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Assessment of Guillain-Barre Syndrome Cases in Brazil in the COVID-19 Era

Authors:
Lorena Daiza Aquino Ferraz at Universidade Estadual de Montes Claros
Lorena Daiza Aquino Ferraz
Nelson Marques at Centro Universitário de Lavras
Nelson Marques
Denise Maria Mendes Lúcio Silveira
Denise Maria Mendes Lúcio Silveira
Marcelo José da Silva de Magalhães at Brazilian Journal of Neuroanatomy
Marcelo José da Silva de Magalhães
  • Brazilian Journal of Neuroanatomy
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Assessment of
Guillain-Barre
Syndrome Cases
in Brazil in the
COVID-19 Era
To the Editor:
There has been amounted evidence of
the neuroinvasive potential of the severe
acute respiratory syndrome coronavirus 2
(SARS-CoV-2). The main neurological
manifestations reported include dizziness,
headache, hypogeusia, hyposmia, muscle
damage, ischemic, and hemorrhagic stroke.1
Guillain-Barre syndrome (GBS) represents
the most common cause of acute sym-
metrical flaccid limb weakness. GBS
encompasses a wide range of clinical syn-
dromes with an acute inflammatory
polyradiculoneuropathy.2GBS is one of the
neurological complications that has been
found in patients with previous diagnosis of
coronavirus disease-2019 (COVID-19).3
The possible mechanism that has been
associated with GBS in patients with COVID-
19 is similar to the pathogenesis involved in
typical GBS, consisting of demyelination of
peripheral nerve roots. Peripheral nerve dam-
age can be caused by the immune response to
SARS-CoV-2, driven by the production of
self-reactive antibodies (antiganglioside).4It is
recognized that viral infections can disrupt
immune tolerance by exposing antigen epito-
pes that induce crossreactive antibodies. There
are many reports indicating antigenic mimicry
between viral and human proteins that cause
autoimmune diseases. As autoimmune
diseases are linked to a deregulated immune
system, this dysregulation can lead to damage
and dysfunction in target organs. Auto-
immune and immune-mediated diseases can
play a pathogenic role in COVID-19 and
some patients have reported the appearance of
autoimmune diseases such as GBS and lupus
erythematosus after coronavirus infection.5
To investigate the impact of the pan-
demic of COVID-19 in the GBS diagnosis
in Brazil, the main goal of this study was
compare data from the Brazilian Unified
Health System (SUS) on the number of
annual GBS cases between the prepan-
demic period (March 2018 to May 2019)
and the pandemic (March 2020 to May
2021), from the 5 Macroregions of Brazil
(North, Northeast, Southeast, South, and
Midwest), representing the Brazilian States
(26 States and the Federal District), through
data extracted and analyzed from the public
database of SUS (http://tabnet.datasus.gov.
br/cgi/tabcgi.exe?sia/cnv/qauf.def).
Table 1 shows the increase in GBS
diagnosis in all five Brazilian Macroregions
since the pandemic period began, ranging
from+27.5%intheNorthregionand
+1.6% in the Midwest region. In Brazil the
rise reached +15,8% diagnosis of GBS,
representing more than 240 cases during
COVID-19 pandemic compared with the
prepandemic period. Table 2 shows the
comparison between the mean incident rates
of GBS in the prepandemic and trans-
pandemic periods, across Brazilian geo-
graphic macroregions and for the country as
a whole. The incident rates of GBS diag-
noses significantly increased in the pan-
demic period throughout Brazil (incidence
rate ratio =1.16, 95% confidence interval:
1.08-1.24, P<0.0001), especially in regions
Northeast and Southeast.
The literature also includes reports on
the correlation between COVID-19 and
GBS.3A systematic review analyzed 73
cases of GBS that included only patients who
had a laboratory test confirming the COVID-
19 infection.6The authors revealed that most
patients showed respiratory and systemic
symptoms, and developed GBS manifes-
tations after COVID-19.6Vaccination has
been investigated as a possible trigger for
GBS.7A study carried out in United King-
dom in the first wave of COVID-19, did not
show a significant increase on GBS cases
and, therefore, no relation between the
diseases,8which differs from this present
data, that shows a significant increase in the
TABLE 1. Difference in the Number of Guillain-Barre Syndrome Cases in All 5 Brazilian
Geographical Regions Between the Prepandemic Period (March 2018 to May 2019) and
the Pandemic Period (March 2020 to May 2021)
Region
Prepandemic
Period
Pandemic
Period Difference %
North 109 139 +30 +27.5
Northeast 251 319 +68 +27.1
Southeast 614 752 +138 +22.5
South 410 419 +9 +2.2
Midwest 183 186 +3 +1.6
Total 1567 1815 +248 +15.8
TABLE 2. Incident Cases of Guillain-Barre Syndrome Cases Per Million Population in Brazilian Macroregions According to the Periods
Prepandemic and Pandemic Periods
Regions of
Brazil
COVID-19 Cases
Per Million Pop
2017-2019 GBS Incidence
Rate (95%CI)
2020-2021 GBS Incidence
Rate (95%CI)
Incidence Ratio
(95%CI) P*
North 100,618 6.2 (5.0-7.4) 7.8 (6.6-9.2) 1.27 (0.98-1.65) 0.057
Northeast 84,509 4.4 (3.8-4.9) 5.6 (5.0-6.2) 1.26 (1.07-1.50) 0.0044
Southeast 95,790 7.1 (6.6-7.5) 8.7 (8.1-9.3) 1.22 (1.09-1.36) 0.0002
South 139,995 13.9 (12.6-23) 14.2 (12.9-15.7) 1.02 (0.88-1.17) 0.754
Midwest 141,915 11.7 (10.0-13.5) 11.9 (10.2-13.7) 1.01 (0.82-1.25) 0.875
Total 103,032 7.0 (6.9-7.6) 8.4 (8.0-8.7) 1.16 (1.08-1.24) <0.001
*P-value obtained by χ
2
statistic.
CI indicates confidence interval; COVID-19, coronavirus disease-2019; GBS, Guillain-Barre syndrome; Pop, population.
The authors declare no conflict of interest.
ISSN: 2331-2637/22/000-000
DOI: 10.1097/NRL.0000000000000406
LETTER TO THE EDITOR
The Neurologist Volume 00, Number 00, ’’ 2022 www.theneurologist.org
|
1
Copyright r2022 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
number of GBS cases during the COVID-19
pandemic.
A recent study reported the time to
onset of GBS symptoms in patients with
COVID-19 was 5 to 10 days, similar
interval observed when GBS occurs dur-
ing or after other infections.9In contrast,
cerebrospinal fluid protein levels appear
higher in COVID-19 patients.10 The
treatment given for these cases used
immunoglobulin IV or plasmapheresis,
supportive care, and antiviral drugs.4
The pandemic period has sig-
nificantly increased the number of GBS
diagnoses in Brazil, and measures to raise
the control of this disease must be carried
out. In addition, physicians and patients
who have already undergone COVID-19
should be aware of this this possible
relation between COVID-19 and GBS
increased cases.
Lorena D. Aquino Ferraz*
Nelson P. Marques, MSc†
Denise M.M. Silveira, MSc‡
Marcelo J.S. de Magalhães, MSc§
Eduardo A. Oliveira, PhD∥
Hercílio Martelli Júnior, PhD†
*Dental School
‡Primary Care Postgraduate Program, State
University of Montes Claros Unimontes
§Department of Neurosurgery, Aroldo
Tourinho Hospital, Montes Claros
∥Department of Pediatrics, Faculty of
Medicine, Federal University of Minas Gerais
(UFMG), Belo Horizonte
¶Center for Rehabilitation of Craniofacial
Anomalies, Dental School, University of
Alfenas, Alfenas, Minas Gerais
†Department of Oral Diagnosis, State
University of Campinas, FOP-UNICAMP
Piracicaba, São Paulo, Brazil
REFERENCES
1. Paybast S, Gorji R, Mavandadi S. Guil-
lain-Barré syndrome as a neurological
complication of novel COVID-19 infec-
tion: a case report and review of the
literature. Neurologist. 2020;25:101–103.
2. Jasti AK, Selmi C, Sarmiento-Monroy JC,
et al. Guillain-Barré syndrome: causes,
immunopathogenic mechanisms and treat-
ment. Expert Rev Clin Immunol. 2016;12:
1175–1189.
3. Garg RK. Spectrum of neurological man-
ifestations in COVID-19: a review. Neurol
India. 2020;68:560–572.
4. Pacheco-Herrero M, Soto-Rojas LO,
Harrington CR, et al. Elucidating the
neuropathologic mechanisms of SARS-
CoV-2 infection. Front Neurol. 2021;
12:60087.
5. Liu Y, Sawalha AH, Lu Q. COVID-19 and
autoimmune diseases. Curr Opin Rheuma-
tol. 2021;33:155–162.
6. Abu-Rumeileh S, Abdelhak A, Foschi M,
et al. Guillain-Barré syndrome spectrum
associated with COVID-19: an up-to-date
systematic review of 73 cases. J Neurol.
2021;268:1133–1170.
7. Dyer O. COVID-19: regulators warn that
rare Guillain-Barré cases may link to J&J
and AstraZeneca vaccines. BMJ. 2021;
374:n1786.
8. Lunn MP, Cornblath DR, Jacobs BC, et al.
COVID-19 vaccine and Guillain-Barré
syndrome: let’s not leap to associations.
Brain. 2021;144:357–360.
9. Toscano G, Palmerini F, Ravaglia S, et al.
Guillain-Barré syndrome associated with
SARS-CoV-2. N Engl J Med. 2020;382:
2574–2576.
10. Carrillo-Larco RM, Altez-Fernandez C,
Ravaglia S, et al. COVID-19 and Guil-
lain-Barre syndrome: a systematic review
of case reports. Wellcome Open Res.
2020;5:107.
Letter to the Editor The Neurologist Volume 00, Number 00, ’’ 2022
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www.theneurologist.org Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Copyright r2022 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
... In some parts of the world, such as Northern Italy, an increase in GBS cases was observed in the initial months of the pandemic compared to the previous year, and it was noted that GBS after COVID-19 infection was also more severe [66]. In Spain [67] and Brazil [68], an increased frequency and severity of GBS was reported in patients with COVID-19. Conversely, the opposite results were obtained in the UK, where, according to data from the national immunoglobulin database, there was a decrease in the number of cases [69]. ...
The Impact of COVID-19 on the Guillain–Barré Syndrome Incidence
Article
Full-text available
  • Jun 2024
Despite the fact that the global COVID-19 pandemic has officially ended, we continue to feel its effects and discover new correlations between SARS-CoV-2 infection and changes in the organism that have occurred in patients. It has been shown that the disease can be associated with a variety of complications, including disorders of the nervous system such as a characteristic loss of smell and taste, as well as less commonly reported incidents such as cranial polyneuropathy or neuromuscular disorders. Nervous system diseases that are suspected to be related to COVID-19 include Guillain–Barré syndrome, which is frequently caused by viruses. During the course of the disease, autoimmunity destroys peripheral nerves, which despite its rare occurrence, can lead to serious consequences, such as symmetrical muscle weakness and deep reflexes, or even their complete abolition. Since the beginning of the pandemic, case reports suggesting a relationship between these two disease entities have been published, and in some countries, the increasing number of Guillain–Barré syndrome cases have also been reported. This suggests that previous contact with SARS-CoV-2 may have had an impact on their occurrence. This article is a review and summary of the literature that raises awareness of the neurological symptoms’ prevalence, including Guillain–Barré syndrome, which may be impacted by the commonly occurring COVID-19 disease or vaccination against it. The aim of this review was to better understand the mechanisms of the virus’s action on the nervous system, allowing for better detection and the prevention of its complications.
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... 15 In Brazil, during the pandemic years (2020-2021), 1,815 cases of GBS were provided care, i.e., 248 more cases (15.8%) than in previous years (2018-2019), which represented an increase in the incidence of GBS during the pandemic: from 1.08 to 1.24 per 100,000 population. 16 In our center, an increase of 56% in GBS cases was observed during the pandemic (2020-2021); however, this information should be considered with reservations because, in those days, several hospitals in Mexico City were converted into COVID-19 care centers, and the National Institute of Neurology and Neurosurgery continued with the care of neurological disorders and supporting other institutions. ...
Guillain-Barre syndrome before and during the COVID-19 pandemic in a referral center of Mexico
Article
  • Sep 2023
  • GAC MED MEX
Background: During the COVID-19 pandemic, an increase in the number of Guillain-Barre syndrome (GBS) cases has been reported. Objective: To describe the clinical characteristics and prognosis of patients with GBS before and during the COVID-19 pandemic. Material and methods: Prospective cohort of GBS patients divided in two subgroups: before (2018-2019) and during (2020-2021) the COVID-19 pandemic. Clinical and paraclinical characteristics, as well as deaths, were recorded. A good prognosis was defined as independent ambulation recovery at three months. Results: Two-hundred and one patients were included (123 during and 78 before the pandemic), out of whom 69% were males; age was 45 ± 16 years, and there was 2.5% of in-hospital deaths. During the pandemic, a higher frequency of the demyelinating variant (50%), bulbar cranial nerves involvement (44% vs. 28%), prior history of vaccination (16% vs. 0%), and a lower MRC score (30 ± 16.7 vs. 34.3 ± 17.7) were documented. An increase in the number of cases was observed from July to September (38 vs. 13). There were no significant differences in independent ambulation recovery or in the number of deaths. Conclusions: During the COVID-19 pandemic, a higher number of GBS cases were treated, out of which 16% were associated with the SARS-CoV-2 vaccine; patients treated during the pandemic did not have a worse prognosis.
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... 15 En Brasil, durante los años de la pandemia (2020-2021) se atendieron 1815 casos de SGB, 248 casos (15.8 %) más que en años anteriores (208-2019), lo que representó un incremento en la incidencia de SGB durante la pandemia: de 1.08 a 1.24 por 100 000 personas. 16 En nuestro centro se apreció un incremento de 56 % de casos de SGB durante la pandemia (2020-2021); no obstante, esta información debe considerarse con reserva debido a que en este tiempo varios hospitales de la Ciudad de México se convirtieron en centros de atención de COVID-19 y el Instituto Nacional de Neurología y Neurocirugía continuó con la atención de padecimientos neurológicos y apoyando a otras instituciones. ...
Síndrome de Guillain-Barré antes y durante la pandemia de COVID-19 en un centro de referencia de México
Article
Full-text available
  • Jul 2023
  • GAC MED MEX
Antecedentes: Durante la pandemia de COVID-19 se ha reportado incremento de casos de síndrome de Guillain-Barré (SGB). Objetivo: Describir características clínicas y pronóstico de pacientes con SGB antes y durante la pandemia de COVID-19. Material y métodos: Cohorte prospectiva de pacientes con SGB estratificados en dos subgrupos: antes (2018-2019) y durante (2020-2021) la pandemia de COVID-19. Se registraron características clínicas, paraclínicas y defunciones. Se definió como buen pronóstico a la recuperación de la marcha independiente a los tres meses. Resultados: Se incluyeron 201 pacientes (123 durante la pandemia y 78 antes), 69 % del sexo masculino, edad de 45 ± 16 años, 2.5 % de muertes intrahospitalarias. Durante la pandemia se observó mayor frecuencia de la variante desmielinizante (50 %), afección de nervios craneales bulbares (44 % versus 28 %), antecedente de vacunación (16 % versus 0 %) y menor puntuación en la escala MRC (30 ± 16.7 versus 34.3 ± 17.7); se observó aumento de casos de julio a septiembre (38 versus 13). No existieron diferencias significativas en la recuperación de la marcha independiente y número de defunciones. Conclusiones: Durante la pandemia se atendió mayor número de casos de SGB, 16 % asociado a la vacuna contra SARS-CoV-2; los pacientes no presentaron peor pronóstico.
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Elucidating the Neuropathologic Mechanisms of SARS-CoV-2 Infection
Article
Full-text available
  • Apr 2021
The current pandemic caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a public health emergency. To date, March 1, 2021, coronavirus disease 2019 (COVID-19) has caused about 114 million accumulated cases and 2.53 million deaths worldwide. Previous pieces of evidence suggest that SARS-CoV-2 may affect the central nervous system (CNS) and cause neurological symptoms in COVID-19 patients. It is also known that angiotensin-converting enzyme-2 (ACE2), the primary receptor for SARS-CoV-2 infection, is expressed in different brain areas and cell types. Thus, it is hypothesized that infection by this virus could generate or exacerbate neuropathological alterations. However, the molecular mechanisms that link COVID-19 disease and nerve damage are unclear. In this review, we describe the routes of SARS-CoV-2 invasion into the central nervous system. We also analyze the neuropathologic mechanisms underlying this viral infection, and their potential relationship with the neurological manifestations described in patients with COVID-19, and the appearance or exacerbation of some neurodegenerative diseases.
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COVID-19 and Guillain-Barre Syndrome: a systematic review of case reports
Article
Full-text available
  • Sep 2020
Background: Guillain-Barre Syndrome (GBS) is a neurological autoimmune disease that can lead to respiratory failure and death. Whether COVID-19 patients are at high risk of GBS is unknown. Through a systematic review of case reports, we aimed to summarize the main features of patients with GBS and COVID-19. Methods: Without any restrictions, we searched MEDLINE, Embase, Global Health, Scopus, Web of Science and MedXriv (April 23 rd, 2020). Two reviewers screened and studied titles, abstracts and reports. We extracted information to characterize sociodemographic variables, clinical presentation, laboratory results, treatments and outcomes. Results: Eight reports (n=12 patients) of GBS and COVID-19 were identified; one was a Miller Fisher case. The age ranged between 23 and 77 years, and there were more men (9/102). GBS symptoms started between 5 and 24 days after those of COVID-19. The protein levels in cerebrospinal fluid samples ranged between 40 and 193 mg/dl. None of the cerebrospinal fluid samples tested positive for COVID-19. Six patients debuted with ascendant weakness and three with facial weakness. Five patients had favourable evolution, four remained with relevant symptoms or required critical care and one died; the Miller Fisher case had successful resolution. Conclusions: GBS is emerging as a disease that may appear in COVID-19 patients. Although limited, preliminary evidence appears to suggest that GBS occurs after COVID-19 onset. Practitioners and investigators should have GBS in mind as they look after COVID-19 patients and conduct research on novel aspects of COVID-19. Comparison with GBS patients in the context of another viral outbreak (Zika), revealed similarities and differences that deserves further scrutiny and epidemiological studies.
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Guillain-Barré syndrome spectrum associated with COVID-19: an up-to-date systematic review of 73 cases
Article
Full-text available
  • Apr 2021
  • J NEUROL
Since coronavirus disease-2019 (COVID-19) outbreak in January 2020, several pieces of evidence suggested an association between the spectrum of Guillain-Barré syndrome (GBS) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Most findings were reported in the form of case reports or case series, whereas a comprehensive overview is still lacking. We conducted a systematic review and searched for all published cases until July 20th 2020. We included 73 patients reported in 52 publications. A broad age range was affected (mean 55, min 11-max 94 years) with male predominance (68.5%). Most patients showed respiratory and/or systemic symptoms, and developed GBS manifestations after COVID-19. However, asymptomatic cases for COVID-19 were also described. The distributions of clinical variants and electrophysi-ological subtypes resemble those of classic GBS, with a higher prevalence of the classic sensorimotor form and the acute inflammatory demyelinating polyneuropathy, although rare variants like Miller Fisher syndrome were also reported. Cer-ebrospinal fluid (CSF) albuminocytological dissociation was present in around 71% cases, and CSF SARS-CoV-2 RNA was absent in all tested cases. More than 70% of patients showed a good prognosis, mostly after treatment with intravenous immunoglobulin. Patients with less favorable outcome were associated with a significantly older age in accordance with previous findings regarding both classic GBS and COVID-19. COVID-19-associated GBS seems to share most features of classic post-infectious GBS and possibly the same immune-mediated pathogenetic mechanisms. Nevertheless, more extensive epidemiological studies are needed to clarify these issues.
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Spectrum of Neurological Manifestations in Covid-19: A Review
Article
Full-text available
  • Jul 2020
COVID-19, in most patients, presents with mild flu-like illness. Elderly patients with comorbidities, like hypertension, diabetes, or lung and cardiac disease, are more likely to have severe disease and deaths. Neurological complications are frequently reported in severely or critically ill patients with comorbidities. In COVID-19, both central and peripheral nervous systems can be affected. The SARS-CoV-2 virus causes the disease COVID-19 and has the potential to invade the brain. The SARS-CoV-2 virus enters the brain either via a hematogenous route or olfactory system. Angiotensin-converting enzyme two receptors, present on endothelial cells of cerebral vessels, are a possible viral entry point. The most severe neurological manifestations, altered sensorium (agitation, delirium, and coma), are because of hypoxic and metabolic abnormalities. Characteristic cytokine storm incites severe metabolic changes and multiple organ failure. Profound coagulopathies may manifest with ischemic or hemorrhagic stroke. Rarely, SARS-CoV-2 virus encephalitis or pictures like acute disseminated encephalomyelitis or acute necrotizing encephalopathy have been reported. Nonspecific headache is a commonly experienced neurological symptom. A new type of headache “personal protection equipment-related headache” has been described. Complete or partial anosmia and ageusia are common peripheral nervous system manifestations. Recently, many cases of Guillain-Barré syndrome in COVID-19 patients have been observed, and a postinfectious immune-mediated inflammatory process was held responsible for this. Guillain-Barré syndrome does respond to intravenous immunoglobulin. Myalgia/fatigue is also common, and elevated creatine kinase levels indicate muscle injury. Most of the reports about neurological complications are currently from China. COVID-19 pandemic is spreading to other parts of the world; the spectrum of neurological complications is likely to widen further.
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Guillain-Barré Syndrome as a Neurological Complication of Novel COVID-19 Infection: A Case Report and Review of the Literature
Article
Full-text available
  • Jul 2020
Introduction: The novel coronavirus (COVID-19) is a global pandemic. Although the main clinical manifestation of COVID-19 is respiratory involvement, there is evidence suggesting the neuroinvasive potential of COVID-19. There are limited reports of neurological complications of COVID-19 infection in the literature. Herein, we aim to describe 2 members of a family affected by COVID-19, presenting with ascending paresthesia with the final diagnosis of Guillain-Barré syndrome. Case report: A 38-year-old man presented with a history of ascending paresthesia and bilateral facial droop since 5 days before admission. The medical history was positive for flu-like symptoms affecting all the members of his family. The neurological examination was notable for bilateral peripheral facial paralysis, generalized areflexia, and derceased sensation in distal limbs. The cerebrospinal fluid analysis revealed an albuminocytologic dissociation. In addition, the electromyography-nerve conduction study findings were suggestive of acute axonal-demyelinating polyneuropathy. Meanwhile the patient was treated with a diagnosis of Guillain-Barré syndrome, his 14-year-old daughter presented with a history of progressive paresthesia and weakness. Similar to her father, the paraclinical evaluations were consistent with Guillain-Barré syndrome. Taking into account clinical findings and the outbreak of COVID-19, the suspicion of COVID-19 was proposed. Eventually, on the basis of throat swab samples stand on polymerase chain reaction, the patients were diagnosed with COVID-19. Conclusion: Our cases revealed the familial occurrence of Guillain-Barré syndrome after COVID-19 infection. The authors emphasize neurological complications of COVID-19.
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Guillain-Barré syndrome: causes, immunopathogenic mechanisms and treatment
Article
Full-text available
Introduction: Guillain-Barrè syndrome is a rare disease representing the most frequent cause of acute flaccid symmetrical weakness of the limbs and areflexia usually reaching its peak within a month. The etiology and pathogenesis remain largely enigmatic and the syndrome results in death or severe disability in 9-17% of cases despite immunotherapy. Areas covered: In terms of etiology, Guillain-Barrè syndrome is linked to Campylobacter infection but less than 0.1% of infections result in the syndrome. In terms of pathogenesis, activated macrophages and T cells and serum antibodies against gangliosides are observed but their significance is unclear. Expert Commentary: Guillain-Barrè syndrome is a heterogeneous condition with numerous subtypes and recent data point towards the role of ganglioside epitopes by immunohistochemical methods. Ultimately, we are convinced that the syndrome results from a permissive genetic background on which environmental factors, including infections, vaccination and the influence of aging, lead to disease.
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COVID-19 vaccine and Guillain-Barré syndrome: let’s not leap to associations
Article
  • Dec 2020
This special commentary refers to ‘Epidemiological and cohort study finds no association between COVID-19 and Guillain-Barré syndrome’ by Keddie et al. (doi:10.1093/brain/awaa433).
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COVID-19 and autoimmune diseases
Article
  • Dec 2020
Purpose of review: The aim of this study was to evaluate the relationship between infection with SARS-CoV-2 and autoimmunity. Recent findings: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome (SARS) associated coronavirus 2 (SARS-CoV-2). Although most of the infected individuals are asymptomatic, a proportion of patients with COVID-19 develop severe disease with multiple organ injuries. Evidence suggests that some medications used to treat autoimmune rheumatologic diseases might have therapeutic effect in patients with severe COVID-19 infections, drawing attention to the relationship between COVID-19 and autoimmune diseases. COVID-19 shares similarities with autoimmune diseases in clinical manifestations, immune responses and pathogenic mechanisms. Robust immune reactions participate in the pathogenesis of both disease conditions. Autoantibodies as a hallmark of autoimmune diseases can also be detected in COVID-19 patients. Moreover, some patients have been reported to develop autoimmune diseases, such as Guillain--Barré syndrome or systemic lupus erythematosus, after COVID-19 infection. It is speculated that SARS-CoV-2 can disturb self-tolerance and trigger autoimmune responses through cross-reactivity with host cells. The infection risk and prognosis of COVID-19 in patients with autoimmune diseases remains controversial, but patient adherence to medication regimens to prevent autoimmune disease flares is strongly recommended. Summary: We present a review of the association between COVID-19 and autoimmune diseases, focusing on similarities in immune responses, cross-reactivity of SARS-CoV-2, the development of autoimmune diseases in COVID-19 patients and the risk of COVID-19 infection in patients with preexisting autoimmune conditions.
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