#Clinical #neurophysiology and #CSF analysis to detect #GBS and #polyneuritis cranialis in #COVID19 patients: a case series (J Med Virol., abstract)

[Source: Journal of Medical Virology, full page: (LINK). Abstract, edited.]

Clinical neurophysiology and cerebrospinal liquor analysis to detect Guillain Barré syndrome and polyneuritis cranialis in COVID‐19 patients: a case series

Paolo Manganotti MD PhD,  Giulia Bellavita MD,  Laura D’Acunto MD,  Valentina Tommasini MD,  Martina Fabris MD,  Arianna Sartori MD,  Lucia Bonzi MD,  Alex Buoite Stella PhD,  Valentina Pesavento MD

First published: 14 July 2020 | DOI:  https://doi.org/10.1002/jmv.26289

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/jmv.26289

 

ABSTRACT

We report a case series of 5 patients affected by SARS‐CoV‐2 who developed neurological symptoms, mainly expressing as polyradiculoneuritis and cranial polyneuritis in the two months of COVID‐19 pandemic in a city in the north east of Italy. A diagnosis of Guillain Barré syndrome was made on the basis of clinical presentation, cerebrospinal fluid analysis and electroneurography (ENG). In four of them 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 significant decrease in amplitude of compound motor action potential cMAP. Four patients presented a mild facial nerve involvement limited to the muscles of the lower face, with sparing of the forehead muscles associated to ageusia. In one patient, taste assessment showed right‐sided ageusia of the tongue, ipsilateral to the mild facial palsy. In three patients we observed albuminocytological dissociation in the cerebrospinal fluid, and notably we found an increase of inflammatory mediators such as the interleukin‐8. Peripheral nervous system involvement after infection with COVID‐19 is possible and may include several signs that may be successfully treated with immunoglobulin therapy.

This article is protected by copyright. All rights reserved.

Keywords: SARS-CoV-2; COVID-19; GBS; Neurology; Italy.

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#GBS Associated with #SARS-CoV-2 Infection in a #Pediatric Patient (J Trop Pediatr., abstract)

[Source: Journal of Tropical Pediatrics, full page: (LINK). Abstract, edited.]

Guillain–Barré Syndrome Associated with SARS-CoV-2 Infection in a Pediatric Patient

Carlos Henrique Michiles Frank, MAst, Taynná Vernalha Rocha Almeida, PhD, Elyana Almeida Marques, MD, Quezia de Sousa Monteiro, MD, Pablo Vinícius Silveira Feitoza, MSc, Mayla Gabriela Silva Borba, MD, Heline Lira Vasconcelos, BPharm, Michele de Souza Bastos, PhD, Marcus Vinicius Guimarães Lacerda, PhD

Journal of Tropical Pediatrics, fmaa044, https://doi.org/10.1093/tropej/fmaa044

Published: 12 July 2020

 

Abstract

We report the case of a 15-year-old male patient presenting frontal headaches with retro-orbital pain accompanied by fever evolving to weakness and pain of the lower limbs, which ascended to upper limbs. A COVID-19 rapid test (IgG and IgM) and nasopharyngeal swab polymerase chain reaction (PCR) was positive for SARS-CoV-2. The blood tests, cerebral spinal fluid (CSF) analysis and CSF aerobic culture revealed no abnormalities. PCR testing of the CSF was negative for the most prevalent etiologies as well as for SARS-CoV-2. Electroneurography study was compatible with the acute motor axonal neuropathy variant of Guillain–Barré syndrome. No cases involving young patients have been presented to date. Therefore, this is the first reported pediatric case of SARS-CoV-2 infection associated with GBS. Evidence reveals that SARS-CoV-2 infection is not limited to the respiratory tract. Neurotropism could explain this important neurologic manifestation of COVID-19 in children.

neuromuscular diseases, Guillain–Barré, syndrome, adolescent, pediatrics, SARS-CoV-2

Issue Section: Case Report

 

Lay Summary

We report the case of a 15-year-old male patient presenting frontal headaches with retro-orbital pain accompanied by fever evolving to weakness and pain of the lower limbs, which ascended to upper limbs. A COVID-19 rapid test and nasopharyngeal molecular test were positive for the SARS-CoV-2 virus. Neurological examination attested Guillain–Barré syndrome, a condition in which the immune system attacks the nerves and could be triggered by a bacterial or viral infection. The blood tests were normal and cerebral spinal fluid analysis was negative for the most common viruses related to GBS as well as for SARS-CoV-2. Although described in adults, no cases involving young patients have been presented to date. Therefore, this is the first reported case of GBS associated with SARS-CoV-2 in children.

Keywords: SARS-CoV-2; COVID-19; GBS; Pediatrics; Neurology.

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#GBS Associated with #SARS-CoV-2 Detection and a #COVID19 Infection in a #Child (J Pediatr Infect Dis Soc., abstract)

[Source: Journal of the Pediatric Infectious Diseases Society, full page: (LINK). Abstract, edited.]

Guillain-Barre Syndrome Associated with SARS-CoV-2 Detection and a COVID-19 Infection in a Child

Maher Khalifa, Fairouz Zakaria, Yasser Ragab, Ahmed Saad, Ahmed Bamaga, Yasser Emad, Johannes J Rasker

Journal of the Pediatric Infectious Diseases Society,  piaa086, https://doi.org/10.1093/jpids/piaa086

Published:  11 July 2020

 

Abstract

Coronavirus disease (COVID-19) is caused by SARS-CoV-2. Physicians in China reported what is believed to be the first adult case of a SARS-CoV-2 infection associated with acute Guillain-Barré syndrome (GBS), followed by five adult Italian patients and another case in the United States of America. In the current report we present one of the first descriptions of an association of GBS and SARS-CoV-2 infection within a child. In our facility, and eleven year old boy presented with typical features of GBS and after five days a morbilliform skin rash over the palms of both hands. Three weeks before the start of the neurological symptoms, the boy had experienced an episode of mild febrile illness with mild respiratory manifestations and a persisting cough. The diagnosis of the SARS-CoV-2 infection was confirmed by oropharyngeal swab on reverse transcription polymerase chain reaction assay. The disease course of our patient strongly suggests a possible relationship between the development of GBS and SARS-CoV-2 infection. The case is discussed in view of the previous case reports with the association of GBS and Covid-19.

Issue Section:  Case Report

This content is only available as a PDF.

© The Author(s) 2020. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society.

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

Keywords: SARS-CoV-2; COVID-19; GBS; Pediatrics; Neurology.

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The emerging #spectrum of #COVID19 #neurology: #clinical, #radiological and #laboratory findings (Brain, abstract)

[Source: Brain, full page: (LINK). Abstract, edited.]

The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings

Ross W Paterson, Rachel L Brown, Laura Benjamin, Ross Nortley, Sarah Wiethoff, Tehmina Bharucha, Dipa L Jayaseelan, Guru Kumar, Rhian E Raftopoulos, Laura Zambreanu … et al.

Brain, awaa240, https://doi.org/10.1093/brain/awaa240

Published: 08 July 2020

 

Abstract

Preliminary clinical data indicate that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with neurological and neuropsychiatric illness. Responding to this, a weekly virtual coronavirus disease 19 (COVID-19) neurology multi-disciplinary meeting was established at the National Hospital, Queen Square, in early March 2020 in order to discuss and begin to understand neurological presentations in patients with suspected COVID-19-related neurological disorders. Detailed clinical and paraclinical data were collected from cases where the diagnosis of COVID-19 was confirmed through RNA PCR, or where the diagnosis was probable/possible according to World Health Organization criteria. Of 43 patients, 29 were SARS-CoV-2 PCR positive and definite, eight probable and six possible. Five major categories emerged: (i) encephalopathies (n = 10) with delirium/psychosis and no distinct MRI or CSF abnormalities, and with 9/10 making a full or partial recovery with supportive care only; (ii) inflammatory CNS syndromes (n = 12) including encephalitis (n = 2, para- or post-infectious), acute disseminated encephalomyelitis (n = 9), with haemorrhage in five, necrosis in one, and myelitis in two, and isolated myelitis (n = 1). Of these, 10 were treated with corticosteroids, and three of these patients also received intravenous immunoglobulin; one made a full recovery, 10 of 12 made a partial recovery, and one patient died; (iii) ischaemic strokes (n = 8) associated with a pro-thrombotic state (four with pulmonary thromboembolism), one of whom died; (iv) peripheral neurological disorders (n = 8), seven with Guillain-Barré syndrome, one with brachial plexopathy, six of eight making a partial and ongoing recovery; and (v) five patients with miscellaneous central disorders who did not fit these categories. SARS-CoV-2 infection is associated with a wide spectrum of neurological syndromes affecting the whole neuraxis, including the cerebral vasculature and, in some cases, responding to immunotherapies. The high incidence of acute disseminated encephalomyelitis, particularly with haemorrhagic change, is striking. This complication was not related to the severity of the respiratory COVID-19 disease. Early recognition, investigation and management of COVID-19-related neurological disease is challenging. Further clinical, neuroradiological, biomarker and neuropathological studies are essential to determine the underlying pathobiological mechanisms, which will guide treatment. Longitudinal follow-up studies will be necessary to ascertain the long-term neurological and neuropsychological consequences of this pandemic.

COVID-19, SARS-CoV-2, encephalitis, ADEM

Issue Section: Original Article

This content is only available as a PDF.

© The Author(s) (2020). Published by Oxford University Press on behalf of the Guarantors of Brain.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

Keywords: SARS-CoV-2; COVID-19; Encephalitis; Encephalopathy; GBS; Stroke; Neurology.

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#COVID 19: a #global #threat to the #nervous system (Ann Neurol., abstract)

[Source: Annals of Neurology, full page: (LINK). Abstract, edited.]

COVID ‐19: a global threat to the nervous system

Igor. J Koralnik M.D.,  Kenneth L. Tyler M.D.

First published: 07 June 2020 | DOI:  https://doi.org/10.1002/ana.25807

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/ana.25807.

 

Abstract

In less than 6 months, the severe acute respiratory syndrome‐coronavirus type 2 (SARS‐CoV‐2) has spread worldwide infecting nearly 6 million people and killing over 350,000. Initially thought to be restricted to the respiratory system, we now understand that coronavirus disease 2019 (COVID‐19) also involves multiple other organs including the central and peripheral nervous system. The number of recognized neurologic manifestations of SARS‐CoV‐2 infection is rapidly accumulating. These may result from a variety of mechanisms including virus‐induced hyper‐inflammatory and hypercoagulable states, direct virus infection of the CNS, and post‐infectious immune mediated processes. Example of COVID‐19 CNS disease include encephalopathy, encephalitis, acute disseminated encephalomyelitis, meningitis, ischemic and hemorrhagic stroke, venous sinus thrombosis and endothelialitis. In the peripheral nervous system COVID‐19 is associated with dysfunction of smell and taste, muscle injury, the Guillain‐Barre syndrome and its variants. Due to its worldwide distribution and multifactorial pathogenic mechanisms, COVID‐19 poses a global threat to the entire nervous system. While our understanding of SARS‐CoV‐2 neuropathogenesis is still incomplete and our knowledge is evolving rapidly, we hope that this review will provide a useful framework and help neurologists in understanding the many neurologic facets of COVID‐19.

Keywords: SARS-CoV-2; COVID-19; Encephalopathy; Encephalitis; GBS; Neurology.

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#COVID19 #polyradiculitis in 24 patients without #SARS‐CoV‐2 in the #CSF (J Med Virol., abstract)

[Source: Journal of Medical Virology, full page: (LINK). Abstract, edited.]

COVID‐19 polyradiculitis in 24 patients without SARS‐CoV‐2 in the cerebro‐spinal fluid

Josef Finsterer MD, PhD,  Fulvio A. Scorza MD,  Ritwik Ghosh MD

First published: 04 June 2020 | DOI:  https://doi.org/10.1002/jmv.26121

Declarations:

Funding: no funding was received

Conflicts of interest: there are no conflicts of interest

Availability of data: all data are available

Code availability: not applicable

Patient consent not applicable

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/jmv.26121

 

Abstract

Objectives

to summarise and discuss current knowledge about COVID‐19‐associated Guillain‐Barre syndrome (GBS).

Method

literature review

Results

altogether 18 articles were found, which reported 23 patients with COVID‐19‐associated GBS. A further patient came to our attention by personal communication. Among these 24 included patients age ranged from 20 to 76y. There was male preponderance. Fourteen patients presented with acute inflammatory demyelinating polyneuropathy (AIDP), 4 with acute motor axonal neuropathy (AMAN), 3 with Miller‐Fisher syndrome (MFS), and 2 with acute motor and sensory axonal neuropathy (AMSAN). In one patient the subtype was not specified. The cerebrospinal fluid (CSF) was tested for SARS‐CoV‐2 in 15 patients but was negative for the virus in all of them. Seven patients required artificial ventilation. Twenty‐one patients received intravenous immunoglobulines (IVIG). Thirteen patients recovered, 6 did not, and 2 patients died.

Conclusions

SARS‐CoV‐2 can cause GBS. SARS‐CoV‐2‐associated GBS occurs in the absence of the virus in the CSF. Clinical presentation, course, response to treatment, and outcome do not vary between SARS‐CoV‐2‐associated GBS and GBS due to other triggers.

This article is protected by copyright. All rights reserved.

Keywords: SARS-CoV-2; COVID-19; GBS; Neurology.

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#GBS Associated with #SARS-CoV-2 (N Engl J Med., summary)

[Source: The New England Journal of Medicine, full page: (LINK). Summary, edited.]

Guillain–Barré Syndrome Associated with SARS-CoV-2

___

TO THE EDITOR: From February 28 through March 21, 2020, in three hospitals in  northern Italy, we examined five patients who had Guillain–Barré syndrome after the  onset of coronavirus disease 2019 (Covid-19), the disease caused by severe acute  respiratory syndrome coronavirus 2 (SARS-CoV-2). During that period, an estimated 1000  to 1200 patients with Covid-19 were admitted to these hospitals. Four of the  patients in this series had a positive nasopharyngeal swab for SARS-CoV-2 at the onset of  the neurologic syndrome, and one had a negative nasopharyngeal swab and negative  bronchoalveolar lavage but subsequently had a positive serologic test for the virus.  Detailed case reports are provided in the Supplementary Appendix, available with the  full text of this letter at NEJM.org.

(…)

Keywords:  SARS-CoV-2; COVID-19; Italy; Neurology; GBS.

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#GBS associated with #SARS-CoV-2 #infection: causality or coincidence? (Lancet Neurol., summary)

[Source: The Lancet Neurology, full page: (LINK). Summary, edited.]

Guillain-Barré syndrome associated with SARS-CoV-2 infection: causality or coincidence?

Hua Zhao †, Dingding Shen †, Haiyan Zhou †, Jun Liu, Sheng Chen

Published: April 01, 2020 | DOI: https://doi.org/10.1016/S1474-4422(20)30109-5

___

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), originating from Wuhan, is spreading around the world and the outbreak continues to escalate. Patients with coronavirus disease 2019 (COVID-19) typically present with fever and respiratory illness.1 However, little information is available on the neurological manifestations of COVID-19. Here, we report the first case of COVID-19 initially presenting with acute Guillain-Barré syndrome.

(…)

Keywords: SARS-CoV-2; COVID-19; GBS; Neurology.

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Comparison of alpha-spending plans for near #realtime #monitoring for #GBS after #influenza #vaccination during the 2010/11 influenza season (Vaccine, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Vaccine. 2020 Jan 10. pii: S0264-410X(19)31674-3. doi: 10.1016/j.vaccine.2019.12.032. [Epub ahead of print]

Comparison of alpha-spending plans for near real-time monitoring for Guillain-Barré after influenza vaccination during the 2010/11 influenza season.

Sandhu SK1, Hua W2, MaCurdy TE3, Franks RL4, Avagyan A4, Chillarige Y4, Wernecke M4, Kelman J5, Ball R2.

Author information: 1 Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA. Electronic address: sukhminder.sandhu@fda.hhs.gov. 2 Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA. 3 Stanford University, Stanford, CA, USA; Acumen LLC, Burlingame, CA, USA. 4 Acumen LLC, Burlingame, CA, USA. 5 Centers for Medicare and Medicaid Services, Washington, DC, USA.

 

Abstract

BACKGROUND:

Near real-time surveillance of the influenza vaccine, which is administered to a large proportion of the US population every year, is essential to ensure safety of the vaccine. For efficient near real-time surveillance, it is key to select appropriate parameters such as monitoring start date, number of interim tests and a scheme for spending a pre-defined total alpha across the entire influenza season. Guillain-Barré Syndrome, shown to be associated with the 1976 influenza vaccine, is used to evaluate how choices of these parameters can affect whether or not a signal is detected and the time to signal. FDA has been monitoring for the risk of GBS after influenza vaccination for every influenza season since 2008.

METHODS:

Using Medicare administrative data and the Updating Sequential Probability Ratio Test methodology to account for claims delay, we evaluated a number of different alpha-spending plans by varying several parameters.

RESULTS:

For relative risks of 5 or greater, almost all alpha-spending plans have 100% power; however, for relative risks of 1.5 or lower, the constant and O’Brien-Fleming plans have increasingly more power. For RRs of 1.5 and greater, the Pocock plan signals earliest but would not signal at a RR of 1.25, as observed in prior influenza seasons. There were no remarkable differences across the different plans in regards to monitoring start dates defined by the number of vaccinations; reducing the number of interim tests improves performance only marginally.

CONCLUSIONS:

A constant alpha-spending plan appears to be robust, in terms of power and time to detect a signal, across a range of these parameters, including alternate monitoring start dates based on either cumulative vaccinations or GBS claims observed, frequency of monitoring, hypothetical relative risks, and vaccine uptake patterns.

Published by Elsevier Ltd.

KEYWORDS: Alpha-spending; Guillain-Barré Syndrome; Immunization; Influenza; Sequential test; Vaccine

PMID: 31932134 DOI: 10.1016/j.vaccine.2019.12.032

Keywords: Drugs safety; Seasonal Influenza; Vaccines; GBS.

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#Zika virus #infection causes temporary #paralysis in adult mice with motor #neuron synaptic retraction and evidence for proximal peripheral #neuropathy (Sci Rep., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Sci Rep. 2019 Dec 20;9(1):19531. doi: 10.1038/s41598-019-55717-3.

Zika virus infection causes temporary paralysis in adult mice with motor neuron synaptic retraction and evidence for proximal peripheral neuropathy.

Morrey JD1, Oliveira ALR2, Wang H3, Zukor K3, de Castro MV2, Siddharthan V3.

Author information: 1 Institute for Antiviral Research, Department of Animal, Dairy, and Veterinary Sciences, 5600 Old Main Hill, Utah State University, Logan, Utah, 84322-5600, United States of America. john.morrey@usu.edu. 2 Institute of Biology, University of Campinas, Campinas, SP, Brazil. 3 Institute for Antiviral Research, Department of Animal, Dairy, and Veterinary Sciences, 5600 Old Main Hill, Utah State University, Logan, Utah, 84322-5600, United States of America.

 

Abstract

Clinical evidence is mounting that Zika virus can contribute to Guillain-Barré syndrome which causes temporary paralysis, yet the mechanism is unknown. We investigated the mechanism of temporary acute flaccid paralysis caused by Zika virus infection in aged interferon αβ-receptor knockout mice used for their susceptibility to infection. Twenty-five to thirty-five percent of mice infected subcutaneously with Zika virus developed motor deficits including acute flaccid paralysis that peaked 8-10 days after viral challenge. These mice recovered within a week. Despite Zika virus infection in the spinal cord, motor neurons were not destroyed. We examined ultrastructures of motor neurons and synapses by transmission electron microscopy. The percent coverage of motor neurons by boutons was reduced by 20%; more specifically, flattened-vesicle boutons were reduced by 46%, and were normalized in recovering mice. Using electromyographic procedures employed in people to help diagnose Guillain-Barré syndrome, we determined that nerve conduction velocities between the sciatic notch and the gastrocnemius muscle were unchanged in paralyzed mice. However, F-wave latencies were increased in paralyzed mice, which suggests that neuropathy may exist between the sciatic notch to the nerve rootlets. Reversible synaptic retraction may be a previously unrecognized cofactor along with peripheral neuropathy for the development of Guillain-Barré syndrome during Zika virus outbreaks.

PMID: 31862897 DOI: 10.1038/s41598-019-55717-3

Keywords: Zika Virus; GBS; Neurology; Animal models.

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