Neurological manifestations in patients with symptomatic COVID-19 admitted to the Bafoussam Regional Hospital, Cameroon

Abstract

Introduction although the main manifestations of COVID-19 are respiratory, several neurological symptoms and complications have also been reported. The pandemic seems to have some epidemiological specificities in sub-Saharan Africa, and this may be reflected in the type and frequency of neurological symptoms. This study aimed to report neurological manifestations associated with symptomatic COVID-19 in a sub-Saharan African setting. Methods we conducted a retrospective review of symptomatic PCR-confirmed COVID-19 cases admitted to the Bafoussam Regional Hospital between March and September 2020. Patients’ files were reviewed at discharge by a consultant neurologist. Socio-demographic characteristics, co-morbidities, symptoms on admission, neurological symptoms during hospitalization, management, and in-hospital outcome were recorded. Comparisons between patients with and without neurological symptoms were performed using Fisher’s exact and Mann-Whitney U test. Results we enrolled 177 symptomatic patients (68% men). Mean age was 54.6 ± 17.8 years (range 2-99 years). Co-morbidities were present in 57.6% of patients, including hypertension (27.1%) and diabetes mellitus (25.4%). Neurological symptoms were found in 113 (63.8%) patients. The most frequent were headache (39.0%), myalgia (35.6%), anosmia (11.9%), impaired consciousness (10.7%) and delirium (5.6%). Regarding the presenting symptoms, fever was more frequent in patients with neurological symptoms than in those without (81.4% versus 50.0%, p< 0.001), while digestive symptoms were less frequent in patients with neurological symptoms (0.9% versus 9.4%, p= 0.004). Conclusion neurological manifestations are frequent and heterogeneous in patients with symptomatic COVID-19. Further studies are needed to clarify the pathophysiology of neurological symptoms in COVID-19 and their impact on patients’ long-term outcome.

Delirium in a Young Predominantly Hispanic Population with COVID-19

“…21 A study by Fogang et al in Cameroon with a broader range of patient ages but a similar mean (54.6 years) reported a delirium rate of 5.6% and an impaired consciousness rate of 10.7%. 22 While conducting this study we observed that many patients were described identically to the patients diagnosed with delirium (confused, agitated, inattentive, etc. ), however the diagnosis of delirium was not documented.…”

“…Our results are consistent with previous literature that indicates delirium is associated with worse health outcomes in COVID-19 patients. 16,22,24 In terms of psychiatric history, patients diagnosed with delirium had pre-existing cognitive deficits and history of substance use. Cognitive deficits have been found in older patients to be associated with development of delirium, and we see here a confirmation of studies suggesting that association is also true in younger patients.…”

“…Our results are consistent with previous literature that indicates delirium is associated with worse health outcomes in COVID-19 patients. 16,22,24…”

Emerging Viral Infections, Hypertension, and Cardiovascular Disease in Sub-Saharan Africa: A Narrative Review

“…14 In a Cameroonian study with 177 COVID-19 patients, 27% had hypertension, 4.5% heart failure, and 1% prior stroke, but none of these were associated with COVID-19 neurological symptoms. 15 In a cross-sectional study in Burkina Faso with 442 patients, 22% had hypertension and 17% CVD, but neither was associated with severe hypoxemia. 16 In a cross-sectional study of 274 patients with long-COVID in Nigeria, 16% had hypertension, but this was not statistically significantly associated with persistent COVID-19 symptoms (aOR, 1.9 [95% CI, 0.3–10.8]), 17 similar to findings from a case-control study in Sudan with 100 COVID-19 cases with hypertension or CVD and 100 controls.…”

“…Six studies found no association between preexisting hypertension, CVD, and COVID-19 infection or severity, but compared with the studies above, all 6 were limited by methodologic issues with hypertension/CVD ascertainment, small sample size, and recruitment from a single site. 13–18 The median age ranged from 18 to 55 years, and the samples were 32% to 51% female. Of 4258 patients with COVID-19 found through a cross-sectional community survey in Zambia, neither hypertension (found in 3.8% of patients with COVID-19) nor CVD (found in 0.4%) were associated with COVID-19 infections, but the diagnoses of hypertension and CVD was apparently determined by patient report, which is notoriously unreliable in Africa where many such cases are undiagnosed.…”