nCoV-2019 infection induces neurological outcome and manifestation, linking its historical ancestor SARS-CoV & MERS-CoV: A systematic review and meta-analysis

Abstract

Importance: The first systematic review and meta-analysis to help clinician to identify early the sign and symptoms of neurological manifestation in COVID-19 positive patients which further help in early management of patients. Objective: Present systematic review and meta-analysis aimed to discuss the prevalence of neurological involvement of the 2019-nCoV patients and assess the symptomatic trend of events as compared to the 2002 “SARS” and 2012 “MERS” pandemics.Methods: The articles were systematically screened through several search engine and databases. The articles published or in preprint were included in the study till 15th May 2020. The systematic review done as per the published literatures which included 31 cross sectional, observational studies and case reports which revealed neural sign and symptoms in SARS-COV-2 disease. For meta-analysis, we included 09 observational and cross sectional studies which included COVID-19 positive patients and assessed the predominance of various neurological sign and symptoms in COVID-19 patients relation to SARS-2002 and MERS-2012. Data were analyzed by using the “MedCalc Statistical Software version 19.2.6 and reported as pooled prevalence. Heterogeneity was investigated (standard I2 test). Results: We have collected and screened about a total 2615 articles, finally we have included 31 articles for the systematic review and 09 for meta-analysis as per the inclusion/exclusion criteria. The analysis was made as per the prevalence rate of neurological symptoms during the COVID-19 positive patients. The cumulative neurological outcome of SARS-2002 and MERS-2012 was assessed to get the trends which is next tried to correlate the events with the current pandemic. During the analysis severity and outcome of neurological manifestations range from simple headache to vague non-focal complaints to severe neurologic impairment associated with seizure or meningitis.Conclusion & Relevance: Central and peripheral nervous system (CNS/PNS) manifestations were seen during the SARS-2002, MERS-2012 and COVID-19. However, none of the publication found with the primary or secondary objective of finding the neurological manifestation in the COVID-19 patients and their mechanism which strengthen the importance to start more precise clinical trials.

Incidence of Anosmia among Covid 19 patients in India

“…This was supported by a meta-analysis done by Manish Mair who gives an incidence rate of 42% for quantitative analysis and 37% for subjective analysis. Another systemic review by Ajai Prakash stated an incidence rate of 48.54% (25,27). Nine studies out of the 16 have said that anosmia is associated with dysgeusia of varied severity.…”

“…The OSNs possess the receptors for perception of smell [22,24]. In humans, there are at least *400 functionally distinct OSNs [25]. Olfactory sensation starts when the odoriferous substance reaches the olfactory cleft and dissolve through the nasal mucosa to binds to the receptors on the dendritic cilia of olfactory sensory neurons (OSNs).…”

Targeting Neurological Manifestations of Coronaviruses by Candidate Phytochemicals: A Mechanistic Approach

“…Werner and co-workers have indicated additional symptoms of several cases, such as acute necrotizing encephalopathy, neck stiffness, bilateral ankle clonus, positive Brudzinski, left Babinski, and right Chaddock signs ( Werner et al, 2020 ). Other neuronal symptoms of COVID-19 are ataxia, refractory status epilepticus ( Xu et al, 2005 ), neuron denaturation/necrosis, broad gliocytes hyperplasia with gliosome formation ( Yassin et al, 2020 ), myalgia, dyspnea ( Prakash et al, 2020 ), taste and smell dysfunctions, acute cerebrovascular and oculomotor nerve palsy ( Nepal et al, 2020 ). Mao et al .…”

“…Werner and co-workers have indicated additional symptoms of several cases, such as acute necrotizing encephalopathy, neck stiffness, bilateral ankle clonus, positive Brudzinski, left Babinski, and right Chaddock signs (Werner et al, 2020). Other neuronal symptoms of COVID-19 are ataxia, refractory status epilepticus (Xu et al, 2005), neuron denaturation/necrosis, broad gliocytes hyperplasia with gliosome formation (Yassin et al, 2020), myalgia, dyspnea (Prakash et al, 2020), taste and smell dysfunctions, acute cerebrovascular and oculomotor nerve palsy (Nepal et al, 2020). Mao et al indicated that elevated creatine phosphokinase (CPK), C-reactive protein (CRP), D-dimer, necrotizing myopathy, thick filament myopathy, critical illness myopathy (nonspecific), and acute quadriplegic myopathy are other neural manifestation of COVID-19 (Mao et al, 2020;Suri et al, 2020;Warner, 2020).…”