Spectrum of Acute Neuropathy Associated With Covid-19: A Clinical and Electrophysiological Study of 13 Patients From a Single Center

Amant H, Chung J, Dimitriades VR, Nakra NA. Case report: Clinical course and treatment of SARS-CoV-2 in a pediatric CAR-T cell recipient with persistent hypogammaglobulinemia

This report describes a pediatric patient who underwent chimeric antigen receptor (CAR) T-cell therapy for refractory B-cell acute lymphoblastic leukemia (B-ALL) four years prior, with resultant hypogammaglobulinemia for which he was receiving weekly subcutaneous immune globulin. He presented with persistent fever, dry cough, and a tingling sensation in his toes following a confirmed COVID-19 infection 3 weeks prior. His initial nasopharyngeal SARS-CoV-2 PCR was negative, leading to an extensive workup for other infections. He was ultimately diagnosed with persistent lower respiratory tract COVID-19 infection based on positive SARS-CoV-2 PCR from bronchoalveolar lavage (BAL) sampling. He was treated with a combination of remdesivir (antiviral) and casirivimab/imdevimab (combination monoclonal antibodies) with immediate improvement in fever, respiratory symptoms, and neurologic symptoms.

[Functional and morphological disorders of taste and olfaction in COVID-19 patients]

Ziele

Testen der Prävalenz und Entwicklung akuter olfaktorischer und gustatorischer Funktionsstörungen und ihrer morphologischen Korrelate bei COVID-19-Patienten, die aufgrund von COVID-19-bedingten Atemwegserkrankungen einen Krankenhausaufenthalt benötigen.

Methoden

Eingeschlossen wurden 53 Krankenhauspatienten (23 Männer, 30 Frauen, Alter 42,54 ± 10,95 Jahre) mit RT-PCR-bestätigter COVID-19-Diagnose. Die Patienten wurden zweimal untersucht: direkt nach der Entlassung aus dem Krankenhaus und 4–6 Wochen später. Elektrogustometrische (EGM-)Schwellen im von der Chorda tympani versorgten Zungenbereich, am weichen Gaumen und im Bereich der Papillae vallatae wurden beidseitig erfasst. Der Geruchssinn wurde mit Riechstäbchen untersucht (Sniffin’ Sticks, Burghart GmbH, Wedel, Deutschland). Mittels Kontaktendoskopie wurden die Nasen- und Mundschleimhäute (fungiforme Papillen, fPap) der Patienten untersucht. Die Ergebnisse wurden mit denen von 53 gesunden Personen verglichen (23 Männer, 30 Frauen, Alter 42,90 ± 10,64 Jahre).

Ergebnisse

Die EGM-Schwellenwerte der Patienten waren in beiden Fällen signifikant höher als die der gesunden Probanden. Die EGM-Schwellenwerte bei der 2. Messung waren signifikant niedriger als bei der 1. Messung. Dementsprechend waren die vom Patienten berichteten gustatorischen Ergebnisse bei der 2. Messung verbessert. Dasselbe Muster wurde bei der Verwendung von Sniffin’ Sticks gefunden. Signifikante Veränderungen in Form und Vaskularisierung von fPap wurden bei Patienten festgestellt, insbesondere beim 1. Mal. Bemerkenswert ist, dass keine signifikanten Unterschiede in der Vaskularisation der Nasenschleimhaut der Patienten beobachtet wurden.

Schlussfolgerung

COVID-19 beeinträchtigt sowohl die Geschmacks- als auch die Geruchsfunktion. Es beeinflusst auch parallel die Struktur und Vaskularisierung der Mundschleimhaut, wenn auch die Nasenschleimhaut in einem viel geringeren, nicht signifikanten Ausmaß. Unsere Ergebnisse deuten darauf hin, dass COVID-19 eine leichte bis schwere Neuropathie mehrerer Hirnnerven verursachen kann.

Neurographic Evidence of Inflammatory Polyneuropathies in Peri-COVID-19 Circumstances and Their Relationship With Acute Disease Severity and Inflammatory Storm

Recently, there has been increasing evidence among people infected with coronavirus disease 2019 (COVID-19) of being diagnosed with the typical acute post-infectious inflammatory polyneuroradiculopathy that was formerly known as Guillain-Barré syndrome (GBS), and it is not uncommon that some of them develop chronic inflammatory demyelinating polyneuroradiculopathy (CIDP). However, there is still a large debate and controversy about the link between COVID-19 and polyneuropathy. As a result, a multicentric retrospective cohort study was conducted in Basrah Governorate in the south of Iraq that included 2240 patients over a period of six months. Of those, 1344 patients had a history of COVID-19 in the previous year, and 1.14% of them developed inflammatory polyneuropathy, while only 0.29% (896 patients) of those with no history of COVID-19 had developed inflammatory polyneuropathy. This difference is highly significant, with a relative risk equal to six. The majority of the inflammatory polyneuropathy (44.4%) was diagnosed four to 12 weeks after the COVID-19 infection, with GBS being the most common type (72.2% of cases). Moreover, the nerve conduction velocity, the distal latency, and the amplitude of the most studied nerves were slower, more prolonged, and lower, respectively, among the COVID-19 groups compared with the non-COVID-19 group. Furthermore, there is an inverse correlation between the nerve conduction velocity in the majority of studied nerves and certain inflammatory biomarkers, such as serum ferritin, interleukin-6, and c-reactive protein. Although the occurrence of inflammatory polyneuropathy is more common among the less severe groups of COVID-19, if it occurs in the severe groups, it shows a more aggressive presentation.

Characteristics of COVID and post COVID polyneuropathies in adults and pediatrics: an Egyptian sample

Background

The aim of this study is to describe the different forms of polyneuropathy associated with coronavirus disease 2019 (COVID-19) as a secondary neurological complication for (COVID-19) and the outcome from different therapeutic regimens in adults and pediatrics in first and second waves of the pandemic.

Case presentation

This study was conducted on 42 patients, they were divided into two groups, group (A) and group (B) in first and second waves respectively. Twenty-five patients presented by ascending weakness preceded by fever, dry cough and respiratory distress, electromyography (EMG) and nerve conduction (NC) studies done and confirmed the clinical diagnosis of demyelinating polyneuropathy. Eight patients presented by acute flaccid quadriparesis, more severe in upper limbs preceded by fever and diarrhea diagnosed as acute axonal polyneuropathy. Five patients presented by severe fatigue and progressive weakness of both lower and upper limbs, they developed fever and cough 10 days after the neurological symptoms. EMG and NC done and confirmed clinical diagnosis of polyneuropathy of demyelinating with secondary axonal picture. Four patients presented 30 to 40 days after their recovery form corona virus infection with gradual progressive weakness of both upper and lower limbs over 2 to 3 months duration, mainly the proximal muscles of lower limbs were affected with areflexia. EMG and NC done and confirmed the diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP).

Conclusion

We should gain a better understanding of the underlying pathophysiology and therapeutic options of polyneuropathies related to COVID-19, which will have an impact on the treatment of the COVID related respiratory failure presenting with neuropathy.