Case Study Raises Questions About COVID-19 and Creutzfeldt-Jakob Disease

Medical News: A recent case study has sparked concerns about the possible connection between COVID-19 and Creutzfeldt-Jakob Disease (CJD), a rare and fatal neurodegenerative disorder. This Medical News report discusses findings presented by researchers Mehri from the Biochemistry Laboratory at the Faculty of Medicine, Tunisia, and Finsterer from the Neurology & Neurophysiology Center in Vienna, Austria. They examined a 73-year-old man who developed CJD-like symptoms after contracting a mild case of COVID-19. The study raises new questions about whether there is a potential link between these two diseases.


Case Study Raises Questions About COVID-19 and Creutzfeldt-Jakob Disease

Case Background
The patient in the study was a 73-year-old man who had mild symptoms of COVID-19. About a month later, he began experiencing rapid cognitive decline. This decline included confusion, depression, problems with walking, incontinence, and eventually mutism (loss of speech). Doctors performed a number of tests, including brain scans and spinal fluid analysis, which revealed abnormalities typically associated with CJD. Despite treatment with steroids, the patient’s condition worsened, and he passed away just three months after the onset of symptoms.
 
Doctors diagnosed the man with probable sporadic CJD, but since no autopsy was performed, it could not be confirmed with absolute certainty. This case has led researchers to question whether COVID-19 could somehow accelerate the progression of CJD or trigger a CJD-like syndrome.
 
What is Creutzfeldt-Jakob Disease?
Creutzfeldt-Jakob Disease, or CJD, is a rare but fatal brain disorder caused by abnormal proteins called prions. These prions cause brain cells to die, leading to rapid mental deterioration and eventually death. There are different types of CJD, including sporadic, which occurs with no known cause, and variant, which has been linked to eating contaminated meat.
 
CJD progresses quickly, and most patients die within a few months of the first symptoms. It is diagnosed through a combination of clinical symptoms, brain imaging, and tests of cerebrospinal fluid (CSF). However, a definitive diagnosis of CJD can only be made through a brain biopsy or autopsy, which involves examining brain tissue directly for signs of prion disease.
 
COVID-19 and CJD: Is There a Link?
Since the beginning of the COVID-19 pandemic, there have been a small number of reports suggesting that SARS-CoV-2, the virus that causes COVID-19, may be linked to the development of neurodegenerative diseases like CJD. However, the evidence remains limited, and many experts are skeptical of any direct connection.
 
In this case, the man’s symptoms began just a month after recovering from COVID-19. This raises the question: could the virus have triggered or accelerated the development of CJD?
 
According to the researchers, it’s unlikely. There are several reasons for this. First, there has been no increase in the overall nu mber of CJD cases during the COVID-19 pandemic. Studies from countries like Australia and the UK, where CJD is closely monitored, have found no significant rise in cases since the pandemic began. In fact, the number of CJD cases has remained fairly consistent, suggesting that SARS-CoV-2 is not causing more people to develop the disease.

Second, the incubation period for CJD is usually quite long - between 11 and 15 years in many cases. This means that if SARS-CoV-2 were causing CJD, we wouldn’t expect to see cases appearing so soon after infection.
 
Key Study Findings
Despite the lack of clear evidence linking COVID-19 and CJD, this case highlights some important questions. The researchers pointed out several aspects of the patient’s condition that warrant further investigation:
 
-Rapid Onset After COVID-19: While CJD typically takes years to develop, this patient’s symptoms began just one month after recovering from COVID-19. It’s unclear whether this is a coincidence or whether COVID-19 somehow played a role in accelerating the disease’s progression.
 
-No Definite Diagnosis Without Autopsy: CJD can only be definitively diagnosed through a brain biopsy or autopsy, but these procedures carry risks, especially with diseases like CJD, which involve infectious prions. In this case, an autopsy was not performed, so the diagnosis remains “probable” rather than confirmed.
 
-Need for Further Research: The researchers called for more studies to explore the possible relationship between COVID-19 and neurodegenerative diseases like CJD. Specifically, they recommend looking at long-term COVID-19 survivors to see if any develop CJD-like symptoms in the future.
 
-Testing for Other Causes: The study also highlighted the importance of ruling out other possible causes of rapid cognitive decline. In this case, the patient’s spinal fluid was tested for only a limited number of viruses, and certain autoimmune conditions were not thoroughly investigated. The researchers suggest that future cases should involve more extensive testing to ensure that all other possible causes are ruled out before diagnosing CJD.
 
Conclusions
The case discussed by Mehri and Finsterer is thought-provoking and raises important questions about the long-term neurological effects of COVID-19. However, based on the current evidence, it seems unlikely that SARS-CoV-2 is directly causing CJD. The number of CJD cases has not increased during the pandemic, and the long incubation period of CJD makes it improbable that the virus would trigger the disease so quickly.
 
That said, it is still possible that COVID-19 could accelerate the progression of pre-existing conditions or cause a CJD-like syndrome in some patients. More research is needed to fully understand the relationship between COVID-19 and neurodegenerative diseases.
 
In the meantime, this case serves as a reminder of the complexity of diagnosing diseases like CJD and the importance of thorough testing to rule out other possible causes of rapid cognitive decline. While the idea of a link between COVID-19 and CJD is intriguing, it remains speculative, and more evidence is needed before any firm conclusions can be drawn.
 
The case report was published in the peer-reviewed journal: Egyptian Journal of Neurology, Psychiatry, and Neurosurgery.
https://link.springer.com/article/10.1186/s41983-024-00880-2
 
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https://www.thailandmedical.news/news/warning-sars-cov-2-infections-can-trigger-and-accelerate-progression-of-creutzfeldt-jakob-disease-in-those-with-e200k-mutation
 
https://www.thailandmedical.news/news/unusually-late-onset-of-rare-brain-disease-after-covid-19