Infectious Disease

Guillain-Barre syndrome in sufferers with COVID-19 requires extra analysis

December 15, 2020

3 min read

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Disclosure:
Fragiel and colleagues do not report any relevant financial information. McDonnell does not report any relevant financial information.

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Recent research from Spain and the United States has described Guillain-Barre syndrome – both novel and recurrent – in patients with COVID-19, adding to the growing literature on the neurological manifestations of the disease.

In the first report, researchers from Spain identified 11 cases of Guillain-Barre Syndrome (GBS) in 71,904 patients with COVID-19 over 61 EDs during a “2-month pandemic peak”. They reported a higher relative incidence of GBS in patients with vs. without COVID-19 (0.15% vs. 0.02%; OR = 6.30; 95% CI, 3.18-12.5) and a higher standardized incidence of the syndrome (9.44 vs. 0.69 ) Cases per 100,000 population-years; OR = 13.5; 95% CI, 9.87-18.4). Patients with COVID-19 who developed GBS were admitted to the intensive care unit more often, but mortality did not increase in these patients compared to control groups.

The researchers noted that additional cases and case series on the clinical features of GBS in patients with COVID-19 were published when they prepared their manuscript. The results in these reports “largely” agreed with their findings, they wrote, and concluded that this research group, taken together, suggested “a possible role for SARS-CoV-2 as an additional viral infection that causes GBS”.

The second report concerned the first known instance of COVID-19, which led to a recurrence of GBS, according to a press release from Rutgers University in New Jersey. The patient, a man aged 54, had already developed GBS twice and appeared for the third time after a positive COVID-19 test.

“The patient came to [ED] with complaints of progressive swallowing difficulties, then fever for three days, followed by weakness in arms, legs and face. ” Erin McDonnell, A medical student at Rutgers Robert Wood Johnson Medical School said in the press release. “His symptoms this time were worse than in previous episodes. He has since recovered. “

Healio Neurology spoke to McDonnell to learn more about the case at Rutgers University and the connection between GBS and COVID-19.

Q: To your knowledge, this is the first report of COVID-19 as a trigger for recurrent GBS, right?

A: Correct. To the best of our knowledge, this is the first case that describes a patient with recurrent GBS as a result of COVID-19 infection. Abu-Rumeileh and colleagues documented more than 70 cases of patients with GBS as a result of COVID-19. Our case represents a patient who had GBS in the past. Approximately 3% to 5% of patients with GBS have later recurrent episodes. There are other case studies describing COVID-19 as a trigger for chronic demyelinating polyneuropathic disorder, which is a relapsing-remitting demyelinating disorder.

Q: Should all patients who have had GBS in the past be concerned about recurrence if they receive COVID-19?

A: Patients who have had GBS in the past may be at risk of recurrence of GBS as a result of COVID-19. Statistics show that of patients who have had GBS in the past, around 5% had recurrent symptoms, but did so before COVID-19. We are still learning more about COVID-19 and its interaction with our own immune systems.

Q: Does this tell us anything about the underlying mechanisms behind GBS?

A: The mechanism behind GBS is based on an autoimmune concept called “Molecular Mimicry”. The immune system mistakenly attacks the patient’s healthy cells, which leads to nerve damage. More research is needed to better understand common antigens between the new coronavirus and specific neural tissue.

Q: H. How could that be Impact on the management of COVID-19 ?

A: We recommend close observation for patients with COVID-19 who present to doctors with neurological and demyelinating symptoms. We also recommend that doctors, if possible, take a thorough medical history to determine whether the patient has had GBS in the past.

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