COVID-19-News: Scientist From Rutgers University Warns That Guillain–Barré Syndrome Can Be Triggered By SARS-CoV-2

COVID-19-News: Medical researchers from the  Rutgers Robert Wood Johnson Medical School-New Jersey have reported the first documented case of COVID-19 triggering a recurrence of Guillain-Barré Syndrome , a rare disorder where the body's immune system attacks nerves and can lead to respiratory failure and death.


 
COVID-19 has been reported to trigger Guillain–Barré syndrome (GBS). While uncommon, recurrent GBS (rGBS) episodes, triggered by antecedent viral infections, have been reported in a small proportion of GBS patients, here the study team describes a patient with a recurrent case of GBS, occurring secondary to COVID-19 infection. Before this patient’s episode, he had two prior GBS flares, each precipitated by a viral infection followed by complete recovery besides intermittent paresthesias. The study team also considered the nosology of this illness in the spectrum of rGBS and Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), with their differing natural histories, prognosis, and therapeutic approaches. For patients who have a history of inflammatory demyelinating polyradiculopathies who develop COVID-19, the study team recommends close observation for neurologic symptoms over the next days and weeks. 
 
The case report was published in the peer reviewed journal: Pathogens https://www.mdpi.com/2076-0817/9/11/965
 
Thailand Medical News had already published warnings about the potential of COVID-19 to cause Guillain–Barré Syndrome as early as July. https://www.thailandmedical.news/news/breaking-guillain-barre-syndrome-a-rare-neurological-disorder-manifesting-in-more-covid-19-patients
 
Guillain- Barré syndrome is a rare disorder in which the body's immune system attacks the nerves. Weakness and tingling in the extremities are usually the first symptoms.
 
These sensations can quickly spread, eventually paralyzing the whole body. In its most severe form Guillain-Barre syndrome is a medical emergency. Most individuals with the condition must be hospitalized to receive treatment.
The symptoms of Guillain-Barre syndrome often begins with tingling and weakness starting in the feet and legs and spreading to the upper body and arms. In about 10% of individuals with the disorder, symptoms begin in the arms or face. As Guillain-Barre syndrome progresses, muscle weakness can evolve into paralysis.
 
Typical signs and symptoms of Guillain-Barre syndrome may include:
 
-Weakness in the legs that spreads to the upper body
 
-Unsteady walking or inability to walk or climb stairs
 
-Prickling, pins and needles sensations in the fingers, toes, ankles or wrists
 
-Difficulty with facial movements, including speaking, chewing or swallowing
Double vision or inability to move eyes
 
-Severe pain that may feel achy, shooting or cramplike and may be worse at night
 
-Rapid heart rate
 
-Low or high blood pressure
 
-Difficulty with bladder control or bowel function
 
-Difficulty breathing
 
Individuals with Guillain-Barre syndrome usually experience their most significant weakness within two weeks after symptoms begin.
 
Recent research has shown that COVID-19 has been associated with a broad range of immune neuropathies, including Guillain–Barré syndrome (GBS) and the worsening of Chronic Inflammatory Demyelinating Polyradiculopathy (CIDP). https://pubmed.ncbi.nlm.nih.gov/32781484/
 
https://pubmed.ncbi.nlm.nih.gov/32911389/
 
Although  there have been several reports of Guillain-Barré Syndrome following COVID-19, this is the first in which COVID-19 actually triggered a recurrence of the condition - in a 54-year-old man who had suffered with Guillain-Barré Syndrome twice and had a third occurrence after testing positive for COVID-19.
 
Erin McDonnell, medical student, Rutgers Robert Wood Johnson Medical School told Thailand Medical News, “The male patient came to the emergency room with complaints of progressive difficulty swallowing, then had a fever for three days, followed by weakness in the arms, legs and face. His symptoms were worse this time than in previous episodes. He has since recovered."
 
The study team looked at about 1,200 hospital patients diagnosed with COVID-19 who were admitted and discharged between March and May of 2020 and this was the only instance where COVID-19 triggered the recurrence of Guillain-Barré Syndrome.
 
Typically Guillain-Barré Syndrome can follow acute viral and bacterial infections, causing symptoms including weakness and tingling in the extremities. As the condition worsens, the weakness quickly spreads, eventually sometimes paralyzing the whole body. While most individuals recover from the condition, about 5 percent of people experience a recurrence, McDonnell said.
 
Dr Payal Parikh, assistant professor at Rutgers Robert Wood Johnson Medical School, who led the study along with Dr Martin Blaser, director of the Center for Advanced Biotechnology and Medicine told Thailand Medical News, "We recommend that patients who develop COVID-19 and have a history of autoimmune (demyelinating) disorders in which the body's immune system attacks the myelin that insulates and protects their nerves be closely observed for several weeks for neurologic symptoms."
 
The study findings will improve the understanding of the spectrum of Guillain-Barré Syndrome, which may be trigged by acute viral or bacterial infection, and help create treatments for COVID-19 patients.
 
The study team concluded, “While initial GBS episodes triggered by COVID-19 have been well-reported, we describe the first case of rGBS to our knowledge and show that its severity was enhanced compared to prior episodes. This case report also adds to the scarce literature that has already proposed a spectrum of relapsing-remitting demyelinating disorders. Overall, better disease nosology improves proper diagnosis and treatment. The growing body of research will likely show that the rate of GBS in COVID-19 patients is higher than the background GBS incidence. Studying rGBS patients allows us to understand COVID-19 pathophysiology better and for comparisons with other viral antecedents to GBS. For patients who have a history of inflammatory demyelinating polyradiculopathies who develop COVID-19, we recommend close observation for neurologic symptoms over the next days and weeks.”
 
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