Guillain-Barré syndrome in the COVID-19 era: just an occasional cluster?

Abstract

In terms of epidemiology, Guillain-Barré syndrome (GBS) accounts for 1-2 new cases/100.000 inhabitants per year [1, 2]. During the last two weeks, in coincidence with the descending slope of the pandemic peak in our region (Friuli Venezia-Giulia, Italy), we noted an unusual cluster of patients affected by GBS. The Neurology of the Udine University Hospital is the only Neurology Unit for the entire territory of the province, making unlikely the possibility of missing new cases, since this is the only facility for neurophysiological investigation and cerebrospinal fluid (CSF) examination in an area of 4,969.3 km 2. Solicited by this observation and by a recent paper reporting the association of GBS with COVID-19 infection [3], we decided to reexamine the frequency of GBS cases during the March-April months of the last three years and to compare it with the admissions for GBS during the same months of the current year (up to April 16th). After having the possibility to perform a quick test (Cellex™ q rapid test [4]) for the presence of IgM and IgG against SARS-CoV-2 nucleocapsid protein (N-protein), we tested the four patients still present in our ward and two more patients already discharged who accepted to come back to the hospital. Furthermore, we briefly described clinical, laboratory and neuro-physiological data of patients admitted this year in Table 1. Data dealing with COVID-19 are reported in Table 2.

Guillain-Barré syndrome and COVID-19: an observational multicentre study from two Italian hotspot regions

“… 24 However, only one patient, who was twice negative at swab test, had positive serology and chest CT scan in this study. 24 …”

“… 22 23 To date, the incidence of GBS in the ‘COVID-19 era’ has been analysed only in a small cohort from Friuli-Venezia Giulia, Italy, where an unusual cluster occurred in the months of March and April 2020. 24 Monthly incidence during the pandemic was 0.65 cases/1 00 000 vs 0.12 cases/100 000 in the March–April period of previous years with a 5.41-fold increase of GBS cases in 2020. 24 However, only one patient, who was twice negative at swab test, had positive serology and chest CT scan in this study.…”

“… 24 Monthly incidence during the pandemic was 0.65 cases/1 00 000 vs 0.12 cases/100 000 in the March–April period of previous years with a 5.41-fold increase of GBS cases in 2020. 24 However, only one patient, who was twice negative at swab test, had positive serology and chest CT scan in this study. 24 …”

Guillain-Barré syndrome in SARS-CoV-2 infection: an instant systematic review of the first six months of pandemic

“…To date, the incidence of GBS in the 'COVID-19 era' has been analysed only in Friuli Venezia-Giulia, Italy, where an unusual cluster (eight cases) occurred in the months of March and April 2020. 23 Monthly incidence was 0.65/100.000 versus 0.12/10.000 in the same months of previous years with 5.41-fold increase. However, only one patients (twice negative at swab test) had positive serology for SARS-CoV-2 and chest CT scan showing interstitial pneumonia.…”

Guillain-Barré syndrome after COVID-19 in Japan

“…Although the possibility of GBS associated with SARS-CoV-2 infection remains to be clarified, the number of GBS cases reported between March 2020 and April 2020 is greater than five times that reported in the last 3 years. 17 Given that reports have begun to describe GBS and neurological complications following SARS-CoV-2 infection, the onset of GBS requires special attention.…”