PMC:7239011 / 56-3504 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7239011","sourcedb":"PMC","sourceid":"7239011","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7239011","text":"We read with interest the report of Guillain-Barré syndrome secondary to SARS-Cov-19 infection (Coen et al. 2020). Recently, there have been multiple reports of Guillain-Barré syndrome (GBS) associated with the COVID-19 infection (Sedaghat and Karimi, 2020, Toscano et al.,, Zhao et al., 2020). Most COVID-19-related GBS presented with acute onset of areflexic quadriparesis. However, there are some important differences to highlight (table 1 ). (Garg et al., 2018). Most patients with COVID-19-related GBS were elderly. Preceding symptoms like ageusia and hyposmia were unique for COVID-19 infection. Patients with COVID-19-related GBS had a severe disease with respiratory failure due to lobar pneumonia and interstitial pneumonitis. They showed ground-glass appearance of lungs on chest computerized tomography. Increased severity of disease is also evident from the electrophysiology study. Where demyelinating neuropathy is more common with typical GBS and GBS related to dengue and Zika virus, majority of COVID-19-related GBS patients had axonal motor (AMAN) and axonal motor-sensory polyneuropathy (AMSAN). A few of these patients showed enhancement of caudal nerve roots on Gadolinium-enhanced MRI of spine. Most COVID-19 patients received hydroxychloroquine, azithromycin, lopinavir and ritonavir in addition to intravenous immunoglobulin (IVIG). However, more than half of patients showed poor outcome in the form of long ICU stay, residual paresis and dysphagia.\nTable 1 Differences in the presentation of Typical GBS, Dengue, Zika virus and COVID SARS related GBS.\nFeature Typical GBS Dengue-related GBS Zika virus-related GBS COVID SARS related GBS\nGeographical distributionAgeSexPreceding illnessMean time to GBSInitial symptomsDysphagiaSignsFacial diplegiaDysautonomiaAtaxiaRespiratory failureOther cranial nerves involvedLeukopeniaThrombocytopeniaNerve conductionCT chestMRI Brain/spineTreatmentOutcome GlobalAll age groupsMales 1.5 times more affectedRespiratory or gastrointestinal\u003c 6 weeksParesthesia, pain followed by weakness of limbsLess commonAreflexic quadreparesisCommonCommonLess common25%Ocular nervesUncommonUncommonAIDP--IVIG, PlasmapherisisGood, persistent disability in 20%-30% Latin America, IndiaAll age groupsMales:Females EqualFever, rash, myalgia, headache1–30 daysAscending weakness, paresthesia, facial weaknessLess commonAreflexic quadri/paraparesisCommonLess commonLess commonLess commonGlossopharyngeal nerveCommonCommonAIDP, AMSAN--IVIG, PlasmapheresisGood Latin America, Europe, East Asia, North AmericalMiddle age to elderlyMore malesFever, headache, rash, arthralgia, diarrhea, conjunctivitis0–10 daysLimb pains, paresthesia, lower limb weakness, facial weaknessMore commonAreflexic quadri/paraparesisCommon (\u003e50%)Common (up to 30%)Common (up to 70%)Less common3rd cranial nerve--AIDP \u003e AMAN, AMSAN--IVIG, PlasmapheresisGood, half may require ICU care China, Iran, Europe, USAUsually elderlyMore malesFever, cough, dyspnea, ageusia, hyposmia5–14 daysParesthesia, lower limb weakness, facial weaknessLess commonAreflexic quadri/paraparesisCommonLess commonLess commonCommon-Common-AMSAN, AMAN, AIDPPneumonia, interstitial pneumonitisEnhancement of caudal nerve rootsIVIG, Lopinavir, ritonavir, HCQ, Azithromycin,Poor, residual weakness, dysphagia, long ICU stay\nAIDP – Acute inflammatory demyelinating polyneuropathy, AMAN – Acute motor axonal neuropathy, AMSAN – Acute motor sensory axonal 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