COVID-19-associated Guillain-Barre syndrome: Difference between revisions
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*Day 2(first lumbar puncture): | *'''Day 2(first lumbar puncture)''': | ||
*Day 10(second lumbar puncture): | **Protein level: Normal; | ||
**No cells; | |||
**Negative PCR assay for SARS-CoV-2<br/> | |||
*'''Day 10(second lumbar puncture)''': | |||
** Protein level:101mg/dl; | |||
**White cell count 4per mm3; | |||
**Negative PCR assay for SARS-CoV-2 | |||
| Negative | | Negative | ||
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| | *'''Day 3''' | ||
**Protein level :123mg/dl; | |||
**No cells were found; | |||
**PCR assay was negative for SARS-CoV-2 | |||
|Not tested | |||
|- | |- | ||
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*'''Day 3''' | |||
**Protein level :193mg/dl; | |||
**No cells were found; | |||
**PCR assay for SARS-CoV-2 negative | |||
| | | Negative | ||
|- | |- | ||
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|4 | |4 | ||
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*'''Day 5''': | |||
** Protein level: Normal; | |||
**No cells; | |||
**PCR assay for SARS-CoV-2 was negative | |||
| | | Not tested | ||
|- | |- | ||
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*'''Day 3''' | |||
**Protein level: 40mg/dl; | |||
**WBC count 3 per mm3; | |||
**PCR assay for SARS-CoV-2 was negative | |||
| | |Negative | ||
|- | |- |
Revision as of 01:32, 28 June 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rinky Agnes Botleroo, M.B.B.S.
Synonyms and keywords:
Overview
Pathophysiology
Guillain-Barre syndrome
- Pathophysiology
- Guillain–Barre syndrome causes immune-mediated damage to the peripheral nerves that usually follows gastrointestinal or respiratory illnesses. The polyneuropathy in Guillain–Barre syndrome is believed to be due to cross-immunity against epitopes of peripheral nerve components that it shares with the epitopes on the cell surface of bacteria that produces an antecedent infection [1]. Most common antecedent infections are Campylobacter jejuni ,Zika virus and influenza virus.
- The mechanism of Guillain–Barre syndrome in patients infected with COVID-19 is not fully understood yet.
- COVID-19 stimulates inflammatory cells and produces various inflammatory cytokines and as a result, it initiates immune-mediated processes[2][3].'Molecular mimicry' as a mechanism of autoimmune disorder plays an important role in formation of Guillain–Barre syndrome. It is not yet clear whether COVID-19 induces the production of antibodies against specific gangliosides that usually appear with certain forms of Guillain–Barre syndrome[3].
In the future further investigations should be conducted about the mechanism of GBS in patients with COVID-19 for better understanding.
- Guillain–Barre syndrome causes immune-mediated damage to the peripheral nerves that usually follows gastrointestinal or respiratory illnesses. The polyneuropathy in Guillain–Barre syndrome is believed to be due to cross-immunity against epitopes of peripheral nerve components that it shares with the epitopes on the cell surface of bacteria that produces an antecedent infection [1]. Most common antecedent infections are Campylobacter jejuni ,Zika virus and influenza virus.
Differentiating COVID-19-associated Guillain-Barre syndrome from other Diseases
Epidemiology and Demographics
- Epidemiology and Demographics
- Five cases of Guillain-Barre syndrome (GBS) in patients with COVID-19 has been reported in three hospitals in northern Italy from February 28 through March 21, 2020.. Four of these patients 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 he developed a positive serologic test for the virus [4].
- The first official case of Guillain-Barre syndrome (GBS) associated in patients with COVID-19 in the United States has been reported by neurologists from Allegheny General Hospital in Pittsburgh, Pennsylvania in June,2020.The patient was a 54-year-old man who was transferred to Allegheny General Hospital after developing ascending limb weakness and numbness that followed symptoms of a respiratory infection.The man reported that his wife was tested positive for COVID-19 infection and that his symptoms started soon after her illness. Later he also tested positive for COVID-19.[5]
- Another case of Guillain–Barre syndrome with COVID-19 has been reported in Iran[6].
- Five cases of Guillain-Barre syndrome (GBS) in patients with COVID-19 has been reported in three hospitals in northern Italy from February 28 through March 21, 2020.. Four of these patients 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 he developed a positive serologic test for the virus [4].
Risk Factors
Natural History, Complications, and Prognosis
.
Diagnosis
History and Symptoms
- The classic clinical manifestations of GBS is
- Progressive, ascending, symmetrical flaccid limbs paralysis
- Areflexia or hyporeflexia and with or without cranial nerve involvement, which can progress over the course of days to several weeks
- In the Italian cases, GBS symptoms began 5-10 days after the first COVID-19 symptoms. The first symptoms of GBS were lower limb weakness in four patients and facial diplegia with subsequent ataxia and paresthesia in one patient. Four patients had generalized flaccid tetraparesis or tetraplegia that developed over 3 to 4 days; No patient had dysautonomic features.[4]
Patient no. | Onset of neurologic symptoms |
Neurologic Signs & Symptoms [7] |
---|---|---|
1 | 7 days after fever, cough, ageusia | Flaccid areflexic tetraplegia evolving to facial weakness, upper limb paresthesia(36 hr), and respiratory failure(day 6) |
2 | 10 days after fever and pharyngitis | Facial diplegia and generalized areflexia evolving to lower limb paresthesia with ataxia (Day 2) |
3 | 10 days after fever and cough | Flaccid tetraparesis and facial weakness evolving to areflexia (day 2) and respiratory failure( day 5) |
4 | 5 days after cough and hyposmia | Flaccid areflexic tetraparesis and ataxia (day 4) |
5 | 7 days after cough,ageusia and anosmia | facial weakness,flaccid areflexic paraplegia(day 2-3) and respiratory failure (day 4) |
- In the US case, the deficits in the 54 year old man were characterized by quadriparesis and areflexia, burning dysesthesias, mild ophthalmoparesis, and dysautonomia. He did not have the loss of smell and taste documented in other COVID-19 patients.[8]. The unique clinical features in the US case are urinary retention secondary to dysautonomia and ocular symptoms of diplopia.[8]
Physical Examination
Laboratory Findings
- The findngs of five Italian patients with Guillain- Barre syndrome after the onset of COVID-19 infection:
Patient no. | CSF findings |
Antiganglioside Antibodies
|
---|---|---|
1 |
|
Negative |
2 |
|
Not tested |
3 |
|
Negative |
4 |
|
Not tested |
5 |
|
Negative |
Treatment
Medical Therapy
.
Primary Prevention
.
Secondary Prevention
References
- ↑ Gupta A, Paliwal VK, Garg RK (July 2020). "Is COVID-19-related Guillain-Barré syndrome different?". Brain Behav. Immun. 87: 177–178. doi:10.1016/j.bbi.2020.05.051. PMC 7239011 Check
|pmc=
value (help). PMID 32445789 Check|pmid=
value (help). - ↑ Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J, Cao B (February 2020). "Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China". Lancet. 395 (10223): 497–506. doi:10.1016/S0140-6736(20)30183-5. PMC 7159299 Check
|pmc=
value (help). PMID 31986264. - ↑ 3.0 3.1 Sedaghat Z, Karimi N (June 2020). "Guillain Barre syndrome associated with COVID-19 infection: A case report". J Clin Neurosci. 76: 233–235. doi:10.1016/j.jocn.2020.04.062. PMC 7158817 Check
|pmc=
value (help). PMID 32312628 Check|pmid=
value (help). - ↑ 4.0 4.1 Toscano, Gianpaolo; Palmerini, Francesco; Ravaglia, Sabrina; Ruiz, Luigi; Invernizzi, Paolo; Cuzzoni, M. Giovanna; Franciotta, Diego; Baldanti, Fausto; Daturi, Rossana; Postorino, Paolo; Cavallini, Anna; Micieli, Giuseppe (2020). "Guillain–Barré Syndrome Associated with SARS-CoV-2". New England Journal of Medicine. 382 (26): 2574–2576. doi:10.1056/NEJMc2009191. ISSN 0028-4793.
- ↑ "Frontiers | Neurological Manifestations of COVID-19 (SARS-CoV-2): A Review | Neurology".
- ↑ "Guillain–Barré Syndrome Associated with SARS-CoV-2 | NEJM".
- ↑ 8.0 8.1 "First Reported US Case of Guillain-Barré Linked to COVID-19".