Neuromuscular Complications of SARS-CoV-2 and Other Viral Infections

Abstract

In this article we review complications to the peripheral nervous system that occur as a consequence of viral infections, with a special focus on complications of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). We discuss neuromuscular complications in three broad categories; the direct consequences of viral infection, autoimmune neuromuscular disorders provoked by viral infections, and chronic neurodegenerative conditions which have been associated with viral infections. We also include discussion of neuromuscular disorders that are treated by immunomodulatory therapies, and how this affects patient susceptibility in the current context of the coronavirus disease 2019 (COVID-19) pandemic. COVID-19 is associated with direct consequences to the peripheral nervous system via presumed direct viral injury (dysgeusia/anosmia, myalgias/rhabdomyolysis, and potentially mononeuritis multiplex) and autoimmunity (Guillain Barré syndrome and variants). It has important implications for people receiving immunomodulatory therapies who may be at greater risk of severe outcomes from COVID-19. Thus far, chronic post-COVID syndromes (a.k.a: long COVID) also include possible involvement of the neuromuscular system. Whether we may observe neuromuscular degenerative conditions in the longer term will be an important question to monitor in future studies.

Clinical Research Progress of Small Molecule Compounds Targeting Nrf2 for Treating Inflammation-Related Diseases

“…COVID-19 is a complex infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Clinical evidence has shown that the main symptoms of COVID-19 can include acute infection of the respiratory tract, as well as inflammatory reactions of multiple organs [ 21 , 22 ]. SARS-CoV-2 enters cells by first binding to angiotensin-converting enzyme 2 (ACE2), followed by cleavage of the virus spike protein by transmembrane protease serine 2 (TMPRSS2) [ 23 ].…”

Drosophila as a Model for Human Viral Neuroinfections

“…Several human picornaviruses are associated with neurological motor disturbances, including poliovirus and coxsackievirus B3 [ 193 ]. A picorna-like virus called Nora virus has recently been shown to cause locomotor disturbance in Drosophila [ 194 ].…”

“…Neurological symptoms have been frequently reported in patients infected with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) [ 193 , 213 ], the causative agent of COVID-19. Presentations can range from a loss of taste and smell, seizures, stroke, epilepsy, meningitis/encephalitis and motor disturbances.…”

Health Equity in Neurosciences

“…Infectious diseases such as human immunodeficiency virus (HIV) and tuberculosis are also more prevalent among Indigenous people in Canada [11,12]. This is relevant to neurologic disease because of the strong association of HIV with various neurologic presentations [13]. Tuberculosis may also infect the nervous system, can be very difficult to recognize clinically, and requires prolonged treatment [14].…”

“…It is associated with high mortality particularly when co-existing HIV infection is present [14]. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic may have also disproportionately affected Indigenous communities [15], which is of major importance due to the various neurological complications which have been reported in association with SARS-CoV-2 [13,16]. Recently, we also became aware that a neurogenetic condition (Kennedy disease, or spinal bulbar muscular atrophy) is highly prevalent among Indigenous people living in prairie provinces [17].…”