Covid-19 associated Guillain-Barre Syndrome: Contrasting tale of four patients from a tertiary care centre in India

Abstract

Background Globally, more than 12 million people have been infected with COVID −19 infection till date with more than 500,000 fatalities. Although, Covid-19 commonly presents with marked respiratory symptoms in the form of cough and dyspnoea, a neurotropic presentation has been described of late as well. Objective In this brief communication we report four cases of Covid-19 who presented to our hospital with features suggestive of Guillain-Barre Syndrome (GBS). Discussion The mechanisms by which SARS-CoV-2 causes neurologic damage are multifaceted, including direct damage to specific receptors, cytokine-related injury, secondary hypoxia, and retrograde travel along nerve fibres. The pathogenesis of GBS secondary to Covid-19 is not well understood. It is hypothesised that viral illnesses related GBS could be due to autoantibodies or direct neurotoxic effects of viruses. Conclusion Nervous system involvement in Covid-19 may have been grossly underestimated. In this era of pandemic, it is very important for the physicians to be aware of association of GBS with Covid-19, as early diagnosis and treatment of this complication could have gratifying results. To the best of our knowledge, this is the first such case series of Guillain-Barre Syndrome associated with Covid-19 to be reported from India.

Guillain–Barré syndrome in low-income and middle-income countries: challenges and prospects

“…During the coronavirus disease 2019 (COVID-19) pandemic, several case reports or case series have indicated a possible association between GBS and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection 71 – 74 . At the time of writing, most such reports were from Europe, although a small number of case reports were from LMIC (four from India, one from Morocco and one from Sudan) 75 – 77 . However, an epidemiological study in the UK found no increase in the incidence of GBS during the COVID-19 pandemic 78 .…”

Guillain–Barré Syndrome Associated with SARS-CoV-2 Infection

“…Four children have been reported so far [ 1 , 3 ]. The first series from India reported four adults; to our knowledge, this is the first child to be reported [ 4 ].…”

Guillain-Barré syndrome associated with SARS-CoV-2 infection: A case report with long term follow up

“…However, most of these cases were reported from western countries, around 80% from Europe ( Uncini et al, 2020 ). Very limited data are available on SARS-CoV-2-associated GBS from low- and middle-income countries except four cases from India, one from Morocco and one from Sudan ( Hasan et al, 2020 ; Nanda et al, 2021 ; El Otmani et al, 2020 ; Sidig et al, 2020 ). About 80% previously reported cases had electro-diagnostic features of demyelinating GBS and 62% showed definite improvement after treatment with IVIg which is consistent with current findings ( Hasan et al, 2020 ; Uncini et al, 2020 ).…”