Characteristics of COVID and post COVID polyneuropathies in adults and pediatrics: an Egyptian sample

Haidy Elshebawy, Mohamed Y Ezzeldin, Eman Hassan Elzamarany, Haidy Elshebawy, Mohamed Y Ezzeldin, Eman Hassan Elzamarany

Abstract

Background: The aim of this study is to describe the different forms of polyneuropathy associated with coronavirus disease 2019 (COVID-19) as a secondary neurological complication for (COVID-19) and the outcome from different therapeutic regimens in adults and pediatrics in first and second waves of the pandemic.

Case presentation: This study was conducted on 42 patients, they were divided into two groups, group (A) and group (B) in first and second waves respectively. Twenty-five patients presented by ascending weakness preceded by fever, dry cough and respiratory distress, electromyography (EMG) and nerve conduction (NC) studies done and confirmed the clinical diagnosis of demyelinating polyneuropathy. Eight patients presented by acute flaccid quadriparesis, more severe in upper limbs preceded by fever and diarrhea diagnosed as acute axonal polyneuropathy. Five patients presented by severe fatigue and progressive weakness of both lower and upper limbs, they developed fever and cough 10 days after the neurological symptoms. EMG and NC done and confirmed clinical diagnosis of polyneuropathy of demyelinating with secondary axonal picture. Four patients presented 30 to 40 days after their recovery form corona virus infection with gradual progressive weakness of both upper and lower limbs over 2 to 3 months duration, mainly the proximal muscles of lower limbs were affected with areflexia. EMG and NC done and confirmed the diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP).

Conclusion: We should gain a better understanding of the underlying pathophysiology and therapeutic options of polyneuropathies related to COVID-19, which will have an impact on the treatment of the COVID related respiratory failure presenting with neuropathy.

Keywords: Adults; Pediatrics; Polyneuropathies; Post COVID.

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

© The Author(s) 2021.

References

    1. World Health Organization; 2020, director-General’s opening remarks at the media briefing on COVID-19-11 March 2020. .
    1. Desforges M, Le Coupanec A, Dubeau P, Bourgouin A, Lajoie L, Dubé M, et al. Human coronaviruses and other respiratory viruses: underestimated opportunistic pathogens of the central nervous system. Viruses. 2019;12(1):14. doi: 10.3390/v12010014.
    1. Zhao H, Shen D, Zhou H, Liu J. Guillain–Barré syndrome associated with SARS-CoV-2 infection: causality or coincidence. Lancet Neurol. 2020;19(5):383–384. doi: 10.1016/S1474-4422(20)30109-5.
    1. Ng KeeKwong KC, Mehta PR, Shukla G, Mehta AR. COVID-19, SARS and MERS. A neurological perspective. J Clin Neurosci. 2020 doi: 10.1016/j.jocn.2020.04.124.
    1. Baig AM, Khaleeq A, Ali U, Syeda H. Evidence of the COVID-19 virus targeting the CNS: tissue distribution, host-virus interaction, and proposed neurotropic mechanisms. ACS Chem Neurosci. 2020;11(7):995–998. doi: 10.1021/acschemneuro.0c00122.
    1. Natoli S, Oliveira V, Calabresi P, Maia LF, Pisani A. Does SARS-Cov-2 invade the brain. Translational lessons from animal models. Eur J Neurol. 2020 doi: 10.1111/ene.14277.
    1. Moore JB, June CH. Cytokine release syndrome in severe COVID-19. Science. 2020;368(6490):473–474. doi: 10.1126/science.abb8925.
    1. Jamilloux Y, Henry T, Belot A, Viel S, Fauter M, Jammal T, et al. Should we stimulate or suppress immune responses in COVID-19, cytokine and anticytokine interventions. Autoimmun Rev. 2020;19(7):102567. doi: 10.1016/j.autrev.2020.102567.
    1. Ye Q, Wang B, Mao J. The pathogenesis and treatment of the ‘Cytokine Storm' in COVID-19. J Infect. 2020;80(6):607–613. doi: 10.1016/j.jinf.2020.03.037.
    1. Virani A, Rabold E, Hanson T, Haag A, Elrufay R, Chema T, et al. Guillain–Barré Syndrome associated with SARS-CoV-2 infection. IDCases. 2020;20:e00771. doi: 10.1016/j.idcr.2020.e00771.
    1. Yaranagula SD, Koduri VKC. Spectrum of acute neuropathy associated with COVID-19: a clinical and electrophysiological study of 13 patients from a single center. Int J Infect Dis. 2021;110:314–319. doi: 10.1016/j.ijid.2021.07.066.
    1. Leonhard SE, Mandarakas MR, Gondim FAA, Bateman K, Ferreira MLB, Cornblath DR, et al. Diagnosis and management of Guillain–Barré syndrome in ten steps. Nat Rev Neurol. 2019;15(11):671–683. doi: 10.1038/s41582-019-0250-9.
    1. da Silva IRF, Frontera JA, Bispo de Filippis AM, Nascimento O. Neurologic complications associated with the zika virus in Brazilian adults. JAMA Neurol. 2017;74(10):1190–1198. doi: 10.1001/jamaneurol.2017.1703.
    1. Sedaghat Z, Karimi N. Guillain–Barre syndrome associated with COVID-19 infection: a case report. J Clin Neurosci. 2020;76:233–235. doi: 10.1016/j.jocn.2020.04.062.
    1. El Otmani H, El Moutawakil B, Rafai MA, Benna N, Kettani C, Soussi M, et al. COVID-19 and Guillain–Barré syndrome: more than a coincidence! Rev Neurol. 2020;176(6):518–519. doi: 10.1016/j.neurol.2020.04.007.
    1. Camdessanche JP, Morel J, Pozzetto B, Paul S, Tholance Y, Botelho-Nevers E. COVID-19 may induce Guillain–Barré syndrome. Rev Neurol. 2020;176(6):516–518. doi: 10.1016/j.neurol.2020.04.003.
    1. Scheidl E, Canseco DD, Hadji-Naumov A, Bereznai B, et al. Guillain–Barre syndrome during SARS-CoV-2 pandemic: a case report and review of recent literature. J Peripher Nerv Syst. 2020 doi: 10.1111/jns.12382.
    1. Padroni M, Mastrangelo V, Asioli GM, Pavolucci L, Rumeileh S, Piscaglia M, et al. Guillain–Barré syndrome following COVID-19: new infection, old complication. J Neurol. 2020;24:1–3.
    1. Ottaviani D, Boso F, Tranquillini E, Gapeni I, Pedrotti G, Cozzio S, et al. Early Guillain–Barré syndrome in coronavirus disease 2019 (COVID-19): a case report from an Italian COVID-hospital. Neurol Sci. 2020;41(6):1351–1354. doi: 10.1007/s10072-020-04449-8.
    1. Abdelnour L, Abdalla ME, Babiker S. COVID 19 infection presenting as motor peripheral neuropathy. J Formos Med Assoc. 2020;119(6):1119–1120. doi: 10.1016/j.jfma.2020.04.024.
    1. Caamaño DS, Beato RA. Facial diplegia, a possible atypical variant of Guillain–Barré Syndrome as a rare neurological complication of SARSCoV-2. J Clin Neurosci. 2020 doi: 10.1016/j.jocn.2020.05.016.
    1. Toscano G, Palmerini F, Ravaglia S, et al. Guillain–Barré syndrome associated with SARS-CoV-2. N Engl J Med. 2020 doi: 10.1056/NEJMc2009191.
    1. Diamanti AP, Rosado MM, Pioli C, Sesti G, Bruno LB. Cytokine release syndrome in COVID-19 patients, a new scenario for an old concern: the fragile balance between infections and autoimmunity. Int J Mol Sci. 2020;21(9):E3330. doi: 10.3390/ijms21093330.

Source: PubMed

3
購読する