Acute Encephalitis Associated with SARS-CoV-2 Confirmed in Cerebrospinal Fluid: First Case in Malaysia

Tee, Tze Yuan; Thabit, Alif Adlan Mohd; Khoo, Ching Soong; Shahrom, Hisham Md; Chan, En Ze; Marzukie, Marsilla; Kamaruddin, Zul Amali Che; Thayan, Ravindran; Chidambaram, Suresh Kumar

doi:10.3988/jcn.2021.17.3.490

J Clin Neurol

2021

DOI: 10.3988/jcn.2021.17.3.490

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Acute Encephalitis Associated with SARS-CoV-2 Confirmed in Cerebrospinal Fluid: First Case in Malaysia

Tze Yuan Tee¹,

Alif Adlan Mohd Thabit

Ching Soong Khoo

et al.

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Cited by 3 publications

(9 citation statements)

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“…The patient benefited significantly from ceftriaxone, meropenem, favipiravir, dexamethasone, methylprednisolone, clonazepam, valproic acid, and tuberculostatics. 1 Complete recovery was achieved 10 days after the onset of the neurological compromise. 1 The study results are appealing, but they raise several comments and concerns, as detailed below.…”

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confidence: 99%

“… 1 Complete recovery was achieved 10 days after the onset of the neurological compromise. 1 The study results are appealing, but they raise several comments and concerns, as detailed below.…”

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confidence: 99%

“…With interest we read the article by Tee et al 1 about a 69-year-old male with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated encephalitis classified as infectious upon confirmation of the virus in the cerebrospinal fluid (CSF) by PCR. The patient benefited significantly from ceftriaxone, meropenem, favipiravir, dexamethasone, methylprednisolone, clonazepam, valproic acid, and tuberculostatics.…”

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confidence: 99%

“…Another limitation is that “results of other CSF analyses” were not specified. 1 It should be reported if investigations for viruses other than SARS-CoV-2 in the CSF were truly negative, if tuberculous meningitis and immune encephalitis were appropriately excluded, and if the CSF was tested for antibodies associated with immune encephalitis. Excluding immune encephalitis is crucial since SARS-CoV-2-associated encephalitis is due to an immune reaction against the virus rather than to a direct viral attack against the central nervous system.…”

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confidence: 99%

“… 3 Several other cases of SARS-CoV-2-associated infectious encephalitis reported in the literature 4 5 were not listed in the table of the case report. 1 …”

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confidence: 99%

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Comments on “CSF-Confirmed SARS-CoV-2 Acute Encephalitis”: SARS-CoV-2-Associated Encephalitis Is Autoimmune Rather Than Infectious

Finsterer

Fiorini

2022

J Clin Neurol

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confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

“… 3 Several other cases of SARS-CoV-2-associated infectious encephalitis reported in the literature 4 5 were not listed in the table of the case report. 1 …”

mentioning

confidence: 99%

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Comments on “CSF-Confirmed SARS-CoV-2 Acute Encephalitis”: SARS-CoV-2-Associated Encephalitis Is Autoimmune Rather Than Infectious

Finsterer

Fiorini

2022

J Clin Neurol

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Role of SARS-CoV-2 in Modifying Neurodegenerative Processes in Parkinson’s Disease: A Narrative Review

et al. 2022

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The COVID-19 pandemic, caused by SARS-CoV-2, continues to impact global health regarding both morbidity and mortality. Although SARS-CoV-2 primarily causes acute respiratory distress syndrome (ARDS), the virus interacts with and influences other organs and tissues, including blood vessel endothelium, heart, gastrointestinal tract, and brain. We are learning much about the pathophysiology of SARS-CoV-2 infection; however, we are just beginning to study and understand the long-term and chronic health consequences. Since the pandemic’s beginning in late 2019, older adults, those with pre-existing illnesses, or both, have an increased risk of contracting COVID-19 and developing severe COVID-19. Furthermore, older adults are also more likely to develop the neurodegenerative disorder Parkinson’s disease (PD), with advanced age as the most significant risk factor. Thus, does SARS-CoV-2 potentially influence, promote, or accelerate the development of PD in older adults? Our initial focus was aimed at understanding SARS-CoV-2 pathophysiology and the connection to neurodegenerative disorders. We then completed a literature review to assess the relationship between PD and COVID-19. We described potential molecular and cellular pathways that indicate dopaminergic neurons are susceptible, both directly and indirectly, to SARS-CoV-2 infection. We concluded that under certain pathological circumstances, in vulnerable persons-with-Parkinson’s disease (PwP), SARS-CoV-2 acts as a neurodegenerative enhancer to potentially support the development or progression of PD and its related motor and non-motor symptoms.

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Encephalitis in Patients with COVID-19: A Systematic Evidence-Based Analysis

Islam

Cavestro

Alam

et al. 2022

Cells

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Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) predominantly infects the respiratory system, several investigations have shown the involvement of the central nervous system (CNS) along the course of the illness, with encephalitis being one of the symptoms. The objective of this systematic review was to evaluate the characteristics (clinical, neuro-radiological aspects, and laboratory features) and outcomes of encephalitis in COVID-19 patients. PubMed, Scopus, and Google Scholar databases were searched from 1 December 2019 until 21 July 2022 to identify case reports and case series published on COVID-19 associated with encephalitis. The quality of the included studies was assessed by the Joanna Briggs Institute critical appraisal checklists. This systematic review included 79 studies, including 91 COVID-19 patients (52.7% male) experiencing encephalitis, where 85.6% were adults (49.3 ± 20.2 years), and 14.4% were children (11.2 ± 7.6 years). RT-PCR was used to confirm 92.2% of the COVID-19 patients. Encephalitis-related symptoms were present in 78.0% of COVID-19 patients at the time of diagnosis. In these encephalitis patients, seizure (29.5%), confusion (23.2%), headache (20.5%), disorientation (15.2%), and altered mental status (11.6%) were the most frequently reported neurologic manifestations. Looking at the MRI, EEG, and CSF findings, 77.6%, 75.5%, and 64.1% of the patients represented abnormal results. SARS-CoV-2-associated or -mediated encephalitis were the most common type observed (59.3%), followed by autoimmune encephalitis (18.7%). Among the included patients, 66.7% were discharged (37.8% improved and 28.9% fully recovered), whereas 20.0% of the reported COVID-19-positive encephalitis patients died. Based on the quality assessment, 87.4% of the studies were of high quality. Although in COVID-19, encephalitis is not a typical phenomenon, SARS-CoV-2 seems like a neuropathogen affecting the brain even when there are no signs of respiratory illness, causing a high rate of disability and fatality.

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Acute Encephalitis Associated with SARS-CoV-2 Confirmed in Cerebrospinal Fluid: First Case in Malaysia

Cited by 3 publications

References 7 publications

Comments on “CSF-Confirmed SARS-CoV-2 Acute Encephalitis”: SARS-CoV-2-Associated Encephalitis Is Autoimmune Rather Than Infectious

Comments on “CSF-Confirmed SARS-CoV-2 Acute Encephalitis”: SARS-CoV-2-Associated Encephalitis Is Autoimmune Rather Than Infectious

Role of SARS-CoV-2 in Modifying Neurodegenerative Processes in Parkinson’s Disease: A Narrative Review

Encephalitis in Patients with COVID-19: A Systematic Evidence-Based Analysis

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