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Valaparla VL, Rane SP, Patel C, Li X. Guillain-Barre syndrome and link with COVID-19 infection and vaccination: a review of literature. Front Neurol 2024; 15:1396642. [PMID: 38899056 PMCID: PMC11185933 DOI: 10.3389/fneur.2024.1396642] [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: 03/06/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
Background Guillain-Barré syndrome (GBS) is an autoimmune disease associated with significant morbidity. A wide variety of infectious and non-infectious triggers have been identified to be associated with GBS. COVID-19 has gained attention in recent years for its role in GBS pathogenesis. Our study aims to review the literature on GBS and its epidemiological and pathophysiological association with COVID-19. Description Recent literature on GBS associated with COVID-19 infections, such as case reports, case series, systematic reviews, and large-scale epidemiological studies, were reviewed. We also reviewed studies that included vaccines against COVID-19 in association with GBS. Studies that focused on understanding the pathobiology of GBS and its association with infectious agents including COVID-19 were reviewed. Conclusion Despite a lack of consensus, GBS is strongly associated with COVID-19 infection. The exact pathophysiological mechanism regarding COVID-19 as a causative agent of GBS is unknown. Mechanisms, such as the proinflammatory state, triggering of autoimmunity, and direct viral invasion, are postulated and remain to be investigated. Adenovirus vector vaccines are most likely associated with GBS, and the consensual reports clearly suggest mRNA vaccines are associated with low risk and may be protective against GBS by reducing the risk of COVID-19 infection.
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Affiliation(s)
| | | | | | - Xiangping Li
- University of Texas Medical Branch at Galveston, Galveston, TX, United States
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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.
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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
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Yoon BA, Kim SY, Kim J, Seok JI, Seok JM, Lee S, Kim JK, Oh SI. Clinical and laboratory findings in scrub typhus associated Guillain-Barré syndrome in South Korea. J Peripher Nerv Syst 2024; 29:82-87. [PMID: 38286033 DOI: 10.1111/jns.12614] [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: 04/20/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND AND AIMS Scrub typhus is an endemic disease in the fall season that occurs in a limited number of places known as the Tsutsugamushi Triangle. Peripheral neuropathy is a common complication of scrub typhus. Herein, we encountered several patients with ascending paralysis after scrub typhus infection, who were diagnosed with Guillain-Barré syndrome (GBS). We aimed to investigate the clinical and laboratory characteristics of patients who developed GBS after scrub typhus. METHODS Patients were retrospectively recruited from six nationwide tertiary centers in South Korea from January 2017 to December 2021. Patients who had been clinically diagnosed with GBS and confirmed to have scrub typhus via laboratory examination and/or the presence of an eschar before the onset of acute limb paralysis were included. The GBS-associated clinical and electrophysiological characteristics, outcomes, and scrub typhus-associated features were collected. RESULTS Of the seven enrolled patients, six were female and one was male. The median time from scrub typhus infection to the onset of limb weakness was 6 (range: 2-14) days. All patients had eschar on their bodies. Four patients (57.1%) were admitted to the intensive care unit and received artificial ventilation for respiratory distress. At 6 months, the median GBS disability score was 2 (range, 1-4) points. INTERPRETATION Patients with scrub typhus-associated GBS have a severe clinical presentation and require intensive treatment with additional immunotherapies. Therefore, GBS should be included in the differential diagnosis when peripheral neuropathies develop during scrub typhus treatment. Notably, scrub typhus is associated to GBS.
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Affiliation(s)
- Byeol-A Yoon
- Peripheral Neuropathy Research Center, Dong-A University College of Medicine, Busan, South Korea
- Department of Neurology, Dong-A University Medical Center, Busan, South Korea
| | - Sun-Young Kim
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Juhyeon Kim
- Department of Neurology, Gyeongsang National University Hospital, Jinju, South Korea
| | - Jung Im Seok
- Department of Neurology, School of Medicine, Catholic University of Daegu, Daegu, South Korea
| | - Jin Myoung Seok
- Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, South Korea
| | - Sukyoon Lee
- Department of Neurology, Inje University Busan Paik Hospital, Busan, South Korea
| | - Jong Kuk Kim
- Peripheral Neuropathy Research Center, Dong-A University College of Medicine, Busan, South Korea
- Department of Neurology, Dong-A University Medical Center, Busan, South Korea
| | - Seong-Il Oh
- Department of Neurology, Kyung Hee University Hospital, Seoul, South Korea
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Yong SJ, Halim A, Liu S, Halim M, Alshehri AA, Alshahrani MA, Alshahrani MM, Alfaraj AH, Alburaiky LM, Khamis F, Muzaheed, AlShehail BM, Alfaresi M, Al Azmi R, Albayat H, Al Kaabi NA, Alhajri M, Al Amri KAS, Alsalman J, Algosaibi SA, Al Fares MA, Almanaa TN, Almutawif YA, Mohapatra RK, Rabaan AA. Pooled rates and demographics of POTS following SARS-CoV-2 infection versus COVID-19 vaccination: Systematic review and meta-analysis. Auton Neurosci 2023; 250:103132. [PMID: 38000119 DOI: 10.1016/j.autneu.2023.103132] [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: 09/16/2023] [Revised: 10/31/2023] [Accepted: 11/21/2023] [Indexed: 11/26/2023]
Abstract
PURPOSE To address recent concerns of postural orthostatic tachycardia syndrome (POTS) occurring after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19) vaccination. METHODS We searched PubMed, Web of Science, and Scopus as of 1st June 2023. We performed a systematic review and meta-analysis of pooled POTS rate in SARS-CoV-2-infected and COVID-19-vaccinated groups from epidemiological studies, followed by subgroup analyses by characteristic. Meta-analysis of risk ratio was conducted to compare POTS rate in infected versus uninfected groups. Meta-analysis of demographics was also performed to compare cases of post-infection and post-vaccination POTS from case reports and series. RESULTS We estimated the pooled POTS rate of 107.75 (95 % CI: 9.73 to 273.52) and 3.94 (95 % CI: 0 to 16.39) cases per 10,000 (i.e., 1.08 % and 0.039 %) in infected and vaccinated individuals based on 5 and 2 studies, respectively. Meta-regression revealed age as a significant variable influencing 86.2 % variance of the pooled POTS rate in infected population (P < 0.05). Moreover, POTS was 2.12-fold more likely to occur in infected than uninfected individuals (RR = 2.12, 95 % CI: 1.71 to 2.62, P < 0.001). Meta-analyzed demographics for cases of post-infection (n = 43) and post-vaccination (n = 17) POTS found no significant differences in several variables between groups, except that the time from exposure to symptom onset was shorter for cases of post-vaccination POTS (P < 0.05). CONCLUSION Although evidence is limited for post-vaccination POTS, our study showed that POTS occur more frequently following SARS-CoV-2 infection than COVID-19 vaccination.
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Affiliation(s)
- Shin Jie Yong
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Selangor, Malaysia.
| | - Alice Halim
- Shanghai Medical College, Fudan University, Shanghai, China
| | - Shiliang Liu
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Michael Halim
- Department of Biomedical Science, School of Science, Engineering and Environment, University of Salford, Greater Manchester, United Kingdom
| | - Ahmad A Alshehri
- Department of Clinical Laboratory Sciences, Faculty of Applied Medical Sciences, Najran University, Najran, Saudi Arabia
| | - Mohammed A Alshahrani
- Department of Clinical Laboratory Sciences, Faculty of Applied Medical Sciences, Najran University, Najran, Saudi Arabia
| | - Mohammed M Alshahrani
- Department of Clinical Laboratory Sciences, Faculty of Applied Medical Sciences, Najran University, Najran, Saudi Arabia
| | - Amal H Alfaraj
- Pediatric Department, Abqaiq General Hospital, First Eastern Health Cluster, Abqaiq, Saudi Arabia
| | - Lamees M Alburaiky
- Pediatric Department, Safwa General Hospital, Eastern Health Cluster, Safwa, Saudi Arabia
| | - Faryal Khamis
- Infection Diseases unit, Department of Internal Medicine, The Royal Hospital, Muscat, Oman
| | - Muzaheed
- Department of Clinical Laboratory Science, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Bashayer M AlShehail
- Pharmacy Practice Department, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mubarak Alfaresi
- Department of Pathology and Laboratory Medicine, Zayed Military Hospital, Abu Dhabi, United Arab Emirates; Department of Pathology, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Reyouf Al Azmi
- Infection Prevention and Control, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Hawra Albayat
- Infectious Disease Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Nawal A Al Kaabi
- Sheikh Khalifa Medical City, Abu Dhabi Health Services Company, Abu Dhabi, United Arab Emirates; College of Medicine and Health Science, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Mashael Alhajri
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Jameela Alsalman
- Infection Disease Unit, Department of Internal Medicine, Salmaniya Medical Complex, Ministry of Health, Manama, Bahrain
| | - Sarah A Algosaibi
- Academic and Clinical Training, Eastern Health Cluster, Rural Health Network, Dammam, Saudi Arabia
| | - Mona A Al Fares
- Department of Internal Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Taghreed N Almanaa
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Yahya A Almutawif
- Department of Medical Laboratories Technology, College of Applied Medical Sciences, Taibah University, Madinah, Saudi Arabia
| | - Ranjan K Mohapatra
- Department of Chemistry, Government College of Engineering, Keonjhar, India
| | - Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Department of Public Health and Nutrition, The University of Haripur, Haripur, Pakistan.
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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.
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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.
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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
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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.
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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
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Maxwell L, Shreedhar P, Levis B, Chavan SA, Akter S, Carabali M. Overlapping research efforts in a global pandemic: a rapid systematic review of COVID-19-related individual participant data meta-analyses. BMC Health Serv Res 2023; 23:735. [PMID: 37415216 PMCID: PMC10327330 DOI: 10.1186/s12913-023-09726-8] [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: 10/24/2022] [Accepted: 06/20/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Individual participant data meta-analyses (IPD-MAs), which involve harmonising and analysing participant-level data from related studies, provide several advantages over aggregate data meta-analyses, which pool study-level findings. IPD-MAs are especially important for building and evaluating diagnostic and prognostic models, making them an important tool for informing the research and public health responses to COVID-19. METHODS We conducted a rapid systematic review of protocols and publications from planned, ongoing, or completed COVID-19-related IPD-MAs to identify areas of overlap and maximise data request and harmonisation efforts. We searched four databases using a combination of text and MeSH terms. Two independent reviewers determined eligibility at the title-abstract and full-text stages. Data were extracted by one reviewer into a pretested data extraction form and subsequently reviewed by a second reviewer. Data were analysed using a narrative synthesis approach. A formal risk of bias assessment was not conducted. RESULTS We identified 31 COVID-19-related IPD-MAs, including five living IPD-MAs and ten IPD-MAs that limited their inference to published data (e.g., case reports). We found overlap in study designs, populations, exposures, and outcomes of interest. For example, 26 IPD-MAs included RCTs; 17 IPD-MAs were limited to hospitalised patients. Sixteen IPD-MAs focused on evaluating medical treatments, including six IPD-MAs for antivirals, four on antibodies, and two that evaluated convalescent plasma. CONCLUSIONS Collaboration across related IPD-MAs can leverage limited resources and expertise by expediting the creation of cross-study participant-level data datasets, which can, in turn, fast-track evidence synthesis for the improved diagnosis and treatment of COVID-19. TRIAL REGISTRATION 10.17605/OSF.IO/93GF2.
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Affiliation(s)
- Lauren Maxwell
- Heidelberger Institut Für Global Health, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 130/3, 69120, Heidelberg, Germany.
| | - Priya Shreedhar
- Heidelberger Institut Für Global Health, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 130/3, 69120, Heidelberg, Germany
| | - Brooke Levis
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Ste Catherine Road, Montreal, QC, H3T 1E2, Canada
| | - Sayali Arvind Chavan
- Institute of Tropical Medicine and Public Health, Charité - Universitätsmedizin Berlin, Südring 2-3, 13353, Berlin, Germany
| | - Shaila Akter
- Heidelberger Institut Für Global Health, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 130/3, 69120, Heidelberg, Germany
| | - Mabel Carabali
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, 2001 McGill College Avenue, Montréal, H3A 1G1, Canada
- Department of Social and Preventive Medicine, School of Public Health, Universite de Montreal, 7101 Parc Avenue, Montreal, H3N 1X9, Canada
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Reddy YM, Murthy JMK, Osman S, Jaiswal SK, Gattu AK, Pidaparthi L, Boorgu SK, Chavan R, Ramakrishnan B, Yeduguri SR. Guillain-Barré syndrome associated with SARS-CoV-2 vaccination: how is it different? a systematic review and individual participant data meta-analysis. Clin Exp Vaccine Res 2023; 12:143-155. [PMID: 37214140 PMCID: PMC10193105 DOI: 10.7774/cevr.2023.12.2.143] [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: 01/01/2023] [Revised: 02/20/2023] [Accepted: 03/31/2023] [Indexed: 05/24/2023] Open
Abstract
Purpose An association between Guillain-Barré syndrome (GBS) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccination has been reported. We aimed to summarize the clinical features of GBS associated with SARS-CoV-2 vaccination and determine the contrasting features from coronavirus disease-19 (COVID-19) associated GBS and GBS following other causes. Materials and Methods We performed PubMed search for articles published between 1 December 2020 and 27 January 2022 using search terms related to "SARS-CoV-2 vaccination" and "GBS". Reference searching of the eligible studies was performed. Sociodemographic and vaccination data, clinical and laboratory features, and outcomes were extracted. We compared these findings with post-COVID-19 GBS and International GBS Outcome Study (IGOS) (GBS from other causes) cohorts. Results We included 100 patients in the analysis. Mean age was 56.88 years, and 53% were males. Six-eight received non-replicating virus vector and 30 took messenger RNA (mRNA) vaccines. The median interval between the vaccination and the GBS onset was 11 days. Limb weakness, facial palsy, sensory symptoms, dysautonomia, and respiratory insufficiency were seen in 78.65%, 53.3%, 77.4%, 23.5%, and 25%, respectively. The commonest clinical and electrodiagnostic subtype were sensory-motor variant (68%) and acute inflammatory demyelinating polyneuropathy (61.4%), respectively. And 43.9% had poor outcome (GBS outcome score ≥3). Pain was common with virus vector than mRNA vaccine, and the latter had severe disease at presentation (Hughes grade ≥3). Sensory phenomenon and facial weakness were common in vaccination cohort than post-COVID-19 and IGOS. Conclusion There are distinct differences between GBS associated with SARS-CoV-2 vaccination and GBS due to other causes. Facial weakness and sensory symptoms were commonly seen in the former and outcomes poor.
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Affiliation(s)
| | | | - Syed Osman
- Department of Neurology, CARE Hospital, Hyderabad, India
| | | | | | | | | | - Roshan Chavan
- Department of Neurology, CARE Hospital, Hyderabad, India
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Yusari IGAAA, Sudira PG, Samatra DPGP. Clinical characteristics of Guillain–Barre syndrome in COVID-19: a systematic review and meta-analysis of observational studies. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2023; 59:40. [PMID: 37009467 PMCID: PMC10042426 DOI: 10.1186/s41983-023-00633-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/28/2023] [Indexed: 03/29/2023] Open
Abstract
Abstract
Background
Guillain–Barre syndrome (GBS) is a complication that occurs in patients with Coronavirus Disease (COVID-19) infection. The spectrum of symptoms varies from mild to severe symptoms, even death. The study aimed to compare the clinical manifestations in GBS patients with and without COVID-19 comorbidity.
Results
A systematic review and meta-analysis of cohort and cross-sectional studies was conducted comparing the characteristics and course of GBS disease in the COVID-19 positive and COVID-19 negative groups. Four articles were selected with a total sample of 61 COVID-19 positive and 110 COVID-19 negative GBS patients. Based on clinical manifestations, COVID-19 infection increased the likelihood of tetraparesis (OR: 2.54; 95% CI 1.12–5.74; p = 0.03) and the presence of facial nerve involvement (OR: 2.34; 95% CI 1.00–5.47; p = 0.05). Demyelinating type GBS or AIDP was more common in the COVID-19 positive group (OR: 2.32; 95% CI 1.16–4.61; p = 0.02). COVID-19 in GBS significantly increased the need for intensive care (OR: 3.32; 95% CI 1.48–7.46; p = 0.004) and the use of mechanical ventilation (OR: 2.42; 95% CI 1.00–5.86; p = 0.05).
Conclusions
GBS following COVID-19 infection showed more severe variations in clinical characteristics compared to the group of GBS patients without COVID-19. Early detection of GBS, especially the typical manifestations post COVID-19 infection, is very important to carry out intensive monitoring and early management before the patient's condition worsens.
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Martinelli-Boneschi F, Colombo A, Bresolin N, Sessa M, Bassi P, Grampa G, Magni E, Versino M, Ferrarese C, Zarcone D, Albanese A, Micieli G, Zanferrari C, Cagnana A, Ferrante C, Zilioli A, Locatelli D, Calloni MV, Delodovici ML, Pozzato M, Patisso V, Bortolan F, Foresti C, Frigeni B, Canella S, Xhani R, Crabbio M, Clemenzi A, Mauri M, Beretta S, La Spina I, Bernasconi S, De Santis T, Cavallini A, Ranieri M, D'Adda E, Fruguglietti ME, Peverelli L, Agosti E, Leoni O, Rigamonti A, Salmaggi A. COVID-19-associated Guillain-Barré syndrome in the early pandemic experience in Lombardia (Italy). Neurol Sci 2023; 44:437-446. [PMID: 36289117 PMCID: PMC9607708 DOI: 10.1007/s10072-022-06429-6] [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: 07/21/2022] [Accepted: 09/23/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To estimate the incidence and describe clinical characteristics and outcome of GBS in COVID-19 patients (COVID19-GBS) in one of the most hit regions during the first pandemic wave, Lombardia. METHODS Adult patients admitted to 20 Neurological Units between 1/3-30/4/2020 with COVID19-GBS were included as part of a multi-center study organized by the Italian society of Hospital Neuroscience (SNO). RESULTS Thirty-eight COVID19-GBS patients had a mean age of 60.7 years and male frequency of 86.8%. CSF albuminocytological dissociation was detected in 71.4%, and PCR for SARS-CoV-2 was negative in 19 tested patients. Based on neurophysiology, 81.8% of patients had a diagnosis of AIDP, 12.1% of AMSAN, and 6.1% of AMAN. The course was favorable in 76.3% of patients, stable in 10.5%, while 13.2% worsened, of which 3 died. The estimated occurrence rate in Lombardia ranges from 0.5 to 0.05 GBS cases per 1000 COVID-19 infections depending on whether you consider positive cases or estimated seropositive cases. When we compared GBS cases with the pre-pandemic period, we found a reduction of cases from 165 to 135 cases in the 2-month study period in Lombardia. CONCLUSIONS We detected an increased incidence of GBS in COVID-19 patients which can reflect a higher risk of GBS in COVID-19 patients and a reduction of GBS events during the pandemic period possibly due to a lower spread of more common respiratory infectious diseases determined by an increased use of preventive measures.
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Affiliation(s)
- Filippo Martinelli-Boneschi
- Neurology Unit, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy. .,Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy.
| | - Antonio Colombo
- Membro Direttivo Nazionale SNO, Polo Neurologico Brianteo, Seregno, MB, Italy
| | - Nereo Bresolin
- Neurology Unit, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.,Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy
| | - Maria Sessa
- U.O. Neurologia Ospedale Giovanni XXIII, Bergamo, Italy
| | - Pietro Bassi
- U.O. Neurologia, Ospedale San Giuseppe, Milan, Italy
| | | | | | - Maurizio Versino
- Università Dell' InsubriaU.O. Neurologia Ospedale Di Varese, Varese, Italy
| | - Carlo Ferrarese
- Università Degli Studi Milano Bicocca, U.O. Neurologia, Ospedale San Gerardo, Monza, Italy
| | - Davide Zarcone
- U.O. Neurologia, Ospedale Sant'Antonio Abate, Gallarate, VA, Italy
| | | | | | - Carla Zanferrari
- U.O. Neurologia, Ospedale Vizzolo Predabissi, Vizzolo Predabissi, MI, Italy
| | | | - Claudio Ferrante
- U.O. Ospedale Policlinico Ponte San Pietro, Ponte San Pietro, BG, Italy
| | | | - Davide Locatelli
- Università Insubria, U.O. NeurochirurgiaOspedale Di Varese, Varese, Italy
| | | | - Maria Luisa Delodovici
- Università Dell' InsubriaU.O. Neurologia Ospedale Di Varese, Varese, Italy.,Membro Direttivo Regionale Lombardo SNO, Milan, Italy
| | - Mattia Pozzato
- Neurology Unit, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.,Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy
| | - Valerio Patisso
- Neurology Unit, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.,Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy
| | - Francesco Bortolan
- U.O. Osservatorio Epidemiologico Regionale, Struttura Epidemiologia E Valutazione Delle Performance, Milan, Regione Lombardia, Italy
| | | | | | | | | | | | | | - Marco Mauri
- Università Dell' InsubriaU.O. Neurologia Ospedale Di Varese, Varese, Italy
| | - Simone Beretta
- Università Degli Studi Milano Bicocca, U.O. Neurologia, Ospedale San Gerardo, Monza, Italy
| | - Isidoro La Spina
- U.O. Neurologia, Ospedale Sant'Antonio Abate, Gallarate, VA, Italy
| | | | | | | | - Michela Ranieri
- U.O. Neurologia, Ospedale Vizzolo Predabissi, Vizzolo Predabissi, MI, Italy
| | | | | | | | - Edoardo Agosti
- Università Insubria, U.O. NeurochirurgiaOspedale Di Varese, Varese, Italy
| | - Olivia Leoni
- U.O. Osservatorio Epidemiologico Regionale, Struttura Epidemiologia E Valutazione Delle Performance, Milan, Regione Lombardia, Italy
| | | | - Andrea Salmaggi
- Coordinatore SNO Lombardia, U.O. Neurologia, Ospedale Manzoni, Lecco, Italy
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13
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Bentley SA, Ahmad S, Kobeissy FH, Toklu HZ. Concomitant Guillain-Barré Syndrome and COVID-19: A Meta-Analysis of Cases. Medicina (B Aires) 2022; 58:medicina58121835. [PMID: 36557036 PMCID: PMC9788175 DOI: 10.3390/medicina58121835] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/03/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Background and Objectives: Recent findings demonstrate that the transmigration of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) to the nervous system implicates severe neurotropic pathologies, including the onset of the rare disease called Guillain-Barré syndrome (GBS) which is characterized by immune-mediated polyneuropathy. This study aimed to identify the predisposing factors and the clinical features of coronavirus disease 2019 (COVID-19)-induced GBS. Materials and Methods: We have performed an analysis of 147 cases. A systematic review of the published research work was performed per the PRISMA statement to obtain individual participant data (IPD) for the meta-analysis. The search was conducted through PubMed, using the combined search terms "Guillain-Barré syndrome" and "COVID-19". All case reports and series in the English language with accessed full text were included in the search. Results: A systematic database search led to the retrieval of 112 peer-reviewed articles published between 1 April 2020, and 8 February 2022. The articles comprised 16 case series and 96 case reports containing IPD for 147 patients. Our findings showed that 77.6% of all cases were 40 years or older. Males comprised most of the cases (65.3%; n = 96). The intensive care unit (ICU) admission was 44.9%, and the need for mechanical ventilation (MV) was 38.1%. The patients presented with hyporeflexia or areflexia (84.4%; n = 124), lower limb strength and sensation impairment (93.2%; n = 138), upper limb strength and sensation impairment (85.7; n = 126), and somatic sensation impairment (72.8%; n = 107). The patients presented with increased cerebral spinal fluid (CSF) protein levels (92%; n = 92) and the presence of CSF albuminocytological dissociation (83.5%; n = 71). The most common variant of GBS observed was acute inflammatory demyelinating polyneuropathy (AIDP). We found that predisposing factors concomitant with COVID-19 and GBS were male gender and older age. Among the cases, patient mortality was 10.9%. Conclusions: A gap of knowledge exists regarding the complete spectrum of clinical characteristics of COVID-19-related GBS. Recent findings suggest that SARS-CoV-2 triggers GBS, as it follows a similar para-infectious pattern as the other viral agents contributing to the onset of GBS.
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Affiliation(s)
- Skylar A. Bentley
- College of Health Sciences, University of Central Florida, Orlando, FL 32816, USA
- Burnette Honors College, University of Central Florida, Orlando, FL 32816, USA
| | - Sarfraz Ahmad
- College of Medicine, University of Central Florida, Orlando, FL 32827, USA
- Advent Health Cancer Institute, Orlando, FL 32804, USA
| | - Firas H. Kobeissy
- Department of Emergency Medicine, College of Medicine, University of Florida, Gainesville, FL 32608, USA
- Correspondence: (F.H.K.); (H.Z.T.); Tel.: +1-352-328-4617 (F.H.K.); +1-352-562-2220 (H.Z.T.)
| | - Hale Z. Toklu
- College of Medicine, University of Central Florida, Orlando, FL 32827, USA
- Correspondence: (F.H.K.); (H.Z.T.); Tel.: +1-352-328-4617 (F.H.K.); +1-352-562-2220 (H.Z.T.)
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14
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Hiraga A, Muto M, Kuwabara S. Loss of Taste as an Initial Symptom of a "Facial Diplegia and Paresthesia" Variant of Guillain-Barré Syndrome. Intern Med 2022; 61:2957-2959. [PMID: 35908975 PMCID: PMC9593143 DOI: 10.2169/internalmedicine.9781-22] [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] [Indexed: 11/06/2022] Open
Abstract
Loss of taste is a relatively common symptom of coronavirus disease 2019 (COVID-19) and has also been considered a rare Guillain-Barré syndrome (GBS) symptom. We herein report a case of a facial diplegia and paresthesia (FDP) variant of GBS that initially presented as a loss of taste occurring two weeks after COVID-19 mRNA vaccination. The patient recovered completely after intravenous immunoglobulin therapy. Clinicians should consider the possibility of post-vaccination FDP manifesting as facial palsy and should be aware that GBS, including the FDP variant, can initially present as an isolated loss of taste.
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Affiliation(s)
| | - Mayumi Muto
- Department of Neurology, Chiba Rosai Hospital, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
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15
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Okayasu T, Ohta R, Yamane F, Abe S, Sano C. Hypoglossal Nerve Palsy Following COVID-19 Vaccination in a Young Adult Complicated by Various Medicines. Cureus 2022; 14:e29212. [PMID: 36259036 PMCID: PMC9569189 DOI: 10.7759/cureus.29212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 11/05/2022] Open
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16
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Role of the Neutrophil to Lymphocyte Ratio in Guillain Barré Syndrome: A Systematic Review and Meta-Analysis. Mediators Inflamm 2022; 2022:3390831. [PMID: 36133742 PMCID: PMC9484954 DOI: 10.1155/2022/3390831] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/20/2022] [Accepted: 08/24/2022] [Indexed: 11/30/2022] Open
Abstract
In this study, we conducted a systematic review and meta-analysis regarding the role of the neutrophil to lymphocyte ratio (NLR) in Guillain Barré syndrome (GBS). The most recent update to the search was on July 18, 2022, through the databases of Web of Science, PubMed, Embase, and Scopus. The Newcastle-Ottawa scale was used for quality assessment of included studies. Finally, 14 studies were included in the review, and among them, ten studies were included in the meta-analysis. Our results showed that NLR levels were significantly increased in the patients with GBS compared with healthy controls (SMD = 1.05; 95%CI = 0.59 to 1.50, P < 0.001). After treatment, NLR levels were decreased to the extent that they became similar to healthy controls (SMD = −0.03, 95%CI = −0.29 to 0.22, P = 0.204). Moreover, NLR was a stable predictor of outcome or response to treatment in such patients (SMD = 1.01, 95%CI = 0.65 to 1.37, P < 0.001); the higher the NLR, the worse the outcome. In addition, patients who underwent mechanical ventilation had higher levels of NLR compared to those who did not (SMD = 0.93, 95%CI = 0.05 to 1.82, P = 0.03). However, NLR levels were not different among distinct GBS subtypes, so it could not distinguish among them. In conclusion, our analysis indicates that the NLR levels are highly elevated in patients with GBS. Therefore, the NLR has the potential to be used as a biomarker to inform diagnosis, prognosis, or treatment responses in GBS, and future studies are warranted.
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17
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Rane RP, Jain A, Hussain KM, Naik S, Shahab A. A Rare Case of Guillain-Barré Syndrome Associated With SARS-CoV-2 Infection Requiring Mechanical Ventilation. Cureus 2022; 14:e25810. [PMID: 35720780 PMCID: PMC9191260 DOI: 10.7759/cureus.25810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 11/05/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) has become a worldwide pandemic since the first case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was identified in December 2019. Numerous neurological consequences have been reported with COVID-19 infection and its approved vaccines. However, Guillain-Barré syndrome (GBS) is a rare neurological complication associated with COVID-19 infection. This case report describes a 62-year-old female with a three-week history of COVID-19 infection who presented with symmetric polyneuropathy in bilateral lower extremities that progressed to involve bilateral upper extremities and skeletal muscles of respiration, resulting in respiratory distress and necessitating intubation and mechanical ventilation. Cerebrospinal fluid (CSF) analysis revealed albumino-cytologic dissociation, and our patient met the National Institute of Neurological Disorders and Strokes (NINDS) criteria for diagnosing Guillain-Barré Syndrome, making GBS to be the most likely diagnosis. This case report aims to strengthen the association of GBS with COVID-19 infection and describes the hospital course of GBS.
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18
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Singh B, Lant S, Cividini S, Cattrall JWS, Goodwin LC, Benjamin L, Michael BD, Khawaja A, Matos ADMB, Alkeridy W, Pilotto A, Lahiri D, Rawlinson R, Mhlanga S, Lopez EC, Sargent BF, Somasundaran A, Tamborska A, Webb G, Younas K, Al Sami Y, Babu H, Banks T, Cavallieri F, Cohen M, Davies E, Dhar S, Fajardo Modol A, Farooq H, Harte J, Hey S, Joseph A, Karthikappallil D, Kassahun D, Lipunga G, Mason R, Minton T, Mond G, Poxon J, Rabas S, Soothill G, Zedde M, Yenkoyan K, Brew B, Contini E, Cysique L, Zhang X, Maggi P, van Pesch V, Lechien J, Saussez S, Heyse A, Brito Ferreira ML, Soares CN, Elicer I, Eugenín-von Bernhardi L, Ñancupil Reyes W, Yin R, Azab MA, Abd-Allah F, Elkady A, Escalard S, Corvol JC, Delorme C, Tattevin P, Bigaut K, Lorenz N, Hornuss D, Hosp J, Rieg S, Wagner D, Knier B, Lingor P, Winkler AS, Sharifi-Razavi A, Moein ST, SeyedAlinaghi S, JamaliMoghadamSiahkali S, Morassi M, Padovani A, Giunta M, Libri I, Beretta S, Ravaglia S, Foschi M, Calabresi P, Primiano G, Servidei S, Biagio Mercuri N, Liguori C, Pierantozzi M, Sarmati L, Boso F, Garazzino S, Mariotto S, Patrick KN, Costache O, Pincherle A, Klok FA, Meza R, Cabreira V, Valdoleiros SR, Oliveira V, Kaimovsky I, Guekht A, Koh J, Fernández Díaz E, Barrios-López JM, Guijarro-Castro C, Beltrán-Corbellini Á, Martínez-Poles J, Diezma-Martín AM, Morales-Casado MI, García García S, Breville G, Coen M, Uginet M, Bernard-Valnet R, Du Pasquier R, Kaya Y, Abdelnour LH, Rice C, Morrison H, Defres S, Huda S, Enright N, Hassell J, D’Anna L, Benger M, Sztriha L, Raith E, Chinthapalli K, Nortley R, Paterson R, Chandratheva A, Werring DJ, Dervisevic S, Harkness K, Pinto A, Jillella D, Beach S, Gunasekaran K, Rocha Ferreira Da Silva I, Nalleballe K, Santoro J, Scullen T, Kahn L, Kim CY, Thakur KT, Jain R, Umapathi T, Nicholson TR, Sejvar JJ, Hodel EM, Tudur Smith C, Solomon T. Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis. PLoS One 2022; 17:e0263595. [PMID: 35653330 PMCID: PMC9162376 DOI: 10.1371/journal.pone.0263595] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/21/2022] [Indexed: 01/08/2023] Open
Abstract
Background Neurological COVID-19 disease has been reported widely, but published studies often lack information on neurological outcomes and prognostic risk factors. We aimed to describe the spectrum of neurological disease in hospitalised COVID-19 patients; characterise clinical outcomes; and investigate factors associated with a poor outcome. Methods We conducted an individual patient data (IPD) meta-analysis of hospitalised patients with neurological COVID-19 disease, using standard case definitions. We invited authors of studies from the first pandemic wave, plus clinicians in the Global COVID-Neuro Network with unpublished data, to contribute. We analysed features associated with poor outcome (moderate to severe disability or death, 3 to 6 on the modified Rankin Scale) using multivariable models. Results We included 83 studies (31 unpublished) providing IPD for 1979 patients with COVID-19 and acute new-onset neurological disease. Encephalopathy (978 [49%] patients) and cerebrovascular events (506 [26%]) were the most common diagnoses. Respiratory and systemic symptoms preceded neurological features in 93% of patients; one third developed neurological disease after hospital admission. A poor outcome was more common in patients with cerebrovascular events (76% [95% CI 67–82]), than encephalopathy (54% [42–65]). Intensive care use was high (38% [35–41]) overall, and also greater in the cerebrovascular patients. In the cerebrovascular, but not encephalopathic patients, risk factors for poor outcome included breathlessness on admission and elevated D-dimer. Overall, 30-day mortality was 30% [27–32]. The hazard of death was comparatively lower for patients in the WHO European region. Interpretation Neurological COVID-19 disease poses a considerable burden in terms of disease outcomes and use of hospital resources from prolonged intensive care and inpatient admission; preliminary data suggest these may differ according to WHO regions and country income levels. The different risk factors for encephalopathy and stroke suggest different disease mechanisms which may be amenable to intervention, especially in those who develop neurological symptoms after hospital admission.
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Affiliation(s)
- Bhagteshwar Singh
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- Department of Infectious Diseases, Christian Medical College, Vellore, India
| | - Suzannah Lant
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Sofia Cividini
- Department of Health Data Science, University of Liverpool, Liverpool, United Kingdom
| | - Jonathan W. S. Cattrall
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Lynsey C. Goodwin
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Laura Benjamin
- Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Benedict D. Michael
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Ayaz Khawaja
- Department of Neurology, Wayne State University, Detroit, Michigan, United States of America
| | | | - Walid Alkeridy
- Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Andrea Pilotto
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Durjoy Lahiri
- Bangur Institute of Neurosciences, Institute of Post-Graduate Medical Education and Research, Kolkata, India
| | - Rebecca Rawlinson
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Sithembinkosi Mhlanga
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Evelyn C. Lopez
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Brendan F. Sargent
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Anushri Somasundaran
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Arina Tamborska
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Glynn Webb
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Komal Younas
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Yaqub Al Sami
- Homerton University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Heavenna Babu
- Department of Neurovirology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Tristan Banks
- Department of Infection, Manchester University NHS Foundation Trust, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Francesco Cavallieri
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Matthew Cohen
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Emma Davies
- Department of Virology, UK Health Security Agency, Manchester University NHS Foundation Trust, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Shalley Dhar
- Department of Neurovirology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Anna Fajardo Modol
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Hamzah Farooq
- Department of Virology, UK Health Security Agency, Manchester University NHS Foundation Trust, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Jeffrey Harte
- Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Samuel Hey
- Department of Infectious Diseases & Tropical Medicine, North Manchester General Hospital, Manchester University Foundation NHS Trust, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Albert Joseph
- Homerton University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Dileep Karthikappallil
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Daniel Kassahun
- Warrington Hospital, Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, United Kingdom of Great Britain and Northern Ireland
| | - Gareth Lipunga
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Rachel Mason
- Kingston Hospital NHS Foundation Trust, Kingston upon Thames, United Kingdom of Great Britain and Northern Ireland
| | - Thomas Minton
- Institute of Clinical Neurosciences, University of Bristol, Bristol, United Kingdom of Great Britain and Northern Ireland
| | - Gabrielle Mond
- North Manchester General Hospital, Manchester University Foundation NHS Trust, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Joseph Poxon
- Epsom and St Helier University Hospitals NHS Foundation Trust, United Kingdom of Great Britain and Northern Ireland
| | - Sophie Rabas
- King’s College Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Germander Soothill
- Regional Infectious Diseases Unit, NHS Lothian, Edinburgh, United Kingdom of Great Britain and Northern Ireland
| | - Marialuisa Zedde
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Konstantin Yenkoyan
- Yerevan State Medical University named after Mkhitar Heratsi, Neuroscience Laboratory, Cobrain Center, Yerevan, Armenia
| | - Bruce Brew
- St Vincent’s Hospital, Sydney, Australia
| | | | | | - Xin Zhang
- St Vincent’s Hospital, Sydney, Australia
| | - Pietro Maggi
- Saint-Luc University Hospital, Brussels, Belgium
| | | | | | | | | | | | | | | | | | | | - Rong Yin
- The 940th Hospital of Joint Logistic Support Force of the People’s Liberation Army, Lanzhou, China
| | | | | | | | | | | | | | | | - Kévin Bigaut
- Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Norbert Lorenz
- Children’s Hospital, Dresden Municipal Hospital Teaching Hospital TUD, Dresden, Germany
| | - Daniel Hornuss
- Medical Center University of Freiburg, Freiburg, Germany
| | - Jonas Hosp
- Medical Center University of Freiburg, Freiburg, Germany
| | - Siegbert Rieg
- Medical Center University of Freiburg, Freiburg, Germany
| | - Dirk Wagner
- Medical Center University of Freiburg, Freiburg, Germany
| | - Benjamin Knier
- Department of Neurology, Technical University of Munich, Munich, Germany
| | - Paul Lingor
- Department of Neurology, Technical University of Munich, Munich, Germany
| | | | | | - Shima T. Moein
- Institute for Research in Fundamental Sciences (IPM), Tehran, Islamic Republic of Iran
| | | | | | - Mauro Morassi
- Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | | | | | | | - Simone Beretta
- San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy
| | | | - Matteo Foschi
- Santa Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy
| | - Paolo Calabresi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Guido Primiano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | | | | | | | - Federica Boso
- Healthcare Trust of the Autonomous Region of Trento, Rovereto, Italy
| | - Silvia Garazzino
- Città della Salute e della Scienza di Torino, Regina Margherita Children’s Hospital, Turin, Italy
| | | | | | | | | | | | - Roger Meza
- Hospital Regional Docente de Trujillo, Trujillo, Peru
| | | | | | | | - Igor Kaimovsky
- Buyanov Moscow City Hospital, Moscow, Russian Federation
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry and Buyanov Moscow City Hospital, Moscow, Russian Federation
| | - Jasmine Koh
- National Neuroscience Institute, Singapore, Singapore
| | | | | | | | | | | | | | | | | | | | - Matteo Coen
- Hopitaux Universitaires de Genève, Geneva, Switzerland
| | | | | | | | - Yildiz Kaya
- Acibadem Mehmet Ali Aydinlar University Medical School, Istanbul, Turkey
| | - Loay H. Abdelnour
- Ulster Hospital, Belfast, United Kingdom of Great Britain and Northern Ireland
| | - Claire Rice
- University of Bristol and North Bristol NHS Trust, Bristol, United Kingdom of Great Britain and Northern Ireland
| | - Hamish Morrison
- Gloucestershire Royal Hospital, Gloucester, United Kingdom of Great Britain and Northern Ireland
| | - Sylviane Defres
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Saif Huda
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Noelle Enright
- Great Ormond Street Hospital for Children, London, United Kingdom of Great Britain and Northern Ireland
| | - Jane Hassell
- Great Ormond Street Hospital for Children, London, United Kingdom of Great Britain and Northern Ireland
| | - Lucio D’Anna
- Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Matthew Benger
- King’s College Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Laszlo Sztriha
- King’s College Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Eamon Raith
- The National Hospital for Neurology & Neurosurgery, London, United Kingdom of Great Britain and Northern Ireland
| | - Krishna Chinthapalli
- University College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Ross Nortley
- University College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Ross Paterson
- University College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Arvind Chandratheva
- University College London Queen Square Institute of Neurology, London, United Kingdom of Great Britain and Northern Ireland
| | - David J. Werring
- University College London Queen Square Institute of Neurology, London, United Kingdom of Great Britain and Northern Ireland
| | - Samir Dervisevic
- Eastern Pathology Alliance Department of Microbiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom of Great Britain and Northern Ireland
| | - Kirsty Harkness
- Sheffield Teaching Hospitals Trust, Sheffield, United Kingdom of Great Britain and Northern Ireland
| | - Ashwin Pinto
- Wessex Neurological Centre, Southampton, United Kingdom of Great Britain and Northern Ireland
| | - Dinesh Jillella
- Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Scott Beach
- Massachusetts General Hospital / Harvard Medical School, Boston, Massachusetts, United States of America
| | - Kulothungan Gunasekaran
- Yale New Haven Health Bridgeport Hospital, Bridgeport, Connecticut, United States of America
| | | | - Krishna Nalleballe
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Jonathan Santoro
- Children’s Hospital Los Angeles and Keck School of Medicine at the University of Southern California, Los Angeles, California, United States of America
| | - Tyler Scullen
- Ochsner Medical Center, New Orleans, Los Angeles, United States of America
| | - Lora Kahn
- Ochsner Medical Center, New Orleans, Los Angeles, United States of America
| | - Carla Y. Kim
- Columbia University Irving Medical Center, New York, New York, United States of America
| | - Kiran T. Thakur
- Columbia University Irving Medical Center, New York, New York, United States of America
| | - Rajan Jain
- New York University Grossman School of Medicine, New York, New York, United States of America
| | | | - Timothy R. Nicholson
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - James J. Sejvar
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Eva Maria Hodel
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | | | - Catrin Tudur Smith
- Department of Health Data Science, University of Liverpool, Liverpool, United Kingdom
| | - Tom Solomon
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- * E-mail:
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19
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SARS-CoV-2-associated Guillain-Barré syndrome in four patients: what do we know about pathophysiology? Acta Neurol Belg 2022; 122:703-707. [PMID: 34476752 PMCID: PMC8412854 DOI: 10.1007/s13760-021-01787-y] [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: 04/20/2021] [Accepted: 08/19/2021] [Indexed: 11/21/2022]
Abstract
Background A growing number of Guillain–Barré syndrome (GBS) and Miller Fisher Syndrome (MFS) cases following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are reported. Nevertheless, this association is still debated, and pathophysiology remains unclear. Methods Between April and December 2020, in three hospitals located in Brussels, Belgium, we examined four patients with GBS following SARS-CoV-2 infection. Results Neurological onset occurred 3 weeks after SARS-CoV-2 symptoms in all patients. Three patients presented with acute inflammatory demyelinating polyneuropathy (AIDP) and had negative anti-ganglioside testing: two suffered from a severe SARS-CoV-2 infection and had good clinical outcome after intravenous immunoglobulin (IVIG) treatment; one with mild SARS-CoV-2 infection had spontaneously favorable evolution without treatment. The fourth patient had critical SARS-CoV-2 infection and presented acute motor and sensory axonal neuropathy (AMSAN) with clinical features highly suggestive of brainstem involvement, as well as positive anti-ganglioside antibodies (anti-GD1b IgG) and had partial improvement after IVIG. Conclusions We report four cases of SARS-CoV-2-associated GBS. The interval of 3 weeks between SARS-CoV-2 symptoms and neurological onset, the clinical improvement after IVIG administration, and the presence of positive anti-ganglioside antibodies in one patient further support the hypothesis of an immune-mediated post-infectious process. Systematic extensive antibody testing might help for a better understanding of physiopathology. Supplementary Information The online version contains supplementary material available at 10.1007/s13760-021-01787-y.
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20
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Mussinatto I, Benevenuta C, Caci A, Calvo M, Impastato M, Barra M, Genovese E, Timeus F. Possible association between Guillain‑Barré syndrome and SARS‑CoV‑2 infection in children: A case report and literature review. Exp Ther Med 2022; 24:462. [PMID: 35747147 PMCID: PMC9204538 DOI: 10.3892/etm.2022.11389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/13/2022] [Indexed: 11/05/2022] Open
Abstract
Neurological manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported in adults and in children, varying from mild to more debilitant symptoms, including fatigue, headache and dizziness. A series of studies have revealed a possible association between Guillain-Barré syndrome (GBS), the most common cause of acute flaccid paralysis at all ages, and SARS-CoV-2 infection. Case reports of novel coronavirus disease 2019 (COVID-19)-associated GBS mainly include adult patients, while only a few pediatric cases have been reported. The present study describes a case of GBS in an Italian 9-year-old girl with previous SARS-CoV-2 infection as a possible trigger, and also conducts a literature review on pediatric COVID-19-associated GBS cases.
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Affiliation(s)
| | | | - Anna Caci
- Department of Pediatrics, Chivasso Hospital, I‑10034 Turin, Italy
| | - Mario Calvo
- Department of Pediatrics, Chivasso Hospital, I‑10034 Turin, Italy
| | - Maria Impastato
- Department of Child Neuropsychiatry, ASL TO 4, Chivasso Hospital, I‑10034 Turin, Italy
| | - Massimo Barra
- Department of Neurology, Chivasso Hospital, I‑10034 Turin, Italy
| | - Egidio Genovese
- Department of Neuroradiology, Chivasso Hospital, I‑10034 Turin, Italy
| | - Fabio Timeus
- Department of Pediatrics, Chivasso Hospital, I‑10034 Turin, Italy
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21
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Aryal R, Karki S, Rajbhandari S, Gajurel BP, Karn R, Rajbhandari R, Paudel S, Gautam N, Shrestha A, Ojha R. Guillain-Barré syndrome associated with Coronavirus disease 2019: A case from Nepal. Clin Case Rep 2022; 10:e05638. [PMID: 35356179 PMCID: PMC8941331 DOI: 10.1002/ccr3.5638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 02/11/2022] [Accepted: 03/07/2022] [Indexed: 12/21/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) has now spread widely after the outbreak since December 31, 2019. Guillain-Barré syndrome is an immunological postinfectious neuropathy, which has been reported to be a rare but possible complication COVID-19. We report a case of Guillain-Barré syndrome associated with COVID-19 in Nepal.
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Affiliation(s)
- Roshan Aryal
- Maharajgunj Medical CampusInstitute of MedicineTribhuvan UniversityKathmanduNepal
| | - Shivaji Karki
- Maharajgunj Medical CampusInstitute of MedicineTribhuvan UniversityKathmanduNepal
| | - Shreesti Rajbhandari
- Maharajgunj Medical CampusInstitute of MedicineTribhuvan UniversityKathmanduNepal
| | | | - Ragesh Karn
- Department of NeurologyInstitute of MedicineTribhuvan UniversityKathmanduNepal
| | - Reema Rajbhandari
- Department of NeurologyInstitute of MedicineTribhuvan UniversityKathmanduNepal
| | - Sunanda Paudel
- Department of NeurologyInstitute of MedicineTribhuvan UniversityKathmanduNepal
| | - Niraj Gautam
- Department of NeurologyInstitute of MedicineTribhuvan UniversityKathmanduNepal
| | - Ashish Shrestha
- Department of NeurologyInstitute of MedicineTribhuvan UniversityKathmanduNepal
| | - Rajeev Ojha
- Department of NeurologyInstitute of MedicineTribhuvan UniversityKathmanduNepal
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22
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Taga A, Lauria G. COVID-19 and the Peripheral Nervous System. A 2-year review from the pandemic to the vaccine era. J Peripher Nerv Syst 2022; 27:4-30. [PMID: 35137496 PMCID: PMC9115278 DOI: 10.1111/jns.12482] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 01/31/2022] [Accepted: 01/31/2022] [Indexed: 11/29/2022]
Abstract
Increasing literature has linked COVID‐19 to peripheral nervous system (PNS) diseases. In addition, as we move from the pandemic to the vaccination era, literature interest is shifting towards the potential association between COVID‐19 vaccines and PNS manifestations. We reviewed published literature on COVID‐19, COVID‐19 vaccines and PNS manifestations between 1 January 2020 and 1 December 2021. For Guillain‐Barré syndrome (GBS), isolated cranial neuropathy (ICN) and myositis associated with COVID‐19, the demographic, clinical, laboratory, electrophysiological and imaging features were included in a narrative synthesis. We identified 169 studies on COVID‐19‐associated complications, including 63 papers (92 patients) on GBS, 29 papers (37 patients) on ICN and 11 papers (18 patients) on myositis. Additional clinical phenotypes included chronic inflammatory demyelinating polyneuropathy, vasculitic neuropathies, neuralgic amyotrophy, critical care‐related complications, and myasthenia gravis. PNS complications secondary to COVID‐19 vaccines have been reported during randomized clinical trials, in real‐world case reports, and during large‐scale surveillance programs. These mainly include cases of GBS, Bell's palsy, and cases of neuralgic amyotrophy. Based on our extensive review of the literature, any conclusion about a pathophysiological correlation between COVID‐19 and PNS disorders remains premature, and solely supported by their temporal association, while epidemiological and pathological data are insufficient. The occurrence of PNS complications after COVID‐19 vaccines seems limited to a possible higher risk of facial nerve palsy and GBS, to a degree that widespread access to the ongoing vaccination campaign should not be discouraged, while awaiting for more definitive data from large‐scale surveillance studies.
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Affiliation(s)
- Arens Taga
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Giuseppe Lauria
- Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan.,Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
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23
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Kaeley N, Kabi A, Pillai A, Shankar T, Ameena M S S. Post-COVID-19 Guillain-Barré Syndrome: A Case Report With Literature Review. Cureus 2022; 14:e21246. [PMID: 35178309 PMCID: PMC8842180 DOI: 10.7759/cureus.21246] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2022] [Indexed: 12/14/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) predominantly affects the respiratory system with manifestations ranging from a mild upper respiratory tract infection to severe acute respiratory distress syndrome. Neurological manifestations of COVID-19 are mainly thrombotic manifestations affecting the nervous system; however, demyelinating manifestation has been less defined. Although some recent studies have described the association between COVID-19 and Guillain-Barré syndrome (GBS), the strength of association and features of GBS in this setting are not yet clear. Here, we report one adult case of COVID-19 infection presenting with acute GBS, which was not preceded by any other respiratory, gastrointestinal, or other systemic infections. We performed a literature search in Medline via PubMed using the keywords or MeSH terms "COVID-19" or "SARS-CoV-2" and "Guillain-Barré syndrome" and "AIDP" and "AMAN," "Miller-Fischer syndrome" or "MFS." We reviewed 99 case reports, 38 reviews, and two meta-analyses. Several published reports have described a possible association between GBS and COVID-19 infection.
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Affiliation(s)
- Nidhi Kaeley
- Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, IND
| | - Ankita Kabi
- Emergency Medicine (Anaesthesiology), All India Institute of Medical Sciences, Rishikesh, IND
| | - Aadya Pillai
- Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, IND
| | - Takshak Shankar
- Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, IND
| | - Salva Ameena M S
- Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, IND
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24
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Finsterer J, Matovu D, Scorza FA. SARS-CoV-2 vaccinations reduce the prevalence of post-COVID Guillain-Barre syndrome. Clinics (Sao Paulo) 2022; 77:100064. [PMID: 35751951 PMCID: PMC9189101 DOI: 10.1016/j.clinsp.2022.100064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/08/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022] Open
Abstract
Guillain-Barre Syndrome (GBS) has been repeatedly reported as a neurological complication of COVID-19 (post-COVID GBS [PCG]). Whether the introduction of SARS-CoV-2 vaccines reduced the prevalence of PCG is unknown. This narrative review aimed to compare the number of published PCG cases between the second half of 2020 (no vaccination available) with those of the first half of 2021 (vaccination available). A total of 124 articles reported 300 patients with PCG between January 2020 and June 2021. The ages ranged from 7 to 94y. There was male dominance. The latency between the onset of COVID-19 and the onset of PCG ranged from -10 to 90d Acute, inflammatory, demyelinating polyneuropathy was diagnosed in 171 patients, acute, motor axonal neuropathy in 24, and acute, motor, and sensory axonal neuropathy in 16 patients. Regarding treatment, 241 patients received immunoglobulins, 28 patients' plasmaphereses, and 7 patients' steroids. Artificial ventilation was required in 59 patients. Full recovery was achieved in 42 cases, partial recovery in 163 cases, and 17 patients died. The number of published PCG patients fell from 192 in the second half of 2020 to 75 patients in the first half of 2021. It is concluded that the prevalence of PCG has decreased since the introduction of SARS-CoV-2 vaccines. SARS-CoV-2 vaccinations have a positive effect on the prevalence of PCG.
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Affiliation(s)
| | - Daniel Matovu
- Disciplina de Neurociência, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, SP, Brasil
| | - Fulvio A Scorza
- Disciplina de Neurociência, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, SP, Brasil
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25
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Martins-Filho PR, Pereira de Andrade AL, Pereira de Andrade AJ, Moura da Silva MD, de Souza Araújo AA, Nunes PS, Santos VS, Ferreira LC, de Aquino Neves EL, Quintans-Júnior LJ. Miller Fisher Syndrome in Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Systematic Review. J Clin Neurol 2021; 17:541-545. [PMID: 34595862 PMCID: PMC8490896 DOI: 10.3988/jcn.2021.17.4.541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/15/2021] [Accepted: 06/15/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND PURPOSE Miller Fisher syndrome (MFS) is a subtype of Guillain-Barré syndrome characterized by the triad of ophthalmoparesis, areflexia, and ataxia. Although cases of MFS have been associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, no studies have synthesized the clinical characteristics of patients with this condition. METHODS In this rapid systematic review, we searched the PubMed database to identify studies on MFS associated with SARS-CoV-2 infection. RESULTS This review identified 11 cases, of whom 3 were hospitalized with motor and/or sensory polyneuropathy as the first sign of SARS-CoV-2 infection. SARS-CoV-2 RNA was not detected in analyses of cerebrospinal fluid, suggesting a mechanism of immune-mediated injury rather than direct viral neurotropism. However, antiganglioside antibodies were found in only two of the nine patients tested. It is possible that target antigens other than gangliosides are involved in MFS associated with SARS-CoV-2 infection. CONCLUSIONS The present patients exhibited clinical improvement after being treated with intravenous immunoglobulin. Although rare, patients with SARS-CoV-2 infection may present neurological symptoms suggestive of MFS. Early recognition of the MFS clinical triad is essential for the timely initiation of treatment.
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Affiliation(s)
| | | | | | | | | | - Paula Santos Nunes
- Laboratory of Pharmaceutical Assays and Toxicity, Federal University of Sergipe, São Cristóvão, Brazil
| | - Victor Santana Santos
- Centre for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, Brazil
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26
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Luijten LWG, Leonhard SE, van der Eijk AA, Doets AY, Appeltshauser L, Arends S, Attarian S, Benedetti L, Briani C, Casasnovas C, Castellani F, Dardiotis E, Echaniz-Laguna A, Garssen MPJ, Harbo T, Huizinga R, Humm AM, Jellema K, van der Kooi AJ, Kuitwaard K, Kuntzer T, Kusunoki S, Lascano AM, Martinez-Hernandez E, Rinaldi S, Samijn JPA, Scheidegger O, Tsouni P, Vicino A, Visser LH, Walgaard C, Wang Y, Wirtz PW, Ripellino P, Jacobs BC. Guillain-Barré syndrome after SARS-CoV-2 infection in an international prospective cohort study. Brain 2021; 144:3392-3404. [PMID: 34553216 PMCID: PMC8677532 DOI: 10.1093/brain/awab279] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/29/2021] [Accepted: 07/04/2021] [Indexed: 12/22/2022] Open
Abstract
In the wake of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, an increasing number of patients with neurological disorders, including Guillain-Barré syndrome (GBS), have been reported following this infection. It remains unclear, however, if these cases are coincidental or not, as most publications were case reports or small regional retrospective cohort studies. The International GBS Outcome Study is an ongoing prospective observational cohort study enrolling patients with GBS within 2 weeks from onset of weakness. Data from patients included in this study, between 30 January 2020 and 30 May 2020, were used to investigate clinical and laboratory signs of a preceding or concurrent SARS-CoV-2 infection and to describe the associated clinical phenotype and disease course. Patients were classified according to the SARS-CoV-2 case definitions of the European Centre for Disease Prevention and Control and laboratory recommendations of the World Health Organization. Forty-nine patients with GBS were included, of whom eight (16%) had a confirmed and three (6%) a probable SARS-CoV-2 infection. Nine of these 11 patients had no serological evidence of other recent preceding infections associated with GBS, whereas two had serological evidence of a recent Campylobacter jejuni infection. Patients with a confirmed or probable SARS-CoV-2 infection frequently had a sensorimotor variant 8/11 (73%) and facial palsy 7/11 (64%). The eight patients who underwent electrophysiological examination all had a demyelinating subtype, which was more prevalent than the other patients included in the same time window [14/30 (47%), P = 0.012] as well as historical region and age-matched control subjects included in the International GBS Outcome Study before the pandemic [23/44 (52%), P = 0.016]. The median time from the onset of infection to neurological symptoms was 16 days (interquartile range 12-22). Patients with SARS-CoV-2 infection shared uniform neurological features, similar to those previously described in other post-viral GBS patients. The frequency (22%) of a preceding SARS-CoV-2 infection in our study population was higher than estimates of the contemporaneous background prevalence of SARS-CoV-2, which may be a result of recruitment bias during the pandemic, but could also indicate that GBS may rarely follow a recent SARS-CoV-2 infection. Consistent with previous studies, we found no increase in patient recruitment during the pandemic for our ongoing International GBS Outcome Study compared to previous years, making a strong relationship of GBS with SARS-CoV-2 unlikely. A case-control study is required to determine if there is a causative link or not.
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Affiliation(s)
- Linda W G Luijten
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands,Department of Neurology, St. Elisabeth-TweeSteden Hospital, 5022 GC, Tilburg, The Netherlands
| | - Sonja E Leonhard
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands
| | - Annemiek A van der Eijk
- Department of Viroscience, Unit Clinical Virology, Erasmus MC, University Medical Center Rotterdam, 3015 CN, Rotterdam, The Netherlands
| | - Alex Y Doets
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands
| | | | - Samuel Arends
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands,Department of Neurology, Haga Hospital, 2545 AA Den Haag, The Netherlands
| | - Shahram Attarian
- Reference Center for Neuromuscular Disorders and ALS, Hôpital de La Timone, 13005 Marseille, France
| | - Luana Benedetti
- Department of Neurology, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
| | - Chiara Briani
- Neurology Unit, Department of Neuroscience, University of Padova, 35128 Padova, Italy
| | - Carlos Casasnovas
- Neuromuscular Unit, Department of Neurology, Bellvitge University Hospital, Neurometabolic Diseases Group, IDIBELL and CIBERER, Barcelona, Spain
| | - Francesca Castellani
- Neurology Unit, Department of Neuroscience, University of Padova, 35128 Padova, Italy
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, 41110 Larissa, Greece
| | | | - Marcel P J Garssen
- Department of Neurology, Jeroen Bosch Hospital, 5223 GZ ‘s-Hertogenbosch, The Netherlands
| | - Thomas Harbo
- Department of Neurology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Ruth Huizinga
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Andrea M Humm
- Unit of Neurology, Department of Internal Medicine, HFR Fribourg—Hôpital Cantonal, CH-1708 Fribourg, Switzerland
| | - Korné Jellema
- Department of Neurology, Haaglanden Medical Center, 2512 VA, Den Haag, The Netherlands
| | - Anneke J van der Kooi
- Department of Neurology, Amsterdam University Medical Center, Location AMC, University of Amsterdam, Neuroscience institute, 1105 AZ Amsterdam, The Netherlands
| | - Krista Kuitwaard
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands,Department of Neurology, Albert Schweitzer Hospital, 3318 AT Dordrecht, The Netherlands
| | - Thierry Kuntzer
- Nerve-muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital CHUV and University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Susumu Kusunoki
- Department of Neurology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama City, Osaka 589-8511, Japan
| | - Agustina M Lascano
- Department of Neurology, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | | | - Simon Rinaldi
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, OX3 9DU Oxford, UK
| | - Johnny P A Samijn
- Department of Neurology, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands
| | - Olivier Scheidegger
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Pinelopi Tsouni
- Nerve-muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital CHUV and University of Lausanne, CH-1011 Lausanne, Switzerland,Department of Neurology, Hôpital du Valais, 1950 Sion, Switzerland
| | - Alex Vicino
- Nerve-muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital CHUV and University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Leo H Visser
- Department of Neurology, St. Elisabeth-TweeSteden Hospital, 5022 GC, Tilburg, The Netherlands
| | - Christa Walgaard
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands,Department of Neurology, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands
| | - Yuzhong Wang
- Department of Neurology, Affiliated Hospital of Jining Medical University, 272029 Jining, China
| | - Paul W Wirtz
- Department of Neurology, Haga Hospital, 2545 AA Den Haag, The Netherlands
| | - Paolo Ripellino
- Department of Neurology, Neurocenter of Southern Switzerland, 6903 Lugano, Switzerland
| | - Bart C Jacobs
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands,Department of Immunology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands,Correspondence to: Bart C. Jacobs, MD, PhD Departments of Neurology and Immunology, Erasmus MC University Medical Center Rotterdam, Room number: EE-2289 Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands E-mail:
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Shams Vahdati S, Ala A, Rahmanpour D, Sadeghi-Hokmabadi E, Tahmasbi F. Neurological manifestations of COVID-19 infection: an umbrella review. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021; 57:113. [PMID: 34483649 PMCID: PMC8401342 DOI: 10.1186/s41983-021-00366-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/06/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Neurological involvements of COVID-19 are one of the most reported manifestations of this infection. This study aims to systematically review the previous systematic reviews which addressed the neurological manifestations of the COVID-19 infection. METHODS Following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, a comprehensive search was conducted in PubMed, Embase, Scopus, Web of Science databases and Google Scholar from December 2019 to December 2020. Articles were critically screened by two independent reviewers and if met the inclusion criteria, entered the study. Assessment of methodological quality was conducted by Assessment of Multiple Systematic Reviews-2 (AMSTAR-2) tool. Statistical analysis was not applicable. From a total of 1302 studies, 308 studies were removed due to their irrelevant title and abstract. After screening the full texts, a total of 66 found to be eligible. Twenty-one studies reported general manifestations of the COVID-19, 13 studies reported cerebrovascular events, 19 olfactory and oral dysfunctions, 5 systematic reviews on Guillen-Barré syndrome (GBS) and 8 articles on the sporadic manifestations like ocular signs and symptoms. The majority of the studies were classified as critically low or low in terms of quality. CONCLUSION Despite great heterogeneity in the current literature, neurological involvements are an important extra-pulmonary aspect of the COVID-19; most commonly in the form of general manifestations like headache and olfactory disturbances. Long-term effects of this virus on the nervous system must be a research priority for future references. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1186/s41983-021-00366-5.
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Affiliation(s)
- Samad Shams Vahdati
- Emergency Medicine Research Team, Emergency Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Ala
- Emergency Medicine Research Team, Emergency Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Dara Rahmanpour
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elyar Sadeghi-Hokmabadi
- Neurosciences Research Center, Neurology Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fateme Tahmasbi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
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A 50-Year-Old Patient with Guillain-Barré Syndrome after COVID-19: A Case Report. MEDICINA-LITHUANIA 2021; 57:medicina57080775. [PMID: 34440980 PMCID: PMC8398507 DOI: 10.3390/medicina57080775] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 11/17/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2, causes acute respiratory disease (coronavirus disease 2019; COVID-19). However, the involvement of other mechanisms is also possible, and neurological complications are being diagnosed more frequently. Here, we would like to present a case of a Polish patient with Guillain–Barré syndrome (GBS), after a documented history of COVID-19: A 50-year-old man, 18 days after the onset of COVID-19 symptoms, had progressive quadriparesis preceded by 1-day sensory disturbances. Based on the clinical picture, the results of diagnostic work-up including a nerve conduction study (ENG) that revealed a demyelinating and axonal sensorimotor polyneuropathy, and cerebrospinal fluid (CSF) analysis that showed albumin–cytological dissociation, an acute inflammatory demyelinating polyneuropathy was confirmed, consistent with GBS. Upon a therapeutic plasma exchange (TPE), the patient’s condition improved. The presented case of GBS in a patient after mild COVID-19 is the first case in Poland that has supplemented those already described in the global literature. Attention should be drawn to the possibility of GBS occurring after SARS-CoV-2 infection, even when it has a mild course.
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Abstract
Background: The coronavirus infection caused by SARS-Cov-2 is characterized by a damage to many organs and systems of the human body. To date, convincing information has been obtained about the involvement of various parts of the nervous system in the pathological process in patients with COVID-19. Among the most frequently described impairments, there are disorders of smell and taste, common disorders of the central nervous system, characterized by general cerebral symptoms, such as headache, asthenization, psychopathological disorders. One of the rare and severe forms of the peripheral nervous system damage in COVID-19 is Guillain-Barre syndrome (GBS), characterized by acute post-infectious inflammatory polyneuropathy with an autoimmune etiology. Clinical case description. We present a clinical case of GBS associated with COVID-19. The disease debuted as a peripheral tetraparesis with a progredient course of up to 21 days. Systemic administration of immunoglobulin stopped the disease progression. The association of GBS with COVID-19 was clarified a month after the disease onset, when bilateral polysegmental pneumonia was diagnosed, and a high level of IgG to the S-protein of SARS-CoV-2 was found, 3 times higher than the level of IgM, which indicated the duration of the disease was not less than three weeks. Conclusion: The GBS development upon infection with SARS-CoV-2 may precede the lung damage. The debut of GBS during the COVID-19 pandemic requires the exclusion of the SARS-CoV-2 etiological role in each case.
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Kajita M, Sato M, Iizuka Y, Mashimo Y, Furuta N, Kakizaki S. Guillain-Barré syndrome after SARS-CoV-2 infection. J Gen Fam Med 2021; 23:47-49. [PMID: 34518789 PMCID: PMC8426991 DOI: 10.1002/jgf2.481] [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: 04/22/2021] [Revised: 06/22/2021] [Accepted: 06/27/2021] [Indexed: 01/08/2023] Open
Abstract
We herein report a case of Guillain‐Barré syndrome (GBS) after SARS‐CoV‐2 infection. The patient was a close contact with a SARS‐CoV‐2 patient. Initially, she did not have any symptoms and quarantined at a hotel. Dysgeusia and olfactory abnormality appeared at day 6 after testing positive for infection and disappeared by day 9. Subsequently, the patient developed numbness of the arms and legs, difficulty walking, and dyspnea and was referred to our hospital. Her clinical examination showed generalized weakness and hyporeflexia. A cerebrospinal fluid analysis showed albuminocytological dissociation. Her nerve conduction studies were consistent with demyelinating polyneuropathy. Intravenous immunoglobulin was administered based on a diagnosis of GBS.
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Affiliation(s)
- Mikiya Kajita
- Department of General Internal Medicine National Hospital Organization Takasaki General Medical Center Takasaki Japan
| | - Masamichi Sato
- Department of General Internal Medicine National Hospital Organization Takasaki General Medical Center Takasaki Japan
| | - Yutaka Iizuka
- Department of General Internal Medicine National Hospital Organization Takasaki General Medical Center Takasaki Japan
| | - Yamato Mashimo
- Department of General Internal Medicine National Hospital Organization Takasaki General Medical Center Takasaki Japan
| | - Natsumi Furuta
- Department of Neurology National Hospital Organization Takasaki General Medical Center Takasaki Japan
| | - Satoru Kakizaki
- Department of Clinical Research National Hospital Organization Takasaki General Medical Center Takasaki Japan.,Department of Gastroenterology and Hepatology Gunma University Graduate School of Medicine Maebashi Japan
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31
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Guillain-Barré syndrome as only manifestation of COVID-19 infection. Clin Neurol Neurosurg 2021; 207:106775. [PMID: 34175645 PMCID: PMC8222978 DOI: 10.1016/j.clineuro.2021.106775] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/05/2021] [Accepted: 06/17/2021] [Indexed: 12/30/2022]
Abstract
Post-infectious/immune mediated effects of COVID-19 infection include descriptions of Guillain-Barré syndrome (GBS) in patients usually with respiratory failure and after 1–2 weeks from the onset of viral illness. Asymptomatic cases for COVID-19 infection were rarely described. Herein, we studied a 62-year-old patient with progressive weakness of lower extremities, rapidly evolving to a severe, flaccid tetraplegia and dysphagia. Neurological symptoms weren’t preceded by fever or pulmonary symptoms. Because of laboratory test abnormalities (thrombocytopenia, lymphocytopenia, high inflammation indexes), the patient underwent to nasopharyngeal swab, resulted positive for SARS-CoV-2 on RT-PCR assay; cerebrospinal fluid (CSF) was negative for SARS-CoV-2. The clinical (severe symmetric distal upper and lower limbs weakness, grade 0/5; decreased proprioceptive sensitivity and hypoesthesia involving the four limbs; loss of deep tendon reflexes), electrophysiological (prevailing axonal polyradiculoneuritis) and CSF features (albumino-cytological dissociation) disclosed the GBS diagnosis (level 1 of diagnostic certainty according to the Brighton criteria). The patient received plasma exchange and immunoglobulin, and, at 4 weeks after treatment and physical therapy, the patient had moderate improvement (weakness at lower and upper extremities was grade 2/5 and 3/5, respectively). Neurologists and clinicians should be aware of the possible link between neurological symptoms and COVID-19 infection, not only after viral prodrome and pulmonary symptoms, but also without COVID-19 symptoms.
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Khedr EM, Shoyb A, Mohamed KO, Karim AA, Saber M. Case Report: Guillain-Barré Syndrome Associated With COVID-19. Front Neurol 2021; 12:678136. [PMID: 34239495 PMCID: PMC8258108 DOI: 10.3389/fneur.2021.678136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/14/2021] [Indexed: 12/31/2022] Open
Abstract
Guillain–Barré syndrome (GBS) is a potentially fatal, immune-mediated disease of the peripheral nervous system that is usually triggered by infection. Only a small number of cases of GBS associated with COVID-19 infection have been published. We report here five patients with GBS admitted to the Neurology, Psychiatry, and Neurosurgery Hospital, Assiut University/Egypt from July 1 to November 20, 2020. Three of the five patients were positive for SARS-CoV-2 following polymerase chain reaction (PCR) of nasopharyngeal swabs on day of admission and another one had a high level of IgM and IgG; all had bilateral ground-glass opacities with consolidation on CT chest scan (GGO) and lymphopenia. All patients presented with two or more of the following: fever, cough, malaise, vomiting, and diarrhea with variable duration. However, there were some peculiarities in the clinical presentation. First, there were only 3 to 14 days between the onset of COVID-19 symptoms and the first symptoms of GBS, which developed into flaccid areflexic quadriplegia with glove and stocking hypoesthesia. The second peculiarity was that three of the cases had cranial nerve involvement, suggesting that there may be a high incidence of cranial involvement in SARS-CoV-2-associated GBS. Other peculiarities occurred. Case 2 presented with a cerebellar hemorrhage before symptoms of COVID-19 and had a cardiac attack with elevated cardiac enzymes following onset of GBS symptoms. Case 5 was also unusual in that the onset began with bilateral facial palsy, which preceded the sensory and motor manifestations of GBS (descending course). Neurophysiological studies showed evidence of sensorimotor demyelinating polyradiculoneuropathy, suggesting acute inflammatory polyneuropathy (AIDP) in all patients. Three patients received plasmapheresis. All of them had either full recovery or partial recovery. Possible pathophysiological links between GBS and COVID-19 are discussed.
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Affiliation(s)
- Eman M Khedr
- Department of Neurology and Psychiatry, Assiut University, Asyut, Egypt.,Department of Neuropsychiatry, Aswan University, Aswan, Egypt
| | - Ahmed Shoyb
- Department of Neuropsychiatry, Aswan University, Aswan, Egypt
| | - Khaled O Mohamed
- Department of Neurology and Psychiatry, Assiut University, Asyut, Egypt
| | - Ahmed A Karim
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany.,Department of Health Psychology and Neurorehabilitation, SRH Mobile University, Riedlingen, Germany
| | - Mostafa Saber
- Department of Neuropsychiatry, Aswan University, Aswan, Egypt
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Freire M, Andrade A, Sopeña B, Lopez-Rodriguez M, Varela P, Cacabelos P, Esteban H, González-Quintela A. Guillain Barré syndrome associated with COVID-19- lessons learned about its pathogenesis during the first year of the pandemic, a systematic review. Autoimmun Rev 2021; 20:102875. [PMID: 34119673 PMCID: PMC8191287 DOI: 10.1016/j.autrev.2021.102875] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/11/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Mayka Freire
- Unidad de Enfermedades Sistémicas e Inmunopatología, Servicio de Medicina Interna, Hospital Clínico Universitario de Santiago de Compostela, Spain.
| | - Ariadna Andrade
- Unidad de Enfermedades Sistémicas e Inmunopatología, Servicio de Medicina Interna, Hospital Clínico Universitario de Santiago de Compostela, Spain
| | - Bernardo Sopeña
- Unidad de Enfermedades Sistémicas e Inmunopatología, Servicio de Medicina Interna, Hospital Clínico Universitario de Santiago de Compostela, Spain
| | - Maria Lopez-Rodriguez
- Unidad de Enfermedades Sistémicas e Inmunopatología, Servicio de Medicina Interna, Hospital Clínico Universitario de Santiago de Compostela, Spain
| | - Pablo Varela
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Clínico Universitario de Santiago de Compostela, Spain
| | | | - Helena Esteban
- Servicio de Farmacia, Hospital Clínico Universitario de Santiago de Compostela, Spain
| | - Arturo González-Quintela
- Unidad de Enfermedades Sistémicas e Inmunopatología, Servicio de Medicina Interna, Hospital Clínico Universitario de Santiago de Compostela, Spain
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Manganotti P, Bellavita G, Tommasini V, D Acunto L, Fabris M, Cecotti L, Furlanis G, Sartori A, Bonzi L, Buoite Stella A, Pesavento V. Cerebrospinal fluid and serum interleukins 6 and 8 during the acute and recovery phase in COVID-19 neuropathy patients. J Med Virol 2021; 93:5432-5437. [PMID: 33951196 PMCID: PMC8242417 DOI: 10.1002/jmv.27061] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/23/2021] [Accepted: 05/03/2021] [Indexed: 01/08/2023]
Abstract
This case series describes three patients affected by severe acute respiratory syndrome coronavirus 2, who developed polyradiculoneuritis as a probable neurological complication of coronavirus disease 2019 (COVID-19). A diagnosis of Guillain Barré syndrome was made on the basis of clinical symptoms, cerebrospinal fluid analysis, and electroneurography. In all of them, the therapeutic approach included the administration of intravenous immunoglobulin (0.4 gr/kg for 5 days), which resulted in the improvement of neurological symptoms. Clinical neurophysiology revealed the presence of conduction block, absence of F waves, and in two cases, a significant decrease in amplitude of compound motor action potential cMAP. Due to the potential role of inflammation on symptoms development and prognosis, interleukin-6 (IL-6) and IL-8 levels were measured in serum and cerebrospinal fluid during the acute phase, while only serum was tested after recovery. Both IL-6 and IL-8 were found increased during the acute phase, both in the serum and cerebrospinal fluid, whereas 4 months after admission (at complete recovery), only IL-8 remained elevated in the serum. These results confirm the inflammatory response that might be linked to peripheral nervous system complications and encourage the use of IL-6 and IL-8 as prognostic biomarkers in COVID-19.
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Affiliation(s)
- Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Trieste, Italy
| | - Giulia Bellavita
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Trieste, Italy
| | - Valentina Tommasini
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Trieste, Italy
| | - Laura D Acunto
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Trieste, Italy
| | - Martina Fabris
- Lab. Malattie Autoimmuni, SOC Istituto di Patologia Clinica, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Laura Cecotti
- Rehabilitation Unit of Severe cerebrovascular lesion, Gervasutta Hospital, Udine, Italy
| | - Giovanni Furlanis
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Trieste, Italy
| | - Arianna Sartori
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Trieste, Italy
| | - Lucia Bonzi
- Rehabilitation Unit, Maggiore City Hospital Department of Medicine, Surgery and Health Sciences, ASUGI, Trieste, Italy
| | - Alex Buoite Stella
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Trieste, Italy
| | - Valentina Pesavento
- Rehabilitation Unit, Maggiore City Hospital Department of Medicine, Surgery and Health Sciences, ASUGI, Trieste, Italy
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Abstract
This edition of What is in the Literature focuses on chronic immune neuropathies as they represent treatable conditions. There are formal criteria to solidify the diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), but patients are encountered who have clinical and electrodiagnostic features of CIDP but do not fulfill diagnostic criteria. These patients are addressed in recent publications. CIDP (and variants) and other forms of immune-mediated neuropathies (multifocal motor neuropathy) are responsive early on to treatment, but long-term factors are less well described, and a number of publications focus on extended consequences. Acute immune neuropathies have been described in the setting of viral illness, and recent publications look at the question as to whether they are associated with the COVID-19 pandemic. Finally, idiopathic sensory neuropathies are the most common polyneuropathy, and consensus efforts to codify features into subtypes can be used clinically for a more precise diagnosis.
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Affiliation(s)
- Mark B Bromberg
- Department of Neurology, University of Utah, Salt Lake City, UT
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36
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Kulikowska J, Kulczyńska-Przybik A, Mroczko B, Kułakowska A. The Significance of COVID-19 Immunological Status in Severe Neurological Complications and Multiple Sclerosis-A Literature Review. Int J Mol Sci 2021; 22:5894. [PMID: 34072715 PMCID: PMC8199258 DOI: 10.3390/ijms22115894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 01/08/2023] Open
Abstract
SARS-CoV-2/Coronavirus 2019 (COVID-19) is responsible for the pandemic, which started in December 2019. In addition to the typical respiratory symptoms, this virus also causes other severe complications, including neurological ones. In diagnostics, serological and polymerase chain reaction tests are useful not only in detecting past infections but can also predict the response to vaccination. It is now believed that an immune mechanism rather than direct viral neuroinvasion is responsible for neurological symptoms. For this reason, it is important to assess the presence of antibodies not only in the serum but also in the cerebrospinal fluid (CSF), especially in the case of neuro-COVID. A particular group of patients are people with multiple sclerosis (MS) whose disease-modifying drugs weaken the immune system and lead to an unpredictable serological response to SARS-CoV-2 infection. Based on available data, the article summarizes the current serological information concerning COVID-19 in CSF in patients with severe neurological complications and in those with MS.
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Affiliation(s)
- Joanna Kulikowska
- Department of Neurology, Medical University of Bialystok, 15-276 Bialystok, Poland;
| | - Agnieszka Kulczyńska-Przybik
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland; (A.K.-P.); (B.M.)
| | - Barbara Mroczko
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland; (A.K.-P.); (B.M.)
| | - Alina Kułakowska
- Department of Neurology, Medical University of Bialystok, 15-276 Bialystok, Poland;
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37
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Leung C. Guillain-Barre syndrome should be monitored upon mass vaccination against SARS-CoV-2. Hum Vaccin Immunother 2021; 17:2957-2958. [PMID: 34032555 DOI: 10.1080/21645515.2021.1922061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
In response to the recent pandemic, vaccines have been developed for large-scale immunization. Despite safety and efficacy verified by health authorities, Guillain-Barre syndrome (GBS) remains a risk of unexpected adverse reactions. Since COVID-19-related GBS cases have largely been reported in Europe, vaccines involving viral genetic materials can potentially trigger GBS, as demonstrated in clinical trials in the Americas. Therefore, medical professionals should be aware of GBS as a potential adverse reaction in SARS-CoV-2 vaccination. Consultation with a neurologist may be needed. Nevertheless, this is not to say that the use of vaccines against SARS-CoV-2 should be suspended and that the association between GBS and the vaccine is confirmed or excluded. The benefits of vaccine still outweigh potential adverse effects.
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Das KY, Midhun Raj KT, Samprathi M, Sridhar M, Adiga R, Vemgal P. Guillain-Barré Syndrome Associated with SARS-CoV-2 Infection. Indian J Pediatr 2021; 88:479. [PMID: 33558992 PMCID: PMC7870282 DOI: 10.1007/s12098-021-03684-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/27/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Kokil Y Das
- Department of Pediatrics, Rainbow Children's Hospital, Bannerghatta Road, Bangalore, 560076, India
| | - K T Midhun Raj
- Department of Pediatrics, Rainbow Children's Hospital, Bannerghatta Road, Bangalore, 560076, India
| | - Madhusudan Samprathi
- Department of Pediatrics, Rainbow Children's Hospital, Bannerghatta Road, Bangalore, 560076, India.
| | - M Sridhar
- Department of Pediatrics, Rainbow Children's Hospital, Bannerghatta Road, Bangalore, 560076, India
| | - Rashmi Adiga
- Department of Neurology, Rainbow Children's Hospital, Bannerghatta Road, Bangalore, India
| | - Prakash Vemgal
- Department of Pediatrics, Rainbow Children's Hospital, Bannerghatta Road, Bangalore, 560076, India
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Papri N, Hayat S, Mohammed A, Afsar MNA, Hasan I, Rahman A, Jahan I, Islam Z. Guillain-Barré syndrome associated with SARS-CoV-2 infection: A case report with long term follow up. J Neuroimmunol 2021; 356:577590. [PMID: 33957540 PMCID: PMC8080536 DOI: 10.1016/j.jneuroim.2021.577590] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/24/2021] [Accepted: 04/25/2021] [Indexed: 12/19/2022]
Abstract
A 50-years old male presented with quadriplegia and paresthesia and was diagnosed as Guillain-Barré syndrome (GBS). He was found positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) six weeks prior to the onset of weakness. GBS disability score was 4. Electrophysiology showed acute inflammatory demyelinating polyradiculopathy. Anti-SARS-CoV-2 IgG was found positive. Immunological tests for Campylobacter jejuni, Zika virus, Hepatitis E virus, Herpes Simplex virus, Haemophilus influanzae and Mycoplasma pneumoniae were negative. Patient received standard dose of intravenous immunoglobulin and after six months had almost complete recovery of muscle power. This case represents possible association of SARS-CoV-2 infection and GBS with good clinical outcome.
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Affiliation(s)
- Nowshin Papri
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka 1212, Bangladesh; Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Shoma Hayat
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka 1212, Bangladesh
| | - Asif Mohammed
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka 1212, Bangladesh
| | - Md Nure Alam Afsar
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka 1212, Bangladesh
| | - Imran Hasan
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka 1212, Bangladesh
| | - Ananna Rahman
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka 1212, Bangladesh
| | - Israt Jahan
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka 1212, Bangladesh
| | - Zhahirul Islam
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka 1212, Bangladesh.
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Akçay N, Menentoğlu ME, Bektaş G, Şevketoğlu E. Axonal Guillain-Barre syndrome associated with SARS-CoV-2 infection in a child. J Med Virol 2021; 93:5599-5602. [PMID: 33851741 PMCID: PMC8250647 DOI: 10.1002/jmv.27018] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/31/2021] [Accepted: 04/12/2021] [Indexed: 12/20/2022]
Abstract
The relation between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and demyelinating Guillain-Barre syndrome (GBS) has been defined. We aim to report the clinical features of a child with axonal GBS associated with SARS-CoV-2. A 6-year-old male presented with symmetric ascending paralysis progressed over a 4-day course and 2 days of fever. He had bilateral lower and upper limb flaccid weakness of 1/5 with absent deep tendon reflexes. He had severe respiratory muscle weakness requiring invasive mechanical ventilation. On admission, SARS-CoV-2 returned as positive by real-time polymerase chain reaction on a nasopharyngeal swab. Cerebrospinal fluid analysis showed elevated protein without pleocytosis. He was diagnosed with GBS associated with SARS-CoV-2 infection. The nerve conduction study was suggestive of acute motor axonal neuropathy. Ten consecutive therapeutic plasma exchange sessions with 5% albumin replacement followed by four sessions on alternate days were performed. On Day 12, methylprednisolone (30 mg/kg/day for 5 days) was given. On Day 18, intravenous immunoglobulin (2 g/kg/day) was given and repeated 14 days after due to severe motor weakness. On Day 60, he was discharged from the hospital with weakness of neck flexor and extensor muscles of 3/5 and the upper limbs and the lower limbs of 2/5 on home-ventilation. Our patient is considered to be the youngest patient presenting with a possible para-infectious association between axonal GBS and SARS-CoV-2 infection. The disease course was severe with a rapid progression, an earlier peak, and prolonged duration in weakness as expected in axonal GBS.
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Affiliation(s)
- Nihal Akçay
- Pediatric Intensive Care Unit, Bakirkoy Dr Sadi Konuk Education and Research Hospital, University of the Health Sciences, Istanbul, Turkey
| | - Mehmet Emin Menentoğlu
- Pediatric Intensive Care Unit, Bakirkoy Dr Sadi Konuk Education and Research Hospital, University of the Health Sciences, Istanbul, Turkey
| | - Gonca Bektaş
- Pediatric Neurology, Bakirkoy Dr Sadi Konuk Education and Research Hospital, University of the Health Sciences, Istanbul, Turkey
| | - Esra Şevketoğlu
- Pediatric Intensive Care Unit, Bakirkoy Dr Sadi Konuk Education and Research Hospital, University of the Health Sciences, Istanbul, Turkey
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Palaiodimou L, Stefanou MI, Katsanos AH, Fragkou PC, Papadopoulou M, Moschovos C, Michopoulos I, Kokotis P, Bakirtzis C, Naska A, Vassilakopoulos TI, Chroni E, Tsiodras S, Tsivgoulis G. Prevalence, clinical characteristics and outcomes of Guillain-Barré syndrome spectrum associated with COVID-19: A systematic review and meta-analysis. Eur J Neurol 2021; 28:3517-3529. [PMID: 33837630 PMCID: PMC8250909 DOI: 10.1111/ene.14860] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/25/2021] [Accepted: 04/06/2021] [Indexed: 12/13/2022]
Abstract
Background and purpose Mounting evidence supports an association between Guillain−Barré syndrome spectrum (GBSs) and severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. However, GBSs in the setting of coronavirus disease 2019 (COVID‐19) remains poorly characterized, whilst GBSs prevalence amongst COVID‐19 patients has not been previously systematically evaluated using a meta‐analytical approach. Methods A systematic review and meta‐analysis of observational cohort and case series studies reporting on the occurrence, clinical characteristics and outcomes of patients with COVID‐19‐associated GBSs was performed. A random‐effects model was used to calculate pooled estimates and odds ratios (ORs) with corresponding 95% confidence intervals (CIs), compared to non‐COVID‐19, contemporary or historical GBSs patients. Results Eighteen eligible studies (11 cohorts, seven case series) were identified including a total of 136,746 COVID‐19 patients. Amongst COVID‐19 patients, including hospitalized and non‐hospitalized cases, the pooled GBSs prevalence was 0.15‰ (95% CI 0%–0.49‰; I2 = 96%). Compared with non‐infected contemporary or historical controls, patients with SARS‐CoV‐2 infection had increased odds for demyelinating GBSs subtypes (OR 3.27, 95% CI 1.32%–8.09%; I2 = 0%). In SARS‐CoV‐2‐infected patients, olfactory or concomitant cranial nerve involvement was noted in 41.4% (95% CI 3.5%–60.4%; I2 = 46%) and 42.8% (95% CI 32.8%–53%; I2 = 0%) of the patients, respectively. Clinical outcomes including in‐hospital mortality were comparable between COVID‐19 GBSs patients and non‐infected contemporary or historical GBSs controls. Conclusion GBSs prevalence was estimated at 15 cases per 100,000 SARS‐CoV‐2 infections. COVID‐19 appears to be associated with an increased likelihood of GBSs and with demyelinating GBSs variants in particular.
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Affiliation(s)
- Lina Palaiodimou
- Second Department of Neurology, 'Attikon' University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria-Ioanna Stefanou
- Second Department of Neurology, 'Attikon' University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Aristeidis H Katsanos
- Second Department of Neurology, 'Attikon' University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada
| | - Paraskevi C Fragkou
- Fourth Department of Internal Medicine, 'Attikon' University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marianna Papadopoulou
- Second Department of Neurology, 'Attikon' University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Department of Physiotherapy, University of West Attica, Athens, Greece
| | - Christos Moschovos
- Second Department of Neurology, 'Attikon' University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Michopoulos
- Second Department of Psychiatry, 'Attikon' Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Kokotis
- First Department of Neurology, 'Eginition' University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Bakirtzis
- Second Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Androniki Naska
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros I Vassilakopoulos
- Third Department of Critical Care Medicine, Evgenideio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Elisabeth Chroni
- Department of Neurology, School of Medicine, University of Patras, Rio-Patras, Greece
| | - Sotirios Tsiodras
- Fourth Department of Internal Medicine, 'Attikon' University Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, 'Attikon' University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Raahimi MM, Kane A, Moore CE, Alareed AW. Late onset of Guillain-Barré syndrome following SARS-CoV-2 infection: part of 'long COVID-19 syndrome'? BMJ Case Rep 2021; 14:14/1/e240178. [PMID: 33462068 PMCID: PMC7813388 DOI: 10.1136/bcr-2020-240178] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We describe a case of delayed onset, acute demyelinating neuropathy secondary to novel SARS-CoV-2 infection. A previously healthy 46-year-old man presented with bilateral leg pain and loss of sensation in his feet 53 days after having COVID-19 pneumonitis. He developed painful sensory symptoms followed by a rapidly progressive lower motor neuron weakness involving all limbs, face and respiratory muscles, needing ventilatory support. In keeping with a diagnosis of Guillain-Barré syndrome, cerebrospinal fluid examination showed albuminocytologic dissociation and nerve conduction studies supported the diagnosis of an acute inflammatory demyelinating polyradiculoneuropathy. The delayed neurological dysfunction seen in our patient following SARS-CoV-2 infection may indicate a novel mechanism of disease that is part of the emerging ‘long COVID-19 syndrome’.
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Affiliation(s)
- Mina M Raahimi
- Critical Care, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Alice Kane
- Acute Medical Unit, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | | | - Ahmad W Alareed
- Neurophysiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
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Guillain-Barré Syndrome in a COVID-19 Patient: A Case Report and Review of Management Strategies. AMERICAN JOURNAL OF MEDICAL CASE REPORTS 2021; 9:198-200. [PMID: 33553616 PMCID: PMC7864392 DOI: 10.12691/ajmcr-9-3-16] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Guillain-Barré syndrome (GBS) in an immune mediated disease that affects peripheral nerves with possible life-threatening complications. GBS has multiple subtypes including acute inflammatory demyelinating polyradiculoneuropathy (AIDP), acute motor axonal neuropathy (AMAN) and acute motor sensory axonal neuropathy (AMSAN), which can make GBS difficult to diagnose. GBS commonly presents after viral infections such as influenza virus, campylobacter jejuni, and zika virus. GBS commonly presents with a prolonged clinical course leading to increased morbidity among affected patients. It is not surprising that COVID-19 has been connected with multiple cases of GBS, which may alter the recovery course for several patients post-COVID. In this report, we present a case of 69-year-old-female who presented with progressive motor weakness and loss of sensation in her extremities after testing positive for antibodies to COVID-19 one-month prior to presentation. Her presentation and treatment of GBS in the setting of COVID-19 is an example of one of the many COVID-19 complications and sheds light on the prolonged recovery course that we may experience as clinicians in the wake of this pandemic.
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