Query: GUILLAIN BARRE COVID-19

title: Guillain Barre syndrome associated with COVID 19 infection: A case report
abstract: Novel outbreak with coronavirus 2019 began since 31 December 2019. Coronaviruses can cause multiple systemic infections that respiratory complications are the most obvious symptoms. In this report, we describe the symptoms of Guillain Barre syndrome (GBS) in one infected patient with COVID 19, for the first time. We reported a 65 years old male patient with complaints of acute progressive symmetric ascending quadriparesis. Two weeks prior to hospitalization, the patient suffered from cough, fever, and RT PCR was reported positive for COVID 19 infection. The electrodiagnostic test showed that the patient is an AMSAN variant of GBS. COVID 19 stimulates inflammatory cells and produces various inflammatory cytokines and as a result, it creates immune mediated processes. GBS is an immune mediated disorder and molecular mimicry as a mechanism of autoimmune disorder plays an important role in creating it. It is unclear whether COVID 19 induces the production of antibodies against specific gangliosides. Further investigations should be conducted about the mechanism of GBS in patients with COVID 19, in the future.

title: Guillain Barre syndrome following COVID 19: new infection, old complication?
abstract: The coronavirus disease 2019 (COVID 19) pandemic originated in Wuhan (China) on December 2019. So far, more than 1,500,000 cases have been confirmed worldwide 150,000 cases in Italy)  Severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) infection is a systemic disorder typically presenting with fever, fatigue and prevalent respiratory disturbances (dry cough, dyspnea, chest pain, interstitial pneumonia)  although neurological manifestations are increasingly reported  Guillain Barre syndrome (GBS) is an acute/subacute immune mediated polyradiculoneuropathy characterized by varying degrees of limbs or cranial nerves weakness, loss of deep tendon reflexes, sensory and dysautonomic symptoms due to peripheral nerves and roots demyelination and/or axonal damage  According to a recent review about twothird of all GBS are preceded by upper respiratory infection or enteritis  Here we describe a case of GBS following a clinically resolved paucisymptomatic COVID 19. A 70 year old woman was referred to our emergency department (ED) on Mar 28 complaining of asthenia, hands and feet paresthesia and gait difficulties progressing within 1 day. On Mar 4 she had developed fever (body temperature BT 38.5 degC) and dry cough. A day later she had been tested positive for SARS CoV 2 RNA on RT PCR with a nasopharyngeal swab. Symptoms of COVID 19 had resolved in a few days. The epidemiological survey had revealed a previous hospital visit to an inpatient in an area with high incidence for COVID 19 (Piacenza, Italy) on Feb28, 29. At the ED admission BT was 36.5 degC, oxygen saturation was 98% on room air. Arterial blood gas analysis showed pO2 76 mmHg with normal p/f ratio 363) Hematological investigations revealed slightly increased white blood cells (10.41 x 109/L, normal 4 10 x 109/L) with 8.15 x 109/L neutrophils (normal 2 8 x 109/L) and lymphocytes in the normal range. D dimer, creatine phosphokinase, blood glucose, hepatic and renal function were normal, as well as c reactive protein, erythrocyte sedimentation rate, folate and vitamin B12 blood levels. A chest high resolution computed tomography revealed some small "ground glass" areas in both lungs. A repeated nasopharyngeal swab for SARS CoV 2 RNA was negative. Mycoplasma Pneumoniae and Cytomegalovirus (CMV) serology (IgM and IgG) Legionella Pneumophila and Streptococcus Pneumoniae urinary tests were unrevealing. The neurological examination disclosed moderate (Medical Research Council grade 4/5) symmetric distal upper and lower limbs weakness, loss of deep tendon reflexes, preserved light touch and pinprick sensation. On Mar 31 a lumbar puncture was performed. The cerebrospinal fluid (CSF) analysis revealed slight albumino cytological dissociation (CSF proteins 48 mg/dL, normal 0 40 mg/dL, white blood cells 1 x 106/L, normal 0 8 x 106/L) Microbiologic testing on CSF was negative (including herpes simplex virus, varicella zoster virus, Epstein Bar virus, CMV, HIV 1, Borrelia Burgdorferi IgM and IgG) Neurophysiologic findings were consistent with a diagnosis of GBS (Table 1) according to current criteria  A trial with 400 mg/die intravenous immunoglobulin (IVIg) for 5 days was started. On Apr 1 the patient was intubated and mechanical ventilation was applied, because of respiratory failure due to the worsening of muscle weakness. Matteo Foschi mattfos89@gmail.com

title: Early Guillain Barre syndrome in coronavirus disease 2019 (COVID 19) a case report from an Italian COVID hospital
abstract: Guillain Barre syndrome (GBS) is an acute polyradiculoneuropathy associated with dysimmune processes, often related to a previous infectious exposure. During Italian severe acute respiratory syndrome coronavirus 2 outbreak, a woman presented with a rapidly progressive flaccid paralysis with unilateral facial neuropathy after a few days of mild respiratory symptoms. Coronavirus was detected by nasopharyngeal swab, but there was no evidence of its presence in her cerebrospinal fluid, which confirmed the typical albumin cytological dissociation of GBS, along with consistent neurophysiological data. Despite immunoglobulin infusions and intensive supportive care, her clinical picture worsened simultaneously both from the respiratory and neurological point of view, as if reflecting different aspects of the same systemic inflammatory response. Similar early complications have already been observed in patients with para infectious GBS related to Zika virus, but pathological mechanisms have yet to be established.

title: Guillain Barre syndrome related to COVID 19 infection
abstract: At the time of this writing, healthcare systems are facing worldwide the pandemic of the coronavirus severe acute respiratory coronavirus 2 (SARS COV 2) and its associated disease, named cronavirus disease 19 (COVID 19) This virus is a new human pathogen, and currently, there are no specific treatment  COVID 19 mostly affects the respiratory system, ranging from mild flu like symptoms to severe pneumonia, but extrarespiratory multisystemic involvement has also been reported.2 Li et al.3 recently described the neuroinvasive potential of COVID 19, but, to our knowledge, no case of acute dysimmune neuropathy has been described so far. Here, the authors report the case of an acute and severe peripheral nervous system disorder possibly related to COVID 19 infection.

title: COVID 19 may induce Guillain Barre syndrome

title: Guillain Barre syndrome following COVID 19: a newly emerging post infectious complication
abstract: A 57 year old man presented with a progressive flaccid symmetrical motor and sensory neuropathy following a 1 week history of cough and malaise. He was diagnosed with Guillain Barre syndrome secondary to COVID 19 and started on intravenous immunoglobulin. He proceeded to have worsening respiratory function and needed intubation and mechanical ventilation. This is the first reported case of this rare neurological complication of COVID 19 in the UK, but it adds to a small but growing body of international evidence to suggest a significant association between these two conditions. Increasing appreciation of this by clinicians will ensure earlier diagnosis, monitoring and treatment of patients presenting with this.

title: Guillain Barre syndrome in the COVID 19 era: just an occasional cluster?
abstract: In terms of epidemiology, Guillain Barre 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 km2. Solicited by this observation and by a recent paper reporting the association of GBS with COVID 19 infection  we decided to re examine 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 (CellexTM q rapid test  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. The total number of GBS in the March April interval of the previous three years is four. In 2020, from March 1st to April 15th, we observed instead seven new cases diagnosed as GBS, in addition to a relapse in one more patient. This means 0.67 cases/month of observation (four cases in six months) in the previous three years, compared to 3.5 cases/month (seven cases in two months) during the current year, which increases to 4 cases/month (eight cases in two months) if we consider also the patient with relapse. Considering a population of 535,516 inhabitants in the province of Udine (2017 census) the monthly incidence in March April period of previous years was 0.12 new cases/100.000 inhabitants per month (in line with the epidemiological literature [1, 2] versus 0.65 cases/100.000 inhabitants per month during the ongoing pandemic. Accordingly, compared to years 2017 2019, the increase of GBS cases in 2020 is 5.41 fold. The suspicion that this striking difference could be due to the pandemic curve in our region is, therefore, legitimate. In fact, it is well known that GBS and related syndromes are often post infectious (as for the influenza epidemics and more recently for Zika virus  with an usual latency of 10 14 days after infection  However, in our series, only one patient (twice negative at swab test) had positive serology and thorax CT scan. Despite the serologic and swab negativity of the others, we think that the association with the descending slope of SARS CoV 2 infection should still be evaluated, since the specificity and sensitivity of these tests are not yet completely assessed and the exact slope of the humoral immune response curve to this new virus is still unknown. It could also be possible that asymptomatic or paucisymptomatic infections may not develop an antibody response sufficient enough to be detected, especially considering that the available test is only qualitative. We wonder if similar clusters have been observed elsewhere. Alessandro Marini alemarini00@gmail.com

title: Novel Coronavirus (COVID 19) Associated Guillain Barre Syndrome: Case Report
abstract: The novel coronavirus infection (COVID 19) has spread rapidly throughout the world, causing considerable morbidity, mortality,1,2 and world health care system strain. Experience from China and Europe, the areas that were afflicted early in the pandemic, suggested that neurological complications consisted of headache, loss of smell,3 as well as taste, with some patients demonstrating altered mentation, dizziness, ataxia and rarely seizures, strokes, or skeletal muscle injury.4 There was an initial report from China describing a case of Guillain Barre syndrome (GBS).5 We now present a similar case of GBS that developed soon after the patient contracted a COVID 19 infection.

title: COVID 19 Associated Bifacial Weakness with Paresthesia Subtype of Guillain Barre Syndrome
abstract: We report a case of bifacial weakness with paresthesia, a recognized Guillain Barre syndrome subtype characterized by rapidly progressive facial weakness and paresthesia without ataxia or other cranial neuropathies, which was temporally associated with antecedent coronavirus 2019 (COVID 19) This case highlights a potentially novel but critically important neurologic association of the COVID 19 disease process. Herein, we detail the clinicoradiologic work up and diagnosis, clinical course, and multidisciplinary medical management of this patient with COVID 19. This case is illustrative of the increasingly recognized but potentially underreported neurologic manifestations of COVID 19, which must be considered and further investigated in this pandemic disease.

title: Covid 19 and Guillain Barre syndrome: More than a coincidence!