Neurological Complications of SARS-CoV, MERS-CoV, and COVID-19

Abstract

This review provides an overview of studies and case reports of neurological and neuromuscular complications associated with severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV), and coronavirus disease 2019 (COVID-19) and describes the possible mechanisms of viral transmission to the central nervous system (CNS). Coronavirus family has shown central and peripheral nervous system tropism in multiple retrospective studies and case reports from different parts of the world. To date, the reported cases of neurological and neuromuscular complications associated with coronaviruses, especially COVID-19, are increasing. Neurological and neuromuscular symptoms and complications ranging from headache and anosmia to more severe encephalitis and stroke have been reported in many studies. However, the neurotropism mechanism of coronaviruses is still not clear and the evidence of central nervous system (CNS) involvement is limited despite the number of studies that attempted to illustrate the possible CNS invasion mechanisms. The reported neurological complications of coronaviruses are summarized in this article. Keywords Neurological complications. COVID-19. SARS. MERS. Encephalopathy. Stroke strains of coronavirus have been identified as human pathogens [2]. These include HCoV-229E, HCoV-OC43, HCoV-HKU1, HCoV-NL63, severe acute respiratory syndrome CoV (SARS-CoV), Middle East respiratory syndrome, and more recently, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Coronaviruses are mainly respiratory pathogens that cause a wide range of upper and lower respiratory tract infections with various neurological complications that will be highlighted in this review paper. Understanding the virological background of these different viral infections might facilitate learners' perception of the disease's prognosis and management. SARS-CoV is an acute respiratory infection that was first reported in November 2002 in Guangdong Province [3]. It spread to other regions in America, Asia, and Europe in late 2003, infecting about 8000 people worldwide, with a mortality rate of 10%. By June 2012, a new strain of coronavirus called the Middle East respiratory syndrome coronavirus (MERS-CoV) emerged from Jeddah, Saudi Arabia [4]. MERS-CoV seems to have originated from bats and infected the intermediary reservoir (the dromedary camel) before being transmitted to humans [2]. Similarly to SARS-CoV, MERS-CoV causes severe respiratory infections that are complicated by multiorgan failure and death in some patients [2]. At the end of January 2020, a total of 2519 cases had been identified worldwide, This article is part of the Topical Collection on Covid-19

Anosmia and dysgeusia in SARS-CoV-2 infection: incidence and effects on COVID-19 severity and mortality, and the possible pathobiology mechanisms - a systematic review and meta-analysis

“…However, our study demonstrated that the prevalence of anosmia was 10.2-fold higher in COVID-19 patient than that in non-COVID-19 patient. During the previous pandemics, such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), anosmia was rarely reported 249 . Only one study reported persistent anosmia after 2 years of recovery from SARS 250 .…”

Assessment and Management of Diabetic Patients During the COVID-19 Pandemic

“…71,[76][77][78] Mechanisms involving endothelial dysfunction and immunomediated injury cause stroke and lead to hypoxia-induced injury and cytokine storm. 71 Yang et al reported that chronic kidney-disease patients with COVID-19 exhibited poor prognosis, high prevalence of neutrophilia, and in-hospital deaths and also that dialysis patients are more susceptible to COVID-19 infection. 79 A study from India reported that 14.2% of 21 COVID-19 patients had DM.…”

Severe Acute Respiratory Syndrome Coronavirus 2-Induced Neurological Complications

“…As reported, CT scans may demonstrate ground-glass opacities, traction bronchiectasis, or even bilateral multilobar consolidation in the lungs (Zhu et al, 2020 ). Neurological manifestations of SARS-CoV-2 infection can be induced by direct invasion of the nervous system or by inflammatory responses (Alshebri et al, 2020 ). Affecting either the neurons or the glia cells can lead to neurological pathologies (Ibrahim, 2020 ).…”

“…Coronaviruses can directly invade the CNS for their neurotropism, causing encephalitis or meningitis (Alshebri et al, 2020 ; Serrano-Serrano et al, 2020 ). Based on the autopsy analyses of 17 COVID-19 patients, 8 individuals were identified SARS-CoV-2 positive in brain tissue with cerebral edema and vascular congestion (Remmelink et al, 2020 ).…”