruđera Boškovića 33, 21000 Split, Croatia; (M.N.); (V.D.)
| | - Ivica Bilić
- School of Medicine, University of Split, Šoltanska 2, 21000 Split, Croatia
- Neurology Department, University Hospital Split, Spinčićeva 1, 21000 Split, Croatia
| |
Collapse
|
24
|
Mohan A, Iyer VA, Kumar D, Batra L, Dahiya P. Navigating the Post-COVID-19 Immunological Era: Understanding Long COVID-19 and Immune Response. Life (Basel) 2023; 13:2121. [PMID: 38004261 PMCID: PMC10672162 DOI: 10.3390/life13112121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/25/2023] [Accepted: 09/30/2023] [Indexed: 11/26/2023] Open
Abstract
The COVID-19 pandemic has affected the world unprecedentedly, with both positive and negative impacts. COVID-19 significantly impacted the immune system, and understanding the immunological consequences of COVID-19 is essential for developing effective treatment strategies. The purpose of this review is to comprehensively explore and provide insights into the immunological aspects of long COVID-19, a phenomenon where individuals continue to experience a range of symptoms and complications, even after the acute phase of COVID-19 infection has subsided. The immune system responds to the initial infection by producing various immune cells and molecules, including antibodies, T cells, and cytokines. However, in some patients, this immune response becomes dysregulated, leading to chronic inflammation and persistent symptoms. Long COVID-19 encompasses diverse persistent symptoms affecting multiple organ systems, including the respiratory, cardiovascular, neurological, and gastrointestinal systems. In the post-COVID-19 immunological era, long COVID-19 and its impact on immune response have become a significant concern. Post-COVID-19 immune pathology, including autoimmunity and immune-mediated disorders, has also been reported in some patients. This review provides an overview of the current understanding of long COVID-19, its relationship to immunological responses, and the impact of post-COVID-19 immune pathology on patient outcomes. Additionally, the review addresses the current and potential treatments for long COVID-19, including immunomodulatory therapies, rehabilitation programs, and mental health support, all of which aim to improve the quality of life for individuals with long COVID-19. Understanding the complex interplay between the immune system and long COVID-19 is crucial for developing targeted therapeutic strategies and providing optimal care in the post-COVID-19 era.
Collapse
Affiliation(s)
- Aditi Mohan
- Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida Sector-125, Noida 201313, Uttar Pradesh, India; (A.M.); (V.A.I.)
| | - Venkatesh Anand Iyer
- Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida Sector-125, Noida 201313, Uttar Pradesh, India; (A.M.); (V.A.I.)
| | - Dharmender Kumar
- Department of Biotechnology, Deenbandhu Chhotu Ram University of Science &Technology, Murthal, Sonipat 131309, Haryana, India;
| | - Lalit Batra
- Regional Biocontainment Laboratory, Center for Predictive Medicine, University of Louisville, Louisville, KY 40222, USA
| | - Praveen Dahiya
- Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida Sector-125, Noida 201313, Uttar Pradesh, India; (A.M.); (V.A.I.)
| |
Collapse
|
25
|
Chen LY, Truong RDT, Shanmugham S. Parainfectious Brown-Séquard syndrome associated with COVID-19. BMJ Case Rep 2023; 16:e254496. [PMID: 37802592 PMCID: PMC10565177 DOI: 10.1136/bcr-2022-254496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2023] [Indexed: 10/10/2023] Open
Abstract
Acute myelitis encompasses syndromes associated with inflammation of the spinal cord. In cases of inflammatory lesions that only involve a unilateral portion of the axial plane of the cord, Brown-Séquard syndrome may occur, resulting in potential ipsilateral corticospinal, dorsal spinocerebellar, or dorsal column dysfunction or contralateral spinothalamic dysfunction below the level of the lesion. We report a case of an adult male who presented with Brown-Séquard syndrome and with a positive SARS-CoV-2 nasopharyngeal swab PCR test. Neurological symptoms rapidly resolved after initiation of high-dose methylprednisolone. The findings reported not only contribute to documenting a new presentation of neurological complications associated with SARS-CoV-2 infection but also non-exclusively supports the body of literature suggesting the immune-mediated response to this infection as a mechanism of neuropathogenesis. In this case, COVID-19-related acute myelitis responded to treatment with a short regimen of high-dose glucocorticoids.
Collapse
Affiliation(s)
- Lily Ye Chen
- Department of Medicine, University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Rachel Diem-Trang Truong
- Department of Medicine, University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Sampathkumar Shanmugham
- Department of Medicine, University of Central Florida College of Medicine, Orlando, Florida, USA
- Department of Internal Medicine, HCA Florida Lake Monroe Hospital, Sanford, Florida, USA
| |
Collapse
|
26
|
Habib AA, Waheed W. Guillain-Barré Syndrome. Continuum (Minneap Minn) 2023; 29:1327-1356. [PMID: 37851033 DOI: 10.1212/con.0000000000001289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE This article summarizes the clinical features, diagnostic criteria, differential diagnosis, pathogenesis, and prognosis of Guillain-Barré syndrome (GBS), with insights into the current and future diagnostic and therapeutic interventions for this neuromuscular syndrome. LATEST DEVELOPMENTS GBS is an acute, inflammatory, immune-mediated polyradiculoneuropathy that encompasses many clinical variants and divergent pathogenic mechanisms that lead to axonal, demyelinating, or mixed findings on electrodiagnostic studies. The type of antecedent infection, the development of pathogenic cross-reactive antibodies via molecular mimicry, and the location of the target gangliosides affect the subtype and severity of the illness. The data from the International GBS Outcome Study have highlighted regional variances, provided new and internationally validated prognosis tools that are beneficial for counseling, and introduced a platform for discussion of GBS-related open questions. New research has been undertaken, including research on novel diagnostic and therapeutic biomarkers, which may lead to new therapies. ESSENTIAL POINTS GBS is among the most frequent life-threatening neuromuscular emergencies in the world. At least 20% of patients with GBS have a poor prognosis and significant residual deficits despite receiving available treatments. Research is ongoing to further understand the pathogenesis of the disorder, find new biomarkers, and develop more effective and specific treatments.
Collapse
|
27
|
Chen Y, Li K, Lv W, Xie J, Qian Y, Cui C, Deng B. What Is the Impact of the Novel Coronavirus and the Vaccination on Guillain-Barre Syndrome? Mol Neurobiol 2023:10.1007/s12035-023-03638-8. [PMID: 37728848 DOI: 10.1007/s12035-023-03638-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
The COVID-19 pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has resulted in devastating medical and economic consequences worldwide over the past 3 years. As the pandemic enters a new stage, it is essential to consider the potential impact on rare diseases such as Guillain-Barre syndrome (GBS), which has been intimately associated with COVID-19 since the first COVID-19-related GBS case was reported in January 2020. There are notable differences between COVID-19-related GBS and GBS without COVID-19 in terms of diagnostic types and clinical manifestations. Furthermore, with the widespread administration of COVID-19 vaccines, there have been reports of GBS occurring shortly after vaccination, which requires close attention despite its rarity. This review also explores the vaccines associated with heightened GBS risks, offering insights that may guide vaccination policies and clinical practice. To provide a visual summary of these findings, we have included a graphical abstract. This article will discuss the characteristic manifestations of GBS patients after being positive for the novel coronavirus and the safety of several COVID-19 vaccines. Firstly, this article comprehensively expounds and discusses the epidemiological aspects of novel coronavirus-related GBS. For example, from the perspective of the same population, the expected incidence of GBS in the COVID-19-positive population (persons/100,000 persons/ year) is about 43 times that of the COVID-19-negative population, and the incidence of GBS is significantly increased. Secondly, the clinical characteristics of COVID-19-negative GBS patients and SARS-CoV-2-GBS (SC2-GBS) patients were summarized and compared. Thirdly, this article reviews GBS cases in the current adverse events after COVID-19 vaccination and analyzes and discusses from multiple perspectives, such as the incidence of GBS events, the age proportion of patients, and the interval of onset.
Collapse
Affiliation(s)
- Yinuo Chen
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- First Clinical College of Wenzhou Medical University, Wenzhou, China
| | - Kezheng Li
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- First Clinical College of Wenzhou Medical University, Wenzhou, China
| | - Wenjing Lv
- Department of Geriatrics, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jiali Xie
- Department of Neurology, Shanghai East Hospital, Tongji University, Shanghai, People's Republic of China
| | - Yuqin Qian
- Department of Neurology, Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Can Cui
- Department of Clinical Sciences Malmö, Lund University, Skåne, Sweden
| | - Binbin Deng
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
- First Clinical College of Wenzhou Medical University, Wenzhou, China.
| |
Collapse
|
28
|
Sanchez-Larsen A, Rojas-Bartolomé L, Fernández-Valiente M, Sopelana D. Anti-NMDA-R encephalitis post-COVID-19: Case report and proposed physiopathologic mechanism. Neurologia 2023; 38:513-516. [PMID: 36191810 PMCID: PMC9523900 DOI: 10.1016/j.nrleng.2022.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- A Sanchez-Larsen
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
| | - L Rojas-Bartolomé
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - M Fernández-Valiente
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - D Sopelana
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| |
Collapse
|
29
|
Gomez F, Mehra A, Ensrud E, Diedrich D, Laudanski K. COVID-19: a modern trigger for Guillain-Barre syndrome, myasthenia gravis, and small fiber neuropathy. Front Neurosci 2023; 17:1198327. [PMID: 37712090 PMCID: PMC10498773 DOI: 10.3389/fnins.2023.1198327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/31/2023] [Indexed: 09/16/2023] Open
Abstract
COVID-19 infection has had a profound impact on society. During the initial phase of the pandemic, there were several suggestions that COVID-19 may lead to acute and protracted neurologic sequelae. For example, peripheral neuropathies exhibited distinctive features as compared to those observed in critical care illness. The peripheral nervous system, lacking the protection afforded by the blood-brain barrier, has been a particular site of sequelae and complications subsequent to COVID-19 infection, including Guillain-Barre syndrome, myasthenia gravis, and small fiber neuropathy. We will discuss these disorders in terms of their clinical manifestations, diagnosis, and treatment as well as the pathophysiology in relation to COVID-19.
Collapse
Affiliation(s)
- Francisco Gomez
- Department of Neurology, University of Missouri, Columbia, MO, United States
| | - Ashir Mehra
- Department of Neurology, University of Missouri, Columbia, MO, United States
| | - Erik Ensrud
- Department of Neurology, University of Missouri, Columbia, MO, United States
| | - Daniel Diedrich
- Department of Anesthesiology and Perioperative Care, Mayo Clinic, Rochester, MN, United States
| | - Krzysztof Laudanski
- Department of Anesthesiology and Perioperative Care, Mayo Clinic, Rochester, MN, United States
| |
Collapse
|
30
|
Guan Y, Yu C, Fei Y, Wang Q, Wang P, Zuo W, Wu H, Qi X, Shi Q. Case Report: Four cases of SARS-CoV-2-associated Guillain-Barré Syndrome with SARS-CoV-2-positive cerebrospinal fluid detected by metagenomic next-generation sequencing: a retrospective case series from China. Front Immunol 2023; 14:1258579. [PMID: 37701436 PMCID: PMC10493301 DOI: 10.3389/fimmu.2023.1258579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is often absent or at low levels in the cerebrospinal fluid (CSF) of patients with previous SARS-CoV-2-associated Guillain-Barré syndrome (GBS). This has led to speculation that SARS-CoV-2-associated GBS is more likely mediated by post-infectious immunity or a parainfection. This understanding has influenced the development of treatment regimens for SARS-CoV-2-associated GBS. This paper reports our experience with four Chinese patients with SARS-CoV-2-associated GBS who tested positive for SARS-CoV-2 RNA in the CSF. They developed symptoms of peripheral nerve damage 4-15 days after fever and confirmed SARS-CoV-2 infection, all of whom presented with progressive weakness of both lower limbs; three with autonomic nerve function impairment such as constipation and urination disorder; and one with polycranial neuritis and Miller-Fisher syndrome. Three patients were tested for anti-ganglioside antibodies, and one tested positive for GD1a-IgG. Four patients recovered well after treatment with anti-viral drugs combined with intravenous immunoglobulin. The present results showed that SARS-CoV-2 RNA can be detected via mNGS in the CSF of some patients with SARS-CoV-2-associated GBS, suggesting that SARS-CoV-2-associated GBS may have multiple pathogeneses.
Collapse
Affiliation(s)
- Yalin Guan
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Changshen Yu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Yunhan Fei
- Department of Emergency, Tianjin Huanhu Hospital, Tianjin, China
| | - Qiushi Wang
- Infection Business Unit, Tianjin Novogene Med LAB Co., Ltd., Tianjin, China
- Infection Business Unit, Novogene Co., Ltd., Beijing, China
| | - Pan Wang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Wenchao Zuo
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Hao Wu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Xuemei Qi
- Department of Neurology, The second hospital of tianjin medical university, Tianjin, China
| | - Qiyun Shi
- Infection Business Unit, Tianjin Novogene Med LAB Co., Ltd., Tianjin, China
- Infection Business Unit, Novogene Co., Ltd., Beijing, China
| |
Collapse
|
31
|
Juric I, Basic-Jukic N. Guillain-Barré syndrome following SARS-CoV-2 infection in kidney transplant recipient successfully treated with therapeutic plasma exchange. Ther Apher Dial 2023; 27:821-822. [PMID: 36718953 DOI: 10.1111/1744-9987.13972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/04/2023] [Accepted: 01/24/2023] [Indexed: 02/01/2023]
Affiliation(s)
- Ivana Juric
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Nikolina Basic-Jukic
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia
| |
Collapse
|
32
|
Al Amrani F, Al-Abdwani R, Al Rashdi F, Al-Ajmi E, Al Futaisi A. Guillain-Barré Syndrome Associated with SARS-CoV-2 in Two Pediatric Patients. Sultan Qaboos Univ Med J 2023; 23:400-404. [PMID: 37655082 PMCID: PMC10467552 DOI: 10.18295/squmj.5.2022.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/24/2022] [Accepted: 05/17/2022] [Indexed: 11/16/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is a recognised complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report two children with GBS associated with SARS-CoV-2 who presented to a tertiary centre in Muscat, Oman in 2021: The first patient was a three-month-old female infant who presented with bradypnea, encephalopathy, and generalised weakness that required mechanical ventilation. Polymerase chain reaction (PCR) testing of the nasopharyngeal swabs (NPS) was positive for SARS-CoV-2. She had axonal variant GBS based on a nerve conduction study, cerebrospinal fluid analysis, and neuroimaging findings. The second patient was a six-year-old girl with fever, vomiting, and diarrhea followed by ascending weakness who presented with quadriplegia and facial weakness. Subsequently, she developed respiratory muscle weakness and required mechanical ventilation. PCR testing of NPS was negative for SARS-Cov-2, however IgG serology analysis was positive. The clinical course of these two patients was rapidly progressive and both of them required mechanical ventilation. The patient with axonal variant GBS made an incomplete recovery.
Collapse
Affiliation(s)
- Fatema Al Amrani
- Pediatric Neurology Unit, Department of Child Health, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Raghad Al-Abdwani
- Pediatric Intensive Care Unit, Department of Child Health, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Fatma Al Rashdi
- Pediatric Emergency Unit, Emergency Medicine Department, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Eiman Al-Ajmi
- Department of Radiology and Molecular Imaging, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Amna Al Futaisi
- Pediatric Neurology Unit, Department of Child Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| |
Collapse
|
33
|
Ruffo di Calabria V, Verdelli A, Quintarelli L, Corrà A, Mariotti EB, Aimo C, Del Bianco E, Bianchi B, Maio V, Massi D, Caproni M. Case Report: Resolution of Lichen Planus Pemphigoides as an unexpected outcome of SARS-CoV-2 infection. Front Immunol 2023; 14:1222459. [PMID: 37503348 PMCID: PMC10368974 DOI: 10.3389/fimmu.2023.1222459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 06/26/2023] [Indexed: 07/29/2023] Open
Abstract
It is well known that viral infections play a relevant role in inducing or protecting from autoimmune diseases, thus representing a major environmental factor in the disruption of the immune system in genetically susceptible individuals. Since the beginning of the Covid-19 pandemic a great number of clinical and epidemiological studies have demonstrated that SARS-CoV-2 infection is no exception to the rule by interfering on many different levels in the normal functioning of our immune system. Even though a growing number of case series and case reports has been cited in the literature linking the infection to the new onset of autoimmune diseases, to date very little has been reported concerning a possible correlation between the virus and the clinical resolution of any kind of autoimmune pathology. Here we describe an interesting case of abrupt and unexpected resolution of Lichen planus pemphigoides mucocutaneous lesions in a fully vaccinated patient after a mildly symptomatic SARS-CoV-2 respiratory infection and we speculate on the possible underlying mechanisms correlating the two events.
Collapse
Affiliation(s)
| | - Alice Verdelli
- Rare Skin Diseases Unit, Department of Health Sciences, Azienda USL Toscana Centro (ERN-SKIN), University of Florence, Florence, Italy
| | - Lavinia Quintarelli
- Rare Skin Diseases Unit, Department of Health Sciences, Azienda USL Toscana Centro (ERN-SKIN), University of Florence, Florence, Italy
| | - Alberto Corrà
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Cristina Aimo
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Elena Del Bianco
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Beatrice Bianchi
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Vincenza Maio
- Section of Anatomic Pathology, Azienda USL Toscana Centro, Florence, Italy
| | - Daniela Massi
- Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Marzia Caproni
- Rare Skin Diseases Unit, Department of Health Sciences, Azienda USL Toscana Centro (ERN-SKIN), University of Florence, Florence, Italy
| |
Collapse
|
34
|
Rabady S, Hoffmann K, Aigner M, Altenberger J, Brose M, Costa U, Denk-Linnert DM, Gruber S, Götzinger F, Helbok R, Hüfner K, Koczulla R, Kurz K, Lamprecht B, Leis S, Löffler J, Müller CA, Rittmannsberger H, Rommer PS, Sator P, Strenger V, Struhal W, Untersmayr E, Vonbank K, Wancata J, Weber T, Wendler M, Zwick RH. [S1 guidelines for the management of postviral conditions using the example of post-COVID-19]. Wien Klin Wochenschr 2023; 135:525-598. [PMID: 37555900 PMCID: PMC10504206 DOI: 10.1007/s00508-023-02242-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2023] [Indexed: 08/10/2023]
Abstract
These S1 guidelines are an updated and expanded version of the S1 guidelines on long COVID differential diagnostic and management strategies. They summarize the state of knowledge on postviral conditions like long/post COVID at the time of writing. Due to the dynamic nature of knowledge development, they are intended to be "living guidelines". The focus is on practical applicability at the level of primary care, which is understood to be the appropriate place for initial access and for primary care and treatment. The guidelines provide recommendations on the course of treatment, differential diagnostics of the most common symptoms that can result from infections like with SARS-CoV-2, treatment options, patient management and care, reintegration and rehabilitation. The guidelines have been developed through an interdisciplinary and interprofessional process and provide recommendations on interfaces and possibilities for collaboration.
Collapse
Affiliation(s)
- Susanne Rabady
- Department Allgemeine Gesundheitsstudien, Kompetenzzentrum für Allgemein- und Familienmedizin, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Dr. Karl-Dorrek-Str. 30, 3500, Krems, Österreich.
| | - Kathryn Hoffmann
- Leiterin der Abteilung Primary Care Medicine, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Martin Aigner
- Abteilung für Psychiatrie und psychotherapeutische Medizin, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Dr. Karl-Dorrek-Str. 30, 3500, Krems, Österreich
| | - Johann Altenberger
- Pensionsversicherungsanstalt, Rehabilitationszentrum Großgmain, Salzburger Str. 520, 5084, Großgmain, Österreich
| | - Markus Brose
- Department Allgemeine Gesundheitsstudien, Kompetenzzentrum für Allgemein- und Familienmedizin, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Dr. Karl-Dorrek-Str. 30, 3500, Krems, Österreich
| | - Ursula Costa
- Ergotherapie und Handlungswissenschaft, fhg - Zentrum für Gesundheitsberufe Tirol GmbH/fh, Innrain 98, 6020, Innsbruck, Österreich
| | - Doris-Maria Denk-Linnert
- Klinische Abteilung für Allgemeine Hals‑, Nasen- und Ohrenkrankheiten, Klin. Abteilung Phoniatrie-Logopädie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Samuel Gruber
- Department Allgemeine Gesundheitsstudien, Kompetenzzentrum für Allgemein- und Familienmedizin, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Dr. Karl-Dorrek-Str. 30, 3500, Krems, Österreich
| | - Florian Götzinger
- Abteilung für Kinderheilkunde, Klinik Ottakring, Montleartstr. 37, 1160, Wien, Österreich
| | - Raimund Helbok
- Universitätsklinik für Neurologie, Johannes Kepler Universität Linz, Standort Neuromed Campus & Med Campus Kepler Universitätsklinikum GmbH, 4020, Linz, Österreich
| | - Katharina Hüfner
- Dep. für Psychiatrie, Psychotherapie, Psychosomatik und Medizinische Psychologie, Universitätsklinik für Psychiatrie II, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
| | - Rembert Koczulla
- Fachbereich Medizin, Klinik für Pneumologie Marburg, Baldingerstr., 35035, Marburg, Deutschland
| | - Katharina Kurz
- Innere Medizin II, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
| | - Bernd Lamprecht
- Universitätsklinik für Innere Medizin mit Schwerpunkt Pneumologie, Kepler Universitätsklinikum, 4020, Linz, Österreich
| | - Stefan Leis
- Universitätsklinik für Neurologie der PMU, MME Universitätsklinikum Salzburg Christian-Doppler-Klinik, Ignaz-Harrer-Str. 79, 5020, Salzburg, Österreich
| | - Judith Löffler
- Innere Medizin II, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
| | - Christian A Müller
- Klinische Abteilung für Allgemeine Hals‑, Nasen- und Ohrenkrankheiten, Klin. Abteilung für Allgemeine HNO, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | | | - Paulus S Rommer
- Universitätsklinik für Neurologie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Paul Sator
- Dermatologische Abteilung, Klinik Hietzing, Wolkersbergenstr. 1, 1130, Wien, Österreich
| | - Volker Strenger
- Klinische Abteilung für Allgemeinpädiatrie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, 8036, Graz, Österreich
| | - Walter Struhal
- Klinische Abteilung für Neurologie, Universitätsklinikum Tulln, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Alter Ziegelweg 10, 3430, Tulln an der Donau, Österreich
| | - Eva Untersmayr
- Institut für Pathophysiologie und Allergieforschung Zentrum für Pathophysiologie, Infektiologie und Immunologie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Karin Vonbank
- Klinische Abteilung für Pulmologie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Johannes Wancata
- Klinische Abteilung für Sozialpsychiatrie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Thomas Weber
- Kardiologische Abteilung Klinikum Wels-Grieskirchen, Grieskirchnerstr. 42, 4600, Wels, Österreich
| | | | - Ralf-Harun Zwick
- Ludwig Boltzmann Institute for Rehabilitation Research, Kurbadstr. 14, 1100, Wien, Österreich
| |
Collapse
|
35
|
Moore O, McLaren S, Newton F. Locked-In Presentation of Guillain-Barre Syndrome Following SARS-COVID-19 Infection. Kans J Med 2023; 16:151-152. [PMID: 37377622 PMCID: PMC10291979 DOI: 10.17161/kjm.vol16.18922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 05/15/2023] [Indexed: 06/29/2023] Open
Affiliation(s)
- Olivia Moore
- Department of Anesthesiology, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Scott McLaren
- Department of Anesthesiology, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Felecia Newton
- Department of Anesthesiology, University of Kansas School of Medicine-Wichita, Wichita, KS
| |
Collapse
|
36
|
AlKahtani NA, Alkhudair JA, Bensaeed NZ, Alshammari YS, Alanazi RF, Khatri IA, Masud N. Guillain-Barré Syndrome in Adults in a Decade: The Largest, Single-Center, Cross-Sectional Study From the Kingdom of Saudi Arabia. Cureus 2023; 15:e40995. [PMID: 37503490 PMCID: PMC10371290 DOI: 10.7759/cureus.40995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Guillain-Barré Syndrome (GBS) is the most common cause of acute, usually post-infectious, peripheral neuropathy resulting in a symmetrical, ascending paralysis. We evaluated the clinical and neurophysiological features, treatment, and outcomes of patients with GBS in our center. METHODS A retrospective chart review on patients with GBS admitted to King Abdulaziz Medical City, Riyadh, Saudi Arabia, from January 2011 to December 2020. Data were analyzed using JMP statistical software version 15 pro. RESULTS A total of 86 patients who met the criteria were included, 55 (64%) were males, with a mean age of 49.5+/-17.5 years. Antecedent infection was reported in 53 (61.6%), 51 (62.2%) presented within one week of symptoms onset. Ascending weakness was seen in 55 (70.5%), while 70 (81.4%) had areflexia. Acute motor axonal neuropathy (AMAN) was the commonest electrophysiological type of GBS in 41 (51.9%) patients. Albuminocytologic dissociation was seen in 48 (57%) who had lumbar puncture. Nearly half, 41 (47.7%) were admitted to the intensive care unit (ICU). Seventy (81.3%) were treated with intravenous immunoglobulin. There was no significant difference in the clinical presentation, management, ICU requirement, and discharge disposition between males and females. Females were more likely to have a higher disability at discharge (p=0.01). Patients younger than 60 years were more likely to require ICU admission (p=<0.01). CONCLUSION Our patients with GBS were slightly older than previously reported from the region. AMAN was the commonest type of GBS. Younger patients were more likely to need ICU admission, whereas females were more likely to have a more severe disability.
Collapse
Affiliation(s)
- Nada A AlKahtani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Joud A Alkhudair
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Nora Z Bensaeed
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Yara S Alshammari
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Rahaf F Alanazi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Ismail A Khatri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Department of Neurology, King Abdullah International Medical Research Center, Riyadh, SAU
- Division of Neurology, Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, SAU
| | - Nazish Masud
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Georgia Southern University, Statesboro, USA
| |
Collapse
|
37
|
Grantham T, Khan S, Behgal J, Rizvi T, Glaser A. Recurrent acute-onset of chronic inflammatory demyelinating polyneuropathy after COVID-19 vaccination. IDCases 2023; 33:e01809. [PMID: 37273773 PMCID: PMC10236287 DOI: 10.1016/j.idcr.2023.e01809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/20/2023] [Accepted: 05/22/2023] [Indexed: 06/06/2023] Open
Abstract
This is the case of 54-year-old male with a past medical history of Chronic Inflammatory Demyelinating Polyneuropathy (CIPD) who was found to have an acute exacerbation of CIPD shortly after receiving his 1st COVID 19 booster (3rd dose of vaccination series) and was successfully treated with intravenous immunoglobulin (IVIG) and then was found to have another acute exacerbation of CIDP 6 months later after receiving his 2nd COVID 19 booster (4th dose of vaccination series) that required intubation and long term tracheostomy. CIPD is an acquired immune-mediated polyneuropathy that mainly affects the peripheral nerve roots nerves. It typically presents with relapsing/remitting, or progressive symmetrical muscle weakness and sensory involvement and can cause decreased respiratory effort. COVID-19 is mainly a respiratory disease, but it has been associated with a wide variety of neurological conditions. Although there have been several findings of acute inflammatory demyelinating polyneuropathy in association with COVID-19, CIDP exacerbation as a result of COVID-19 has rarely been seen in the literature. Furthermore, CIDP exacerbation as a result of COVID-19 vaccination is even less frequently seen.
Collapse
Affiliation(s)
- Tyler Grantham
- Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY 10305, United States of America
| | - Shahkar Khan
- Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY 10305, United States of America
| | - Jai Behgal
- Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY 10305, United States of America
| | - Taqi Rizvi
- Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY 10305, United States of America
| | - Allison Glaser
- Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY 10305, United States of America
| |
Collapse
|
38
|
Abdelhak A, Barba L, Romoli M, Benkert P, Conversi F, D'Anna L, Masvekar RR, Bielekova B, Prudencio M, Petrucelli L, Meschia JF, Erben Y, Furlan R, De Lorenzo R, Mandelli A, Sutter R, Hert L, Epple V, Marastoni D, Sellner J, Steinacker P, Aamodt AH, Heggelund L, Dyrhol-Riise AM, Virhammar J, Fällmar D, Rostami E, Kumlien E, Blennow K, Zetterberg H, Tumani H, Sacco S, Green AJ, Otto M, Kuhle J, Ornello R, Foschi M, Abu-Rumeileh S. Prognostic performance of blood neurofilament light chain protein in hospitalized COVID-19 patients without major central nervous system manifestations: an individual participant data meta-analysis. J Neurol 2023:10.1007/s00415-023-11768-1. [PMID: 37184659 PMCID: PMC10183689 DOI: 10.1007/s00415-023-11768-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND AND AIMS To investigate the prognostic value of blood neurofilament light chain protein (NfL) levels in the acute phase of coronavirus disease 2019 (COVID-19). METHODS We conducted an individual participant data (IPD) meta-analysis after screening on MEDLINE and Scopus to May 23rd 2022. We included studies with hospitalized adult COVID-19 patients without major COVID-19-associated central nervous system (CNS) manifestations and with a measurement of blood NfL in the acute phase as well as data regarding at least one clinical outcome including intensive care unit (ICU) admission, need of mechanical ventilation (MV) and death. We derived the age-adjusted measures NfL Z scores and conducted mixed-effects modelling to test associations between NfL Z scores and other variables, encompassing clinical outcomes. Summary receiver operating characteristic curves (SROCs) were used to calculate the area under the curve (AUC) for blood NfL. RESULTS We identified 382 records, of which 7 studies were included with a total of 669 hospitalized COVID-19 cases (mean age 66.2 ± 15.0 years, 68.1% males). Median NfL Z score at admission was elevated compared to the age-corrected reference population (2.37, IQR: 1.13-3.06, referring to 99th percentile in healthy controls). NfL Z scores were significantly associated with disease duration and severity. Higher NfL Z scores were associated with a higher likelihood of ICU admission, need of MV, and death. SROCs revealed AUCs of 0.74, 0.80 and 0.71 for mortality, need of MV and ICU admission, respectively. CONCLUSIONS Blood NfL levels were elevated in the acute phase of COVID-19 patients without major CNS manifestations and associated with clinical severity and poor outcome. The marker might ameliorate the performance of prognostic multivariable algorithms in COVID-19.
Collapse
Affiliation(s)
- Ahmed Abdelhak
- Department of Neurology, University of California San Francisco (UCSF), San Francisco, USA
| | - Lorenzo Barba
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Michele Romoli
- Department of Neuroscience, Neurology Unit, Maurizio Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Pascal Benkert
- Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Francesco Conversi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Lucio D'Anna
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
- Department of Brain Sciences, Imperial College London, London SW7 2AZ, UK
| | - Ruturaj R Masvekar
- Neuroimmunological Diseases Section, National Institute of Allergy and Infectious Diseases, National Institute of Health, Bethesda, MD, USA
| | - Bibiana Bielekova
- Neuroimmunological Diseases Section, National Institute of Allergy and Infectious Diseases, National Institute of Health, Bethesda, MD, USA
| | - Mercedes Prudencio
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, 32224, USA
- Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL, 32224, USA
| | - Leonard Petrucelli
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, 32224, USA
- Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL, 32224, USA
| | - James F Meschia
- Department of Neurology, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Young Erben
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Roberto Furlan
- Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
- Institute of Experimental Neurology, Division of Neuroscience, Vita e Salute San Raffaele University, Milan, Italy
| | - Rebecca De Lorenzo
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandra Mandelli
- Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Raoul Sutter
- Department of Acute Medical Care, Intensive Care Unit, University Hospital Basel, Basel, Switzerland
| | - Lisa Hert
- Department of Acute Medical Care, Intensive Care Unit, University Hospital Basel, Basel, Switzerland
| | - Varenka Epple
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Damiano Marastoni
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | - Petra Steinacker
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Lars Heggelund
- Department of Internal Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Anne Margarita Dyrhol-Riise
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Johan Virhammar
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden
| | - David Fällmar
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Elham Rostami
- Department of Medical Sciences, Uppsala University, Neurosurgery,, Sweden
- Department of Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Eva Kumlien
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ari J Green
- Department of Neurology, University of California San Francisco (UCSF), San Francisco, USA
| | - Markus Otto
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Jens Kuhle
- Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Multiple Sclerosis Centre, Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Matteo Foschi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
- Department of Neuroscience, Neurology Unit, S.Maria Delle Croci Hospital of Ravenna, AUSL Romagna, Ravenna, Italy.
| | - Samir Abu-Rumeileh
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
| |
Collapse
|
39
|
Malik JR, Acharya A, Avedissian SN, Byrareddy SN, Fletcher CV, Podany AT, Dyavar SR. ACE-2, TMPRSS2, and Neuropilin-1 Receptor Expression on Human Brain Astrocytes and Pericytes and SARS-CoV-2 Infection Kinetics. Int J Mol Sci 2023; 24:ijms24108622. [PMID: 37239978 DOI: 10.3390/ijms24108622] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/02/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
Angiotensin Converting Enzyme 2 (ACE-2), Transmembrane Serine Protease 2 (TMPRSS-2) and Neuropilin-1 cellular receptors support the entry of SARS-CoV-2 into susceptible human target cells and are characterized at the molecular level. Some evidence on the expression of entry receptors at mRNA and protein levels in brain cells is available, but co-expression of these receptors and confirmatory evidence on brain cells is lacking. SARS-CoV-2 infects some brain cell types, but infection susceptibility, multiple entry receptor density, and infection kinetics are rarely reported in specific brain cell types. Highly sensitive Taqman ddPCR, flow-cytometry and immunocytochemistry assays were used to quantitate the expression of ACE-2, TMPRSS-2 and Neuropilin-1 at mRNA and protein levels on human brain-extracted pericytes and astrocytes, which are an integral part of the Blood-Brain-Barrier (BBB). Astrocytes showed moderate ACE-2 (15.9 ± 1.3%, Mean ± SD, n = 2) and TMPRSS-2 (17.6%) positive cells, and in contrast show high Neuropilin-1 (56.4 ± 39.8%, n = 4) protein expression. Whereas pericytes showed variable ACE-2 (23.1 ± 20.7%, n = 2), Neuropilin-1 (30.3 ± 7.5%, n = 4) protein expression and higher TMPRSS-2 mRNA (667.2 ± 232.3, n = 3) expression. Co-expression of multiple entry receptors on astrocytes and pericytes allows entry of SARS-CoV-2 and progression of infection. Astrocytes showed roughly four-fold more virus in culture supernatants than pericytes. SARS-CoV-2 cellular entry receptor expression and "in vitro" viral kinetics in astrocytes and pericytes may improve our understanding of viral infection "in vivo". In addition, this study may facilitate the development of novel strategies to counter the effects of SARS-CoV-2 and inhibit viral infection in brain tissues to prevent the spread and interference in neuronal functions.
Collapse
Affiliation(s)
- Johid Reza Malik
- Antiviral Pharmacology Laboratory, Department of Pharmacy Practice and Science, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Arpan Acharya
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Sean N Avedissian
- Antiviral Pharmacology Laboratory, Department of Pharmacy Practice and Science, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Siddappa N Byrareddy
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Department of Genetics, Cell Biology, and Anatomy, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, 17177 Stockholm, Sweden
| | - Courtney V Fletcher
- Antiviral Pharmacology Laboratory, Department of Pharmacy Practice and Science, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Anthony T Podany
- Antiviral Pharmacology Laboratory, Department of Pharmacy Practice and Science, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Shetty Ravi Dyavar
- Antiviral Pharmacology Laboratory, Department of Pharmacy Practice and Science, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE 68198, USA
| |
Collapse
|
40
|
Zhu H, Byrnes C, Lee YT, Tuymetova G, Duffy HBD, Bakir JY, Pettit SN, Angina J, Springer DA, Allende ML, Kono M, Proia RL. SARS-CoV-2 ORF3a expression in brain disrupts the autophagy-lysosomal pathway, impairs sphingolipid homeostasis, and drives neuropathogenesis. FASEB J 2023; 37:e22919. [PMID: 37071464 DOI: 10.1096/fj.202300149r] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/10/2023] [Accepted: 03/30/2023] [Indexed: 04/19/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes injury to multiple organ systems, including the brain. SARS-CoV-2's neuropathological mechanisms may include systemic inflammation and hypoxia, as well as direct cell damage resulting from viral infections of neurons and glia. How the virus directly causes injury to brain cells, acutely and over the long term, is not well understood. In order to gain insight into this process, we studied the neuropathological effects of open reading frame 3a (ORF3a), a SARS-CoV-2 accessory protein that is a key pathological factor of the virus. Forced ORF3a brain expression in mice caused the rapid onset of neurological impairment, neurodegeneration, and neuroinflammation-key neuropathological features found in coronavirus disease (COVID-19, which is caused by SARS-CoV-2 infection). Furthermore, ORF3a expression blocked autophagy progression in the brain and caused the neuronal accumulation of α-synuclein and glycosphingolipids, all of which are linked to neurodegenerative disease. Studies with ORF3-expressing HeLa cells confirmed that ORF3a disrupted the autophagy-lysosomal pathway and blocked glycosphingolipid degradation, resulting in their accumulation. These findings indicate that, in the event of neuroinvasion by SARS-CoV-2, ORF3a expression in brain cells may drive neuropathogenesis and be an important mediator of both short- and long-term neurological manifestations of COVID-19.
Collapse
Affiliation(s)
- Hongling Zhu
- Genetics of Development and Disease Section, Genetics and Biochemistry Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Colleen Byrnes
- Genetics of Development and Disease Section, Genetics and Biochemistry Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Y Terry Lee
- Genetics of Development and Disease Section, Genetics and Biochemistry Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Galina Tuymetova
- Genetics of Development and Disease Section, Genetics and Biochemistry Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Hannah B D Duffy
- Genetics of Development and Disease Section, Genetics and Biochemistry Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Jenna Y Bakir
- Genetics of Development and Disease Section, Genetics and Biochemistry Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Sydney N Pettit
- Genetics of Development and Disease Section, Genetics and Biochemistry Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Jabili Angina
- Genetics of Development and Disease Section, Genetics and Biochemistry Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Danielle A Springer
- Murine Phenotyping Core, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Maria L Allende
- Genetics of Development and Disease Section, Genetics and Biochemistry Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Mari Kono
- Genetics of Development and Disease Section, Genetics and Biochemistry Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Richard L Proia
- Genetics of Development and Disease Section, Genetics and Biochemistry Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| |
Collapse
|
41
|
Saini L, Krishna D, Gunasekaran PK, Tiwari S, Kumar P, Goyal JP, Khera D, Choudhary B, Didel S, Gaur R, Laxmi V, Panda S, Singh K. Clinical Profile, Follow-up, and Role of Neuroimaging in Pediatric Guillain-Barré Syndrome in the COVID Era: An Ambispective Study. J Child Neurol 2023; 38:407-413. [PMID: 37365810 DOI: 10.1177/08830738231184089] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Background: To define the varied presentations of Guillain-Barré syndrome in children in the COVID era and 6 months' follow-up outcome. Methods: Ambispective study of 15 months' duration involving children with Guillain-Barré syndrome aged 1 month to 18 years at a tertiary care pediatric hospital. They were categorized into groups A and B based on COVID-19 serology testing. Hughes Disability Scale was used for disability assessment. Modified Rankin scale was used for improvement assessment in follow-up. Results: Of 19 children with Guillain-Barré syndrome, 9 (47%) were females and 10 (53%) were males. Groups A and B had children with negative (8) and positive serology (11), respectively. The most common presentation in both groups was motor weakness. Post-COVID pediatric Guillain-Barré syndrome presented with variants of Guillain-Barré syndrome rather than the classical form (P = .03). In group B, patients with elevated inflammatory markers had poor response to intravenous immunoglobulin, and 5 of 11 patients had good response to pulse steroids, probably depicting an inflammation-predominant pathology. Conclusion: Post-COVID Guillain-Barré syndrome in children presented with Guillain-Barré syndrome variants rather than the classic form. Neuroimaging is of great value in both confirming Guillain-Barré syndrome diagnosis and excluding differentials. Patients with elevated inflammatory markers and residual weakness may be given a pulse steroid trial.
Collapse
Affiliation(s)
- Lokesh Saini
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Deepthi Krishna
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Sarbesh Tiwari
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Prawin Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Jagdish Prasad Goyal
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Daisy Khera
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Bharat Choudhary
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Siyaram Didel
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ravi Gaur
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Veena Laxmi
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Samhita Panda
- Department of Neurology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Kuldeep Singh
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| |
Collapse
|
42
|
Manganotti P, Garascia G, Furlanis G, Buoite Stella A. Efficacy of intravenous immunoglobulin (IVIg) on COVID-19-related neurological disorders over the last 2 years: an up-to-date narrative review. Front Neurosci 2023; 17:1159929. [PMID: 37179564 PMCID: PMC10166837 DOI: 10.3389/fnins.2023.1159929] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/03/2023] [Indexed: 05/15/2023] Open
Abstract
Introduction Among the clinical manifestations of SARS-CoV-2 infection, neurological features have been commonly reported and the state-of-the-art technique suggests several mechanisms of action providing a pathophysiological rationale for central and peripheral neurological system involvement. However, during the 1st months of the pandemic, clinicians were challenged to find the best therapeutic options to treat COVID-19-related neurological conditions. Methods We explored the indexed medical literature in order to answer the question of whether IVIg could be included as a valid weapon in the therapeutic arsenal against COVID-19-induced neurological disorders. Results Virtually, all reviewed studies were in agreement of detecting an acceptable to great efficacy upon IVIg employment in neurological diseases, with no or mild adverse effects. In the first part of this narrative review, the interaction of SARS-CoV-2 with the nervous system has been discussed and the IVIg mechanisms of action were reviewed. In the second part, we collected scientific literature data over the last 2 years to discuss the use of IVIg therapy in different neuro-COVID conditions, thus providing a summary of the treatment strategies and key findings. Discussion Intravenous immunoglobulin (IVIg) therapy is a versatile tool with multiple molecular targets and mechanisms of action that might respond to some of the suggested effects of infection through inflammatory and autoimmune responses. As such, IVIg therapy has been used in several COVID-19-related neurological diseases, including polyneuropathies, encephalitis, and status epilepticus, and results have often shown improvement of symptoms, thus suggesting IVIg treatment to be safe and effective.
Collapse
|
43
|
Tran DH, Basra D, Bilgrami Z, Challa SR, Kwon C, Marciniak E, Verceles AC. Guillain‐Barre syndrome secondary to COVID‐19 infection: A case report. Clin Case Rep 2023; 11:e7104. [PMID: 37006840 PMCID: PMC10062311 DOI: 10.1002/ccr3.7104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 04/03/2023] Open
Abstract
Guillain‐Barre syndrome (GBS) is a rare autoimmune disease that often manifests as a post‐viral complication. However, its association with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is unclear. We present a rare case of GBS secondary to COVID‐19 infection complicated by rapidly progressive sensorimotor deterioration resistant to plasma exchange therapy.
Collapse
Affiliation(s)
- Dena H. Tran
- Division of Pulmonary and Critical Care MedicineUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Dalwinder Basra
- Department of MedicineAmerican University of Antigua College of MedicineSaint JohnsAntigua and Barbuda
| | - Zaid Bilgrami
- Department of MedicineUniversity of Maryland Medical Center Midtown CampusBaltimoreMarylandUSA
| | - Suryanarayana R. Challa
- Department of MedicineUniversity of Maryland Medical Center Midtown CampusBaltimoreMarylandUSA
| | - Christina Kwon
- Department of MedicineUniversity of Maryland Medical Center Midtown CampusBaltimoreMarylandUSA
| | - Ellen Marciniak
- Division of Pulmonary and Critical Care MedicineUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Avelino C. Verceles
- Division of Pulmonary and Critical Care MedicineUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| |
Collapse
|
44
|
Bentes AA, Dos Santos Junior WR, Pessoa NL, Costa TA, Oliveira GFG, Diniz LMO, Torres BR, Teixeira DC, Mendes RB, Avelar ABA, Campos MA, Kroon EG, Drumond BP. Neuro-COVID-19 With or Without the Multisystem Inflammatory Syndrome (MIS-C): A Single-Center Study : COVID-19: Neurologic Manifestations in Children. J Mol Neurosci 2023; 73:250-258. [PMID: 36976476 PMCID: PMC10044054 DOI: 10.1007/s12031-023-02109-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/22/2023] [Indexed: 03/29/2023]
Abstract
This study evaluates the range of neurological manifestation in children with COVID-19 (neuro-COVID-19) both with and without the multisystem inflammatory syndrome (MIS-C) and the persistence of symptoms after hospital discharge. The study was conducted as a prospective study of children and adolescents under 18 years of age who were admitted to a children's hospital for infectious diseases from January 2021 to January 2022. The children had no previous neurological or psychiatric disorders. Out of the 3021 patients evaluated, 232 were confirmed to have COVID-19 and 21 of these patients (9%) showed neurological manifestations associated with the virus. Of these 21 patients, 14 developed MIS-C, and 7 had neurological manifestations unrelated to MIS-C. There was no statistical difference regarding the neurological manifestations during hospitalization and outcomes between patients with neuro-COVID-19 who had or did not have MIS-C, except for seizures that occurred more frequently in patients with neuro-COVID-19 without MIS-C (p-value = 0.0263). One patient died, and 5 patients still had neurological or psychiatric manifestations at discharge, which persisted for up to 7 months. The study highlights that SARS-CoV-2 infection can affect the central and peripheral nervous system, particularly in children and adolescents with MIS-C, and that it is crucial to be vigilant for long-term adverse outcomes, as the neurological and psychiatric effects of COVID-19 in children are emerging during an important stage of brain development.
Collapse
Affiliation(s)
- Aline Almeida Bentes
- Departamento de Pediatria, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190 - Santa Efigênia, 30130-100, Belo Horizonte, MG, Brazil.
- Hospital Infantil João Paulo II, FHEMIG, Minas Gerais, Brazil.
| | | | - Natalia Lima Pessoa
- Laboratório de Vírus, Departamento de Microbiologia, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
- Imunologia de Doenças Virais, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, Brazil
| | - Thais Alkifeles Costa
- Laboratório de Vírus, Departamento de Microbiologia, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | | | - Lilian Martins Oliveira Diniz
- Departamento de Pediatria, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190 - Santa Efigênia, 30130-100, Belo Horizonte, MG, Brazil
- Hospital Infantil João Paulo II, FHEMIG, Minas Gerais, Brazil
| | | | | | | | | | - Marco Antônio Campos
- Imunologia de Doenças Virais, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, Brazil
| | - Erna Geessien Kroon
- Laboratório de Vírus, Departamento de Microbiologia, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Betania Paiva Drumond
- Laboratório de Vírus, Departamento de Microbiologia, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| |
Collapse
|
45
|
Pimentel V, Luchsinger VW, Carvalho GL, Alcará AM, Esper NB, Marinowic D, Zanirati G, da Costa JC. Guillain-Barré syndrome associated with COVID-19: A systematic review. Brain Behav Immun Health 2023; 28:100578. [PMID: 36686624 PMCID: PMC9842533 DOI: 10.1016/j.bbih.2022.100578] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/09/2022] [Indexed: 01/19/2023] Open
Abstract
With the outbreak of coronavirus disease 2019 (COVID-19), the whole world was impacted by a pandemic. With the passage of time and knowledge about the dynamics and viral propagation of this disease, the short-, medium- and long-term repercussions are still being discovered. During this period, it has been learned that various manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can affect the nervous system. In recent months, a variety of studies and case reports have proposed an association between COVID-19 and Guillain-Barré syndrome (GBS). The present work aims to systematically review the publications available to date to verify the relationship between these two pathologies and the characteristics of post-COVID GBS. There were 156 studies included in this work, resulting in a total of 436 patients. The findings show a mean age of the patients of 61,38 years and a male majority. The GBS symptoms began on average 19 days after the onset of COVID-19 infection. Regarding GBS, the main manifestations found included generalized weakness, reflex reduction, facial paresis/paralysis and hypoesthesia. As expected, the most common result in cerebrospinal fluid (CSF) analysis was albuminocytological dissociation. A pattern of blood analysis findings common to all patients was not observed due to non-standardization of case reports. Regarding electrodiagnostic studies, acute inflammatory demyelinating polyneuropathy (AIDP) appeared as the most common subtype of GBS in this study. There have been reports, to a lesser extent, of acute motor axonal neuropathy (AMAN), acute sensorimotor axonal neuropathy (AMSAN), the pharyngeal-cervical-brachial variant (PCB), and Miller-Fisher syndrome (MFS). The GBS treatment used was mainly intravenous immunoglobulin (IVIG) and plasma exchange (PLEX). Therefore, the present study reports a high prevalence of hospitalization and intensive care units ICU admissions, conjecturing a relationship between the development of GBS and the severity of COVID-19. Despite the severity, most patients showed improvement in GBS symptoms after treatment, and their residual symptoms did not include motor involvement. Therefore, the development of GBS seems to be related to COVID-19 infection, as reported by the present systematic review.
Collapse
Affiliation(s)
- Vitória Pimentel
- Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil,Undergraduate Research Program, School of Medicine and Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Vanessa Wallau Luchsinger
- Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil,Undergraduate Research Program, School of Medicine and Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Gabriel Leal Carvalho
- Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil,Undergraduate Research Program, School of Medicine and Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Allan Marinho Alcará
- Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil,Graduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Nathalia Bianchini Esper
- Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil,Center for the Developing Brain, Child Mind Institute, New York, NY, USA
| | - Daniel Marinowic
- Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil,Graduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil,Graduate Program in Medicine, Pediatrics and Child Health, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Gabriele Zanirati
- Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil,Graduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Jaderson Costa da Costa
- Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil,Graduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil,Graduate Program in Medicine, Pediatrics and Child Health, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil,Corresponding author. Pontifical Catholic University of Rio Grande do Sul (PUCRS), 90619-900, Jd. Botânico, Porto Alegre, Rio Grande do Sul, Brazil
| |
Collapse
|
46
|
Sidoli C, Bruni AA, Beretta S, Mazzola P, Bellelli G. Guillain-Barré syndrome AMSAN variant in a 90-year-old woman after COVID-19: a case report. BMC Geriatr 2023; 23:114. [PMID: 36859256 PMCID: PMC9975860 DOI: 10.1186/s12877-023-03833-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 02/16/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) is an inflammatory disease of the peripheral nervous system characterized by rapidly evolving polyneuropathy caused by autoimmune demyelination and/or axonal degeneration. Since SARS-CoV-2 outbreak, several GBS cases following exposure to coronavirus disease-2019 (COVID-19) have been reported in literature, raising the concern of the latter being a potential trigger event for GBS. CASE PRESENTATION We report the case of a 90-year-old Caucasian woman who was admitted to our hospital because of fatigue, worsening gait and leg strength, dysphonia, dysarthria and dysphagia, started 3 weeks after being exposed to COVID-19. Based on clinical presentation GBS was suspected, so she performed a lumbar puncture and electromyography, which confirmed the diagnosis of acute motor and sensory axonal neuropathy (AMSAN) variant. We administered high dose of intravenous immunoglobulin with slight neurological improvement. However, after 2 weeks of hospitalization with maximization of care, her physical condition worsen, manifesting severe frailty. The patient was discharged with home support services for managing parenteral nutrition and intense scheduled physiotherapy. A few days later, the patient experienced a further decline in her clinical condition and died at home. CONCLUSIONS To the best of our knowledge, we report the oldest woman with GBS AMSAN variant after COVID-19 described in the existing literature. Our case supports further research aimed at improving recognition, characterization and prompt management of neurological diseases related to COVID-19 in older patients.
Collapse
Affiliation(s)
- Chiara Sidoli
- School of Medicine and Surgery, University of Milano-Bicocca, U8 Building, Floor 4, Lab 4045, Via Cadore, 48, 20900, Monza, MB, Italy
| | | | - Simone Beretta
- School of Medicine and Surgery, University of Milano-Bicocca, U8 Building, Floor 4, Lab 4045, Via Cadore, 48, 20900, Monza, MB, Italy
- Neurology Unit, San Gerardo hospital ASST Monza, Monza, MB, Italy
- NeuroMI - Milan Center for Neuroscience, Clinical Neurosciences Research Area, Milan, MI, Italy
| | - Paolo Mazzola
- School of Medicine and Surgery, University of Milano-Bicocca, U8 Building, Floor 4, Lab 4045, Via Cadore, 48, 20900, Monza, MB, Italy.
- Acute Geriatrics Unit, San Gerardo hospital ASST Monza, Monza, MB, Italy.
- NeuroMI - Milan Center for Neuroscience, Clinical Neurosciences Research Area, Milan, MI, Italy.
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, U8 Building, Floor 4, Lab 4045, Via Cadore, 48, 20900, Monza, MB, Italy
- Acute Geriatrics Unit, San Gerardo hospital ASST Monza, Monza, MB, Italy
- NeuroMI - Milan Center for Neuroscience, Clinical Neurosciences Research Area, Milan, MI, Italy
| |
Collapse
|
47
|
Kim S, Lee EK, Sohn E. Two Case Reports of Chronic Inflammatory Demyelinating Polyneuropathy After COVID-19 Vaccination. J Korean Med Sci 2023; 38:e57. [PMID: 36852853 PMCID: PMC9970789 DOI: 10.3346/jkms.2023.38.e57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/28/2022] [Indexed: 02/12/2023] Open
Abstract
The occurrence of chronic inflammatory demyelinating polyneuropathy (CIDP) related to coronavirus disease 2019 (COVID-19) has rarely been reported. We describe two patients who were diagnosed with CIDP after COVID-19 vaccination. A 72-year-old man presented with a progressive tingling sensation and weakness below both knees for two weeks. He had been vaccinated against COVID-19 (mRNA-1273 vaccine) a month before the appearance of symptoms. Demyelinating polyneuropathy was observed in the nerve conduction studies (NCS). Intravenous immunoglobulin (IVIg) was administered under the diagnosis of Guillain-Barré syndrome (GBS), and his symptoms were improved. However, his symptoms relapsed at 10 weeks from the onset. Oral prednisolone, azathioprine, and IVIg were administered as treatment. The second case was a 50-year-old man who complained of a bilateral leg tingling sensation and gait disturbance lasting four weeks. He had received the Ad26.COV2.S vaccine against COVID-19 five weeks prior. Demyelinating polyneuropathy was observed in the NCS. He was treated with oral prednisolone, azathioprine, and IVIg for CIDP because his symptoms had lasted for more than 12 weeks from the onset. A causal relationship has not been established between COVID-19 vaccination and CIDP; however, CIDP may follow COVID-19 vaccination. As CIDP treatment is different from that for GBS, clinicians should closely monitor patients diagnosed with GBS associated with COVID-19 whether they deteriorate after initial treatment.
Collapse
Affiliation(s)
- Sooyoung Kim
- Department of Neurology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Eun Kyoung Lee
- Department of Neurology, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Korea
| | - Eunhee Sohn
- Department of Neurology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
| |
Collapse
|
48
|
Zheng X, Fang Y, Song Y, Liu S, Liu K, Zhu J, Wu X. Is there a causal nexus between COVID-19 infection, COVID-19 vaccination, and Guillain-Barré syndrome? Eur J Med Res 2023; 28:98. [PMID: 36841799 PMCID: PMC9958317 DOI: 10.1186/s40001-023-01055-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/08/2023] [Indexed: 02/27/2023] Open
Abstract
Guillain-Barré syndrome (GBS) is an immune-mediated inflammatory polyradiculoneuropathy, which commonly leads to a very high level of neurological disability. Especially, after the global outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the causation between GBS and SARS-CoV-2 infection and the coronavirus disease 2019 (COVID-19) vaccination have aroused widespread concern. In the review, we analyzed the impacts of SARS-CoV-2 infection and COVID-19 vaccination on GBS globally, aiming to further understand the characteristics of GBS associated with COVID-19. Based on the electrophysiological data, patients suffering from GBS related to COVID-19 manifested as an acute inflammatory demyelinating polyneuropathy (AIDP). Moreover, we summarized the current findings, which may evidence GBS linking to SARS-CoV-2 infection and COVID-19 vaccination, and discussed the underlying mechanisms whether and how the SARS-CoV-2 virus and COVID-19 vaccination can induce GBS and its variants.
Collapse
Affiliation(s)
- Xiaoxiao Zheng
- grid.64924.3d0000 0004 1760 5735Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Jilin University, Xinmin Street 1#, Changchun, 130021 China
| | - Yong Fang
- grid.64924.3d0000 0004 1760 5735Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Jilin University, Xinmin Street 1#, Changchun, 130021 China
| | - Yanna Song
- grid.412558.f0000 0004 1762 1794Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shan Liu
- grid.64924.3d0000 0004 1760 5735The Second Hospital of Jilin University, Jilin University, Changchun, China
| | - Kangding Liu
- grid.64924.3d0000 0004 1760 5735Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Jilin University, Xinmin Street 1#, Changchun, 130021 China
| | - Jie Zhu
- Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Jilin University, Xinmin Street 1#, Changchun, 130021, China. .,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Karolinska University Hospital, Solna, Stockholm, Sweden.
| | - Xiujuan Wu
- Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Jilin University, Xinmin Street 1#, Changchun, 130021, China.
| |
Collapse
|
49
|
Ahmed A, El‐Amin R, Musa AM, Elsayed MA, Fahal LA, Ahmed ES, Ali Y, Nebie IE, Mohamed NS, Zinsstag J, Siddig EE, EL‐Sadig SM. Guillain-Barre syndrome associated with COVID-19 infection: A case series. Clin Case Rep 2023; 11:e6988. [PMID: 36852114 PMCID: PMC9957700 DOI: 10.1002/ccr3.6988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 01/03/2023] [Accepted: 02/06/2023] [Indexed: 02/27/2023] Open
Abstract
In this communication, we reported a series of six patients presented with Guillain-Barré syndrome that associated with COVID-19 infection, which was confirmed with RT-PCR. Here we discuss the laboratory investigation and case management, as well as clinical presentation and outcome of each case. The current report demonstrated the first case series of COVID-19-associated GBS-cases in Sudan.
Collapse
Affiliation(s)
- Ayman Ahmed
- Institute of Endemic DiseaseUniversity of KhartoumKhartoumSudan,Swiss Tropical and Public Health Institute (Swiss TPH)AllschwilSwitzerland,University of BaselBaselSwitzerland
| | - Rahba El‐Amin
- Faculty of MedicineUniversity of KhartoumKhartoumSudan
| | | | | | | | | | - Yousif Ali
- Health Emergencies and Epidemics Control General DirectorateSudan Federal Ministry of HealthKhartoumSudan
| | - Ipyn Eric Nebie
- Swiss Tropical and Public Health Institute (Swiss TPH)AllschwilSwitzerland,University of BaselBaselSwitzerland
| | - Nouh Saad Mohamed
- Molecular Biology UnitSirius Training and Research CentreKhartoumSudan
| | - Jakob Zinsstag
- Swiss Tropical and Public Health Institute (Swiss TPH)AllschwilSwitzerland,University of BaselBaselSwitzerland
| | - Emmanuel Edwar Siddig
- Mycetoma Research CentreUniversity of KhartoumKhartoumSudan,Faculty of Medical Laboratory SciencesUniversity of KhartoumKhartoumSudan
| | | |
Collapse
|
50
|
Abu-Rumeileh S, Abdelhak A, Foschi M, D'Anna L, Russo M, Steinacker P, Kuhle J, Tumani H, Blennow K, Otto M. The multifaceted role of neurofilament light chain protein in non-primary neurological diseases. Brain 2023; 146:421-437. [PMID: 36083979 PMCID: PMC9494370 DOI: 10.1093/brain/awac328] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 09/02/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022] Open
Abstract
The advancing validation and exploitation of CSF and blood neurofilament light chain protein as a biomarker of neuroaxonal damage has deeply changed the current diagnostic and prognostic approach to neurological diseases. Further, recent studies have provided evidence of potential new applications of this biomarker also in non-primary neurological diseases. In the present review we summarize the state of the art, future perspectives, but also limitations, of neurofilament light chain protein as a CSF and blood biomarker in several medical fields, including intensive care medicine, surgery, internal medicine and psychiatry. In particular, neurofilament light chain protein is associated with the degree of neurological impairment and outcome in patients admitted to intensive care units or in the perioperative phase and it seems to be highly interconnected with cardiovascular risk factors. Beyond that, interesting diagnostic and prognostic insights have been provided by the investigation of neurofilament light chain protein in psychiatric disorders as well as in the current coronavirus disease-19 pandemic and in normal ageing. Altogether, current data outline a multifaceted applicability of CSF and blood neurofilament light chain protein ranging from the critical clinical setting to the development of precision medicine models suggesting a strict interplay between the nervous system pathophysiology and the health-illness continuum.
Collapse
Affiliation(s)
- Samir Abu-Rumeileh
- Department of Neurology, Martin-Luther-University of Halle-Wittenberg, Halle (Saale), Germany
| | - Ahmed Abdelhak
- Department of Neurology, University of California San Francisco (UCSF), San Francisco, USA
- Department of Neurology, Ulm University Hospital, Ulm, Germany
| | - Matteo Foschi
- Department of Neuroscience, Neurology Unit – S. Maria delle Croci Hospital of Ravenna, AUSL Romagna, Ravenna, Italy
| | - Lucio D'Anna
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London, NHS Healthcare Trust, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Michele Russo
- Department of Cardiology, S. Maria dei Battuti Hospital, AULSS 2 Veneto, Conegliano, Italy
| | - Petra Steinacker
- Department of Neurology, Martin-Luther-University of Halle-Wittenberg, Halle (Saale), Germany
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Markus Otto
- Department of Neurology, Martin-Luther-University of Halle-Wittenberg, Halle (Saale), Germany
- Department of Neurology, Ulm University Hospital, Ulm, Germany
| |
Collapse
|