Guillain-Barré syndrome in a patient infected with SARS-CoV-2, a case report

Farzi, Mohammad Amin; Ayromlou, Hormoz; Jahanbakhsh, Naser; Bavil, Parisa Hadavi; Janzadeh, Abdolali; Shayan, Farid Karkon

doi:10.1016/j.jneuroim.2020.577294

Cited by 42 publications

(39 citation statements)

References 13 publications

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“…In all (n = 72) but four patients [10,37,40,56], GBS manifestations developed after those of COVID-19 [median (IQR): 14 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), min 2-max 33 days]. Differently, COVID-19 symptoms began concurrent in one case [37], 1 day [40] and 8 days [55] after GBS onset in two other cases and never developed in another one [10] (Table 1).…”

Section: Clinical Features Of Gbs Spectrummentioning

confidence: 99%

Guillain–Barré syndrome spectrum associated with COVID-19: an up-to-date systematic review of 73 cases

et al. 2020

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Since coronavirus disease-2019 (COVID-19) outbreak in January 2020, several pieces of evidence suggested an association between the spectrum of Guillain-Barré syndrome (GBS) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Most findings were reported in the form of case reports or case series, whereas a comprehensive overview is still lacking. We conducted a systematic review and searched for all published cases until July 20th 2020. We included 73 patients reported in 52 publications. A broad age range was affected (mean 55, min 11-max 94 years) with male predominance (68.5%). Most patients showed respiratory and/or systemic symptoms, and developed GBS manifestations after COVID-19. However, asymptomatic cases for COVID-19 were also described. The distributions of clinical variants and electrophysiological subtypes resemble those of classic GBS, with a higher prevalence of the classic sensorimotor form and the acute inflammatory demyelinating polyneuropathy, although rare variants like Miller Fisher syndrome were also reported. Cerebrospinal fluid (CSF) albuminocytological dissociation was present in around 71% cases, and CSF SARS-CoV-2 RNA was absent in all tested cases. More than 70% of patients showed a good prognosis, mostly after treatment with intravenous immunoglobulin. Patients with less favorable outcome were associated with a significantly older age in accordance with previous findings regarding both classic GBS and COVID-19. COVID-19-associated GBS seems to share most features of classic post-infectious GBS and possibly the same immune-mediated pathogenetic mechanisms. Nevertheless, more extensive epidemiological studies are needed to clarify these issues.

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Section: Clinical Features Of Gbs Spectrummentioning

confidence: 99%

Guillain–Barré syndrome spectrum associated with COVID-19: an up-to-date systematic review of 73 cases

et al. 2020

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“…Among the 68 studies on the CNS effects, 46 were case reports [16,17,, followed by 10 retrospective studies [64][65][66][67][68][69][70][71][72][73], 4 observational cohort studies [74][75][76][77], 3 prospective studies [78][79][80], 3 case-control studies [81][82][83] and 2 cross-sectional studies [84,85]. Among the 21 studies regarding PNS disorders, there were 19 case reports [86][87][88][89][90][91][92][93][94][95][96][97][98][99][100][101][102][103][104], 1 prospective study [78] and 1 retrospective study [68]. Two studies reported both CNS and PNS effects of COVID-19 [68,78].…”

Section: Categorization and Characteristics Of The Selected Studiesmentioning

confidence: 99%

“…As regards the PNS, the most frequent manifestations reported by literature were Guillain-Barré [78,87,88,90,93,[95][96][97][98][99][100][101][102]104] and Miller Fisher syndromes [89,91,94]. SARS-CoV-2 neuro-invasiveness is a complex process that probably depends on multiple interacting factors such as viral load, tissue neurotropism and host immune response.…”

Section: Effects Of Sars-cov-2 On Pnsmentioning

confidence: 99%

Neurological Complications of COVID-19 and Possible Neuroinvasion Pathways: A Systematic Review

Orrù

Conversano

Malloggi

et al. 2020

IJERPH

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The Coronavirus Disease 2019 (COVID-19) outbreak has shocked the whole world with its unexpected rapid spread. The virus responsible for the disease, the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), enters host cells by means of the envelope spike protein, which binds to angiotensin-converting enzyme 2 receptors. These receptors are highly expressed in heart, lungs, respiratory tract epithelium, endothelial cells and brain. Since an increasing body of significant evidence is highlighting a possible neuroinvasion related to SARS-CoV-2, a state of the art on the neurological complications is needed. To identify suitable publications, our systematic review was carried out by searching relevant studies on PubMed and Scopus databases. We included studies investigating neurologic manifestations of SARS-CoV-2 in patients over 18. According to the analyzed studies, the most frequent disorders affecting central nervous system (CNS) seem to be the following: olfactory and taste disorders, ischemic/hemorrhagic stroke, meningoencephalitis and encephalopathy, including acute necrotizing encephalopathy, a rare type of encephalopathy. As regards the peripheral nervous system (PNS), Guillain-Barré and Miller Fisher syndromes are the most frequent manifestations reported in the literature. Important clinical information on the neurological manifestations of SARS-CoV-2 would help clinicians raise awareness and simultaneously improve the prognosis of critically ill patients.

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“…Among those existing medications used for COVID-19 are intravenous immunoglobulins (IVIG) which are known for their anti-in ammatory effects and approved in several immune mediated disorders, including Kawasaki syndrome. Such disorders have increasingly been reported also to COVID-19 [1][2][3][4][5]. Recently, two marketed IVIG products were shown to react with SARS-CoV 2 antigens in vitro [6].…”

Section: Introductionmentioning

confidence: 99%

Effects of Intravenous Immunoglobulin on the Course of Severe COVID-19: Results From a Retrospective Data Analysis of a Patient Cohort in Turkey Treated With or Without Octagam®

Esen¹,

Özcan²,

Orhun³

et al. 2020

Preprint

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Background: There is some evidence from case reports and a few studies in China that critically ill COVID-19 patients may benefit from treatment with intravenous immunoglobulins (IVIG). We compared clinical outcomes and biomarkers in a Turkish cohort of patients with severe COVID-19 who were treated with the institution's standard of care (SOC), either alone or in combination with IVIG.Methods: Data from COVID-19 patients treated in two intensive care units at the University hospital of Istanbul was analyzed retrospectively. Patients received preliminary SOC according to the institution's treatment algorithm, to which Octagam 5% at 30 g/day for 5 days was added in one of the two wards. Both groups were compared regarding baseline characteristics, survival, and changes in inflammation markers (C-reactive protein=CRP, ferritin, procalcitonin, interleukin-6, D‑dimer, leukocytes). Imbalance in baseline APACHE II scores was addressed by propensity-score-matching; otherwise Kaplan-Meier and multiple logistic regression models were used.Results: Data from 93 patients was analyzed, 51 had received IVIG and 42 had not. About 75% of patients were male and both groups had comparable body mass index (BMI) and blood group distribution. IVIG-treated patients were younger (means 65 vs. 71 years) and had slightly lower baseline disease scores (APACHE II: 20.6 vs. 22.4; SOFA: 5.0 vs. 7.0). Overall survival (OS) was 61% in the IVIG and 38% in the control group. After controlling for imbalances at baseline, there was still a trend for better OS (OR: 2.2, 95%CI: 0.9-5.4, p=0.091) and a significantly longer median survival time with IVIG (68 vs. 18 days, p=0.014). IVIG significantly reduced CRP levels, but had no relevant effect on other inflammation markers.Conclusion: Adjunct treatment with IVIG might add to the COVID-19 armamentarium, but results need to be confirmed in a randomized, controlled trial.

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Guillain-Barré syndrome in a patient infected with SARS-CoV-2, a case report

Cited by 42 publications

References 13 publications

Guillain–Barré syndrome spectrum associated with COVID-19: an up-to-date systematic review of 73 cases

Guillain–Barré syndrome spectrum associated with COVID-19: an up-to-date systematic review of 73 cases

Neurological Complications of COVID-19 and Possible Neuroinvasion Pathways: A Systematic Review

Effects of Intravenous Immunoglobulin on the Course of Severe COVID-19: Results From a Retrospective Data Analysis of a Patient Cohort in Turkey Treated With or Without Octagam®

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