Guillain-Barré syndrome in SARS-CoV-2 infection: an instant systematic review of the first six months of pandemic

A systematic review from 1 January to 30 June 2020 revealed 42 patients with Guillain-Barré syndrome (GBS) associated with SARS-CoV-2 infection. Single cases and small series were reported from 13 countries, the majority from Europe (79.4%) and especially from Italy (30.9%). SARS-CoV-2 infection was...

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Vydáno v:	Journal of neurology, neurosurgery and psychiatry Ročník 91; číslo 10; s. 1105 - 1110
Hlavní autoři:	Uncini, Antonino, Vallat, Jean-Michel, Jacobs, Bart C
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	England BMJ Publishing Group Ltd 01.10.2020 BMJ Publishing Group LTD
Témata:	Adult Aged Ataxia Betacoronavirus Coronavirus Infections - complications Coronavirus Infections - diagnosis Coronavirus Infections - therapy Coronaviruses COVID-19 Cytomegalovirus Disease transmission Encephalitis Female Fever Guillain-Barre syndrome Guillain-Barre Syndrome - diagnosis Guillain-Barre Syndrome - therapy Guillain-Barre Syndrome - virology Humans Infections Laboratories Male Middle Aged Neuromuscular neurovirology Pandemics Patients Pneumonia Pneumonia, Viral - complications Pneumonia, Viral - diagnosis Pneumonia, Viral - therapy SARS-CoV-2 Serology Severe acute respiratory syndrome coronavirus 2 Systematic review systematic reviews Ventilators Young Adult Italy China Guillain-Barre syndrome neurovirology systematic reviews
ISSN:	0022-3050, 1468-330X, 1468-330X
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Shrnutí:	A systematic review from 1 January to 30 June 2020 revealed 42 patients with Guillain-Barré syndrome (GBS) associated with SARS-CoV-2 infection. Single cases and small series were reported from 13 countries, the majority from Europe (79.4%) and especially from Italy (30.9%). SARS-CoV-2 infection was demonstrated by nasopharyngeal swab (85.7%) and serology (14.3%). Median time between COVID-19 and GBS onset in 36 patients was 11.5 days (IQR: 7.7–16). The most common clinical features were: limb weakness (76.2%), hypoareflexia (80.9 %), sensory disturbances (66.7 %) and facial palsy (38.1%). Dysautonomia occurred in 19%, respiratory failure in 33.3% and 40.5% of patients were admitted in intensive care unit. Most patients (71.4%) had the classical clinical presentation but virtually all GBS variants and subtypes were reported. Cerebrospinal fluid (CSF) albumin-cytological dissociation was found in 28/36 (77.8%) and PCR for SARS-CoV-2 was negative in 25/25 patients. Electrodiagnosis was demyelinating in 80.5% and levels 1 and 2 of Brighton criteria of diagnostic certainty, when applicable, were fulfilled in 94.5% patients. Antiganglioside antibodies were positive in only 1/22 patients. Treatments were intravenous immunoglobulin and/or plasma exchange (92.8%) with, at short-time follow-up, definite improvement or recovery in 62.1% of patients. One patient died. In conclusion, the most frequent phenotype of GBS in SARS-CoV-2 infection is the classical sensorimotor demyelinating GBS responding to the usual treatments. The time interval between infectious and neuropathic symptoms, absence of CSF pleocytosis and negative PCR support a postinfectious mechanism. The abundance of reports suggests a pathogenic link between SARS-CoV-2 infection and GBS but a case-control study is greatly needed.
Bibliografie:	Review ObjectType-Article-1 ObjectType-Evidence Based Healthcare-3 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 ObjectType-Undefined-3
ISSN:	0022-3050 1468-330X 1468-330X
DOI:	10.1136/jnnp-2020-324491