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| LETTER TO EDITOR |
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| Year : 2021 | Volume
: 7
| Issue : 2 | Page : 152-153 |
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Guillain-Barre Syndrome in COVID-19 patients: An emerging dilemma
Venkata Dinesh Kumar Kandula1, Tarun Kumar Suvvari2
1 GSL Medical College and General Hospital, Rajahmundry, Andhra Pradesh, India
2 Rangaraya Medical College, Kakinada, Andhra Pradesh, India
| Date of Submission | 29-Apr-2021 |
| Date of Decision | 01-May-2021 |
| Date of Acceptance | 03-May-2021 |
| Date of Web Publication | 30-Dec-2021 |
Correspondence Address:
Tarun Kumar Suvvari
Rangaraya Medical College, Kakinada, Andhra Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jcrsm.jcrsm_27_21
How to cite this article:
Kumar Kandula VD, Suvvari TK. Guillain-Barre Syndrome in COVID-19 patients: An emerging dilemma. J Curr Res Sci Med 2021;7:152-3 |
Dear Sir,
COVID-19 has led to severe medical complications in a hospitalized patients; In addition, recently, some patients infected with COVID-19 have been found suffering from a rare neurological complication known as Guillain-Barre Syndrome (GBS).[1]
GBS is a rare neurological disorder in which our body's immune system attacks our own peripheral nerves. Each year, it is estimated that about 100,000 patients worldwide contract GBS.[2] GBS can range from mild weakness to devastating paralysis. According to many shreds of evidence, molecular mimicry has a key role in developing this disorder. In campylobacter jejuni gastrointestinal infections, there is a molecular similarity between lipopolysaccharide present in the outer membrane of bacteria and gangliosides of the peripheral nerves.[3] Therefore, this triggered an immune response against infection, leading to cross-reaction on host nerves. GBS patients present with a fulminant course of symptoms, including ascending weakness and sensory symptoms. Symmetric involvement is a known key feature of GBS, and nadir is usually reached within 4–6 weeks.[4] Previously, its association with MERS-CoV has been theorized, so its the new association with COVID-19 undoubtedly needs further attention.[5],[6]
According to a systematic review done by Abu-Rumeileh et al., where they considered 73 GBS cases from all the continents except Australia, all were symptomatic for COVID-19 except two patients. They noticed fever, cough, dyspnea/pneumonia, hypo-/ageusia, hypo-/anosmia, and diarrhea as the most common clinical manifestations, whereas clinical manifestations of GBS developed in all patients (except four) after those of COVID-19. Sensory symptoms alone or in combination with para/tetraparesis were seen to be common clinical manifestations at the onset. However, cranial nerve involvement was not commonly noticed at the onset. Moreover, almost all the patients presented with an absence of reflexes (in lower limbs or generalized). They also noticed gait ataxia at onset or during the disease. Here, almost all the cases were treated with intravenous immunoglobulins except 10 cases. These 10 were given plasma therapy and steroid therapy.[7]
In the study done by Nanda et al., where they considered four patients from a tertiary care center in India, all of the four patients developed clinical manifestations of GBS within 5–10 days (typical time interval described in many studies). However, in contrast to GBS's typical clinical manifestations, only one out of four patients presented with cranial nerve involvement.[8] This is quite similar to the systematic review done by Abu-Rumeileh et al. They also did not notice cranial nerve involvement in any of their cases.[7] Here, three out of four patients had shown a good response to intravenous immunoglobulins.[8]
Two different procedures have been described to explain the peripheral and central nervous system damage in COVID-19, (a) hematogenous or trans-neuronal and (b) secondary neurological involvement due to abnormal immune response. The first procedure is supposed to be responsible for common neurological manifestations such as hypogeusia, hyposmia, headache, dizziness, and vertigo in COVID-19 patients. However, severe complications, such as GBS and encephalitis, are due to the second mechanism.[9],[10]
More standard epidemiological studies are needed to ascertain the association between GBS and COVID-19. Moreover, all the physicians must be aware of the association between COVID-19 and GBS so that early diagnosis and treatment of this complication could help to get gratifying results. Furthermore, COVID-19 contracted patients should also focus on neurological examination to encounter the features of GBS specifically. More future prospective multi-centric studies are needed to understand this well.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Abolmaali M, Heidari M, Zeinali M, Moghaddam P, Ramezani Ghamsari M, Jamshidi Makiani M, et al. Guillain-Barré syndrome as a parainfectious manifestation of SARS-CoV-2 infection: A case series. J Clin Neurosci 2021;83:119-22.  |
| 2. | Sejvar JJ, Baughman AL, Wise M, Morgan OW. Population incidence of Guillain-Barré syndrome: A systematic review and meta-analysis. Neuroepidemiology 2011;36:123-33. |
| 3. | Yuki N, Taki T, Inagaki F, Kasama T, Takahashi M, Saito K, et al. A bacterium lipopolysaccharide that elicits Guillain-Barré syndrome has a GM1 ganglioside-like structure. J Exp Med 1993;178:1771-5. |
| 4. | Fokke C, van den Berg B, Drenthen J, Walgaard C, van Doorn PA, Jacobs BC. Diagnosis of Guillain-Barré syndrome and validation of Brighton criteria. Brain 2014;137:33-43. |
| 5. | Kim JE, Heo JH, Kim HO, Song SH, Park SS, Park TH, et al. Neurological complications during treatment of middle east respiratory syndrome. J Clin Neurol 2017;13:227-33. |
| 6. | Zhou Z, Kang H, Li S, Zhao X. Understanding the neurotropic characteristics of SARS-CoV-2: From neurological manifestations of COVID-19 to potential neurotropic mechanisms. J Neurol 2020;267:2179-84. |
| 7. | Abu-Rumeileh S, Abdelhak A, Foschi M, Tumani H, Otto M. Guillain-Barré syndrome spectrum associated with COVID-19: An up-to-date systematic review of 73 cases. J Neurol 2021;268:1133-70. |
| 8. | Nanda S, Handa R, Prasad A, Anand R, Zutshi D, Dass SK, et al. COVID-19 associated Guillain-Barre Syndrome: Contrasting tale of four patients from a tertiary care centre in India. Am J Emerg Med 2021;39:125-8. |
| 9. | Dalakas MC. Guillain-Barré syndrome: The first documented COVID-19-triggered autoimmune neurologic disease: More to come with myositis in the offing. Neurol Neuroimmunol Neuroinflamm. 2020;7:e781. doi: 10.1212/NXI.0000000000000781. |
| 10. | Wang L, Shen Y, Li M, Chuang H, Ye Y, Zhao H, et al. Clinical manifestations and evidence of neurological involvement in 2019 novel coronavirus SARS-CoV-2: A systematic review and meta-analysis. J Neurol 2020;267:2777-89. |
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