Post-infectious focal encephalitis due to COVID-19

Fukushima, Elisa Fumi Akagi; Nasser, Abdulla; Bhargava, Ashish; Moudgil, Shyam S.

doi:10.18683/germs.2021.1247

Cited by 12 publications

(7 citation statements)

References 12 publications

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“…In addition, there were many cases where lumbar puncture was performed but CSF was not tested for SARS-CoV-2 without providing justifications for not testing [ 53 , 54 , 55 , 56 ]. Other case studies reported that CSF samples were not tested for COVID-19 because there is no Food and Drug Administration (FDA) approved PCR kit or a commercially available kit for SARS-CoV-2 diagnosis in CSF [ 57 , 58 ]. While some authors requested CSF SARS-CoV-2 PCR for the laboratory in their country/hospital, it was denied [ 59 , 60 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Implications of COVID-19 Presence in CSF: Systematic Review of Case Reports

Elmakaty

Ferih

Karen

et al. 2022

Cells

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This systematic review focused on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients that had detected SARS-CoV-2 virus in cerebrospinal fluid (CSF). A systematic literature search was carried out in PubMed, Embase, Scopus, Web of Science, Medrxiv, and Biorxiv databases from inception to 19 December 2021. Case reports or case series involving patients with proved SARS-CoV-2 presence in CSF by polymerize chain reaction were included. Our search strategy produced 23 articles documenting a total of 23 patients with positive SARS-CoV-2 in the CSF. Fever (55%) was the most common symptom, followed by headaches (41%), cough (32%), and vomiting/nausea (32%). The majority of the cases included was encephalitis (57%), 8 of which were confirmed by magnetic resonance imaging. The second most prevalent presentation was meningitis. The cerebral spinal fluid analysis found disparities in protein levels and normal glucose levels in most cases. This study demonstrates that SARS-CoV-2 can enter the nervous system via various routes and cause CNS infection symptoms. SARS-CoV-2 has been shown to infect the CNS even when no respiratory symptoms are present and nasopharyngeal swabs are negative. As a result, SARS-CoV-2 should be considered as a possible cause of CNS infection and tested for in the CSF.

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Section: Discussionmentioning

confidence: 99%

Clinical Implications of COVID-19 Presence in CSF: Systematic Review of Case Reports

Elmakaty

Ferih

Karen

et al. 2022

Cells

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“…In humans, establishing SARS-CoV-2 as a cause of postinfectious encephalitis would always prove challenging, and more so, when it occurs as a delayed complication as in our patient. Indeed, in two previously reported cases, an immune-mediated mechanism was postulated without definitive evidence of intrathecal viral RNA or specific antibodies [ 7 , 8 ]. Exclusion of other common aetiologies of encephalitis and evidence of SARS-CoV-2-specific intrathecal IgG and IgM antibodies in our patient authenticated SARS-CoV-2 as the cause of the postinfectious encephalitis fulfilling criteria for a definitive diagnosis [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

Delayed presentation of postinfectious encephalitis associated with SARS-CoV-2 infection: a case report

Gunawardhana¹,

Nanayakkara²,

Gamage³

et al. 2021

Neurol Sci

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Neurological manifestations of SARS-CoV-2 are increasingly being recognised and can arise as a result of direct viral invasion, para-infectious or postinfectious immune mechanisms. We report a delayed presentation of COVID-19 postinfectious immune-mediated encephalitis and status epilepticus occurring in a 47-year-old woman 4 weeks after SARS-CoV-2 pulmonary disease. SARS-CoV-2-specific IgG and IgM antibodies were detected in her cerebrospinal fluid with features of encephalitis evident in both magnetic resonance imaging of the brain and electroencephalogram. She made a complete recovery following treatment with high-dose intravenous corticosteroids and intravenous immunoglobulins. Diagnosis of COVID-19 postinfectious encephalitis may prove challenging in patients presenting many weeks following the initial infection. A high index of clinical suspicion and testing intrathecal SARS-CoV-2-specific antibodies are key to its diagnosis. Early immunotherapy is likely to result in a good outcome.

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“…Nevertheless, the patient experienced a nearly complete recovery after 6 months. Fukushima et al (2021) exposed the case of a 20-year-old previously healthy man who was admitted because of a persistent headache. Six weeks prior to this admission, he was hospitalized for a new onset seizure, confirmed by electroencephalography.…”

Section: Encephalitis/meningoencephalitismentioning

confidence: 99%

Efficacy of intravenous immunoglobulin (IVIg) on COVID-19-related neurological disorders over the last 2 years: an up-to-date narrative review

et al. 2023

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IntroductionAmong the clinical manifestations of SARS-CoV-2 infection, neurological features have been commonly reported and the state-of-the-art technique suggests several mechanisms of action providing a pathophysiological rationale for central and peripheral neurological system involvement. However, during the 1st months of the pandemic, clinicians were challenged to find the best therapeutic options to treat COVID-19-related neurological conditions.MethodsWe explored the indexed medical literature in order to answer the question of whether IVIg could be included as a valid weapon in the therapeutic arsenal against COVID-19-induced neurological disorders.ResultsVirtually, all reviewed studies were in agreement of detecting an acceptable to great efficacy upon IVIg employment in neurological diseases, with no or mild adverse effects. In the first part of this narrative review, the interaction of SARS-CoV-2 with the nervous system has been discussed and the IVIg mechanisms of action were reviewed. In the second part, we collected scientific literature data over the last 2 years to discuss the use of IVIg therapy in different neuro-COVID conditions, thus providing a summary of the treatment strategies and key findings.DiscussionIntravenous immunoglobulin (IVIg) therapy is a versatile tool with multiple molecular targets and mechanisms of action that might respond to some of the suggested effects of infection through inflammatory and autoimmune responses. As such, IVIg therapy has been used in several COVID-19-related neurological diseases, including polyneuropathies, encephalitis, and status epilepticus, and results have often shown improvement of symptoms, thus suggesting IVIg treatment to be safe and effective.

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Post-infectious focal encephalitis due to COVID-19

Cited by 12 publications

References 12 publications

Clinical Implications of COVID-19 Presence in CSF: Systematic Review of Case Reports

Clinical Implications of COVID-19 Presence in CSF: Systematic Review of Case Reports

Delayed presentation of postinfectious encephalitis associated with SARS-CoV-2 infection: a case report

Efficacy of intravenous immunoglobulin (IVIg) on COVID-19-related neurological disorders over the last 2 years: an up-to-date narrative review

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