Confirmed severe acute respiratory syndrome coronavirus 2 encephalitis in cerebrospinal fluid: a case report

Ayuningtyas, Triana; Natadidjaja, Ronald Irwanto; Octaviani, Chyntia; Sahli, Felly; Adlani, Hadianti

doi:10.1186/s13256-022-03376-w

Cited by 3 publications

(3 citation statements)

References 8 publications

(7 reference statements)

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“…Several cases developed neurological impairment following respiratory symptoms. The latency between the onset of the infection with respiratory manifestations and the onset of neurological complications varied between 3 days and 41 days [ 12 , 24 , 27 , 28 , 30 , 32 , 34 , 36 , 37 , 43 , 45 , 51 , 56 , 58 , 64 , 65 , 70 , 76 , 80 , 81 , 82 , 83 , 85 , 86 , 89 , 90 , 91 , 93 , 94 ]. Overall, 13 patients were intubated and mechanically ventilated due to respiratory distress; in these cases, the detection of neurological impairment happened when sedation was interrupted, with latency ranging between 4 and 38 days depending on the case [ 27 , 32 , 34 , 76 , 80 , 82 , 85 , 93 ].…”

Section: Resultsmentioning

confidence: 99%

“…In patients whose respiratory distress was less evident, neurological manifestation appeared after a few days in most cases [ 27 , 28 , 30 , 37 , 45 , 56 , 58 , 65 , 89 , 91 , 93 , 94 ]. In some cases, the latency ranged from over two weeks to 60 days [ 12 , 24 , 27 , 64 , 90 ]. Three patients began their illness with symptoms other than respiratory and developed neurological impairments between 5 and 17 days after the onset of the initial symptoms [ 22 , 47 , 50 ].…”

Section: Resultsmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Islam

Cavestro

Alam

et al. 2022

Cells

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“…A number of studies have now shown brain infection in COVID-19 patients [33][34][35][36][37] , with viral RNA or protein detected in the brains of 20-38% of patients that died of COVID-19 38,39 . A number of groups have also reported detection of viral RNA in cerebrospinal fluid of COVID-19 patients [40][41][42][43][44] , including patients infected with omicron virus 45 .…”

Section: Introductionmentioning

confidence: 99%

Increased neurovirulence of omicron BA.5 and XBB variants over BA.1 in K18-hACE2 mice and human brain organoids

Stewart

Ellis

Yan

et al. 2022

Preprint

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A frequently repeated premise is that viruses evolve to become less pathogenic. This appears also to be true for SARS-CoV-2, although the increased level of immunity in human populations makes it difficult to distinguish between reduced intrinsic pathogenicity and increasing protective immunity. The reduced pathogenicity of the omicron BA.1 sub-lineage compared to earlier variants is well described and appears to be due to reduced utilization of TMPRRS2. That this reduced pathogenicity remains true for omicron BA.5 was recently reported. In sharp contrast, we show that a BA.5 isolate was significantly more pathogenic in K18-hACE2 mice than a BA.1 isolate, with BA.5 infection showing increased neurovirulence, encephalitis and mortality, similar to that seen for an original strain isolate. BA.5 also infected human cortical brain organoids to a greater extent than a BA.1 and original strain isolate. Neurons were the target of infection, with increasing evidence of neuron infection in COVID-19 patients. These results argue that while omicron virus may be associated with reduced respiratory symptoms, BA.5 shows increased neurovirulence compared to earlier omicron sub-variants.

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Increased neurovirulence of omicron BA.5 over BA.1 in human brain organoids and K18-hACE2 mice

Stewart

Ellis

Yan

et al. 2023

Preprint

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The reduced pathogenicity of the omicron BA.1 sub-lineage compared to earlier variants is well described, although whether such attenuation is retained for later variants like BA.5 remains controversial. We show that a BA.5 isolate was significantly more pathogenic in K18-hACE2 mice than a BA.1 isolate, with BA.5 infections showing increased neuroinvasiveness, resulting in brain infection and mortality, similar to that seen for original ancestral isolates. BA.5 also infected human cortical brain organoids to a greater extent than the BA.1 and original ancestral isolates. In the brains of mice neurons were the main target of infection, and in human organoids neuronal progenitor cells and immature neurons were infected. Evidence for brain infection and brain damage in certain COVID-19 patients is becoming compelling, with the results herein illustrating the increasing intrinsic neuropathogenic potential of evolving omicron variants.

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Confirmed severe acute respiratory syndrome coronavirus 2 encephalitis in cerebrospinal fluid: a case report

Cited by 3 publications

References 8 publications

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

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

Increased neurovirulence of omicron BA.5 and XBB variants over BA.1 in K18-hACE2 mice and human brain organoids

Increased neurovirulence of omicron BA.5 over BA.1 in human brain organoids and K18-hACE2 mice

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