COVID‐19‐associated Guillain‐Barre syndrome: Postinfectious alone or neuroinvasive too?

Abstract

Coronavirus disease 2019 (COVID‐19) has been shown to be associated with a lot of neurological complications, of whom Guillain‐Barre syndrome (GBS) is an important post‐infectious consequentiality. More than 220 patients with GBS have been reported thus far. We intend to share our experience with five patients of GBS where one of them had severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) in the cerebrospinal fluid (CSF). This is the first‐ever report demonstrating the presence of SARS‐CoV‐2 in the CSF of an adult patient; a similar occurrence has recently been described in a pediatric patient. We wish to emphasize the fact that commonly GBS occurs as a result of a post‐infectious process but in a few cases where the symptoms of COVID‐19 and GBS occur concurrently, corresponding to the viremic phase, separate pathogenesis needs to be thought of. This para‐infectious nature is exemplified by the presence of virus in the cerebrospinal fluid of one of our patients. We review the neuroinvasive potential of SARS‐Cov‐2 in this regard and draw parallels with Cytomegalovirus, Zika virus, and Human Immunodeficiency virus‐associated occurrences of GBS.

Patients' attitude towards vaccination after Guillain Barré syndrome

“…In the meantime, it is known that COVID‐19 infection may trigger GBS. 37 , 38 Also in addition, different kinds of COVID‐19 vaccines have been reported to have the potential to trigger GBS. 39 , 40 , 41 , 42 …”

Cellular and Molecular Effects of SARS-CoV-2 Linking Lung Infection to the Brain

“…Moreover, the same study hypothesizes about the similarities between severe COVID −19 phenotypes and those present in patients with lupus and antiphospholipid syndrome, both of which are typical for the presence of anti-phospholipid autoantibodies, and in extremely severe cases, can cause multiple organ failure (75). Additionally, a growing number of case reports describing a connection between SARS−CoV−2 and the Guillain-Barrésyndrome (GBS) has emerged recently (167)(168)(169)(170)(171). GBS is a state of acute limb paralysis caused typically by an antecedent infectious disease (often a gastrointestinal or respiratory infection) or other immune stimulation that induces an aberrant autoimmune response that targets peripheral nerves and leads to weakness and loss of sensation (172,173).…”

“…GBS is a state of acute limb paralysis caused typically by an antecedent infectious disease (often a gastrointestinal or respiratory infection) or other immune stimulation that induces an aberrant autoimmune response that targets peripheral nerves and leads to weakness and loss of sensation (172,173). The reported cases of COVID −19-associated GBS highlight the similarities with cytomegalovirus, Zika virus, and HIV-associated GBS, and thus also suggest a neuroinvasive potential of SARS−CoV−2 (170). At the same time, these findings further underline the importance of immune modulation and autoimmune processes in SARS−CoV−2 infected patients.…”

Guillain‐Barré syndrome is immunogenic in SARS‐CoV‐2 infected

“…2 Whether the presence of virus-RNA in these two cases represents false-positive results is unknown as no results of test-/retest-reliability were provided in either case. 1,2 Though it is conceivable that the low number of patients positive for virus-RNA in the CSF is due to the low number of SACAG patients undergoing investigative workup for virus-RNA in the CSF, there are several arguments that favor the immunogenic etiology of the condition.…”