Meningoencephalitis associated with COVID-19: A systematic review

Abstract

Background and aims: With the growing number of COVID-19 cases in recent times, the varied range of presentations is progressively becoming an addressing issue among clinicians. A significant set of patients with extra pulmonary symptoms has been reported worldwide. Neurological involvement in the form of altered mental status, loss of consciousness in considerable amounts has drawn attention of physicians all across the globe. Here we venture out to summarise the clinical profile, investigations and radiological findings among patients with SARS-CoV-2 associated meningoencephalitis in the form of a systematic review, which may aid clinicians in early diagnosis and prognostic evaluation of the disease. Methodology: This review was carried out based on the existing PRISMA (Preferred Report for Systemic Review and Meta analyses) consensus statement. The data for this review was collected from four databases: Pubmed/Medline, NIH Litcovid, Embase and Cochrane library and Preprint servers up till 10th June, 2020. Search strategy comprised of a range of keywords from relevant medical subject headings which includes "SARS-COV-2", "COVID-19", "meningoencephalitis" etc. All peer reviewed, case control, case report, pre print articles satisfying our inclusion criteria were involved in the study. The inclusion prerequisites comprised of confirmed SARS-CoV-2 cases with neurological manifestations, previous cases of SARS-CoV, MERS-CoV with neurological involvement provided all the studies were published in English language. Quantitative data was expressed in mean+/-SD, while the qualitative date in percentages. Paired t test was used for analysing the data based on differences between mean and respective values with a p value of <0.05 considered to be statistically significant. Results: A total of 43 cases were involved from 24 studies after screening from databases and preprint servers, out of which 29 of them had completed investigation profile and were included in the final analysis. Clincial and Laboratory findings as well as neuroimaging findings (CT, MRI and MRS) revealed consistent presentations towards association of COVID-19 with meningoencephalitis. Epileptogenic pictures were also evident on EEG (electroencephalogram) findings. Conclusion: SARS-CoV-2 has been isolated from CSF as well as cerebrum of cases with meningoencephalitis depicting the natural tendency of the virus to invade the central nervous system. Speculations about retrograde olfactory transport or alternative haematogenous spread seem to be correlating with above findings. This review may raise the index of suspicion about COVID-19 among clinicians while attending patients with neurological manifestations.

Encephalitis as a neurological complication of COVID‐19: A systematic review and meta‐analysis of incidence, outcomes, and predictors

“…Most often, patients present with respiratory symptoms and develop encephalitis an average of 14.5 days later, during their hospital stay [7,21,25]. Therefore, it could be beneficial for physicians to monitor severely ill COVID-19 patients more closely to mitigate the development of encephalitis as a complication of COVID-19 should it occur [11]. However, a few COVID-19 patients who suffer from encephalitis as a complication are asymptomatic carriers of COVID-19 and only experience encephalitis symptoms [33][34][35].…”

“…The association of encephalitis with severe patient outcomes suggests that systematic studies are required to determine the risk factors predisposing to its development. Currently, systematic reviews that consolidate findings on encephalitis as a complication of COVID-19 are scarce, providing limited information on this condition [10][11][12][13]. To address this important gap in the literature, a systematic review was conducted to more comprehensively evaluate the epidemiology, clinical course, risk factors, and outcomes of patients who suffer from encephalitis as a complication of COVID-19.…”

COVID-19-associated meningoencephalitis in a Brazilian patient: case report and literature review

“…In a study of post-mortem brain biopsies from patients with COVID-19, activation of microglia and infiltration of cytotoxic T lymphocytes were observed, mainly in the brainstem and cerebellum. Microglia express the CD68 marker intensely, causing an increase in the phagocytic activity 12 . Among the main pathways that the virus can reach the CNS is the hematogenous pathway, which has already been described for other coronaviruses.…”

Excessive eating and weight gain:A rare post-acute COVID-19 syndrome

“…The reported case describes polyphagia as a new CNS long-hauler related to the COVID-19. We hypothesize the possible mechanism to be related to the CNS meningoencephalitis following SARS CoV-2 infection [ 7 ] and the subsequent degeneration of neuronal and glial cells due to smoldering inflammatory response to SARS-CoV-2 virions, leading to neuronal degeneration [ 5 , 7 ]. The degeneration can lead to damage of important pathways that control appetite leading to polyphagia.…”