Guillain‐Barré syndrome associated with SARS‐CoV‐2 infection: A systematic review and individual participant data meta‐analysis

Abstract

Several published reports have described a possible association between Guillain-Barré syndrome (GBS) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. This systematic review aimed to summarize and meta-analyze the salient features and prognosis of SARS-CoV-2-associated GBS. We searched the PubMed (Medline), Web of Science and Cochrane databases for articles published between 01 January 2020 and 05 August 2020 using SARS-CoV-2 and GBS-related keywords. Data on sociodemographic characteristics, antecedent symptoms, clinical, serological and electrophysiological features, and hospital outcomes were recorded. We included 45 articles from 16 countries reporting 61 patients with SARS-CoV-2-associated GBS. Most (97.7%) articles were from high-and upper-middle-income countries. Forty-two (68.9%) of the patients were male; median (interquartile range) age was 57 (49-70) years. Reverse transcriptase polymerase chain reaction for SARS-CoV-2 was positive in 90.2% of patients. One report of SARS-CoV-2-associated familial GBS was found which affected a father and daughter of a family. Albuminocytological dissociation in cerebrospinal fluid was found in 80.8% of patients. The majority of patients (75.5%) had a demyelinating subtype of GBS. Intravenous immunoglobulin and plasmapheresis were given to 92.7% and 7.3% of patients, respectively. Around two-thirds (65.3%) of patients had a good outcome (GBS-disability score ≤ 2) on discharge from hospital. Two patients died in hospital. SARS-CoV-2-associated GBS mostly resembles the classical presentations of GBS that respond to standard treatments. Extensive surveillance is required in low-and lower-middle-income countries to identify and report similar cases/series. Further large-scale case-control studies are warranted to strengthen the current evidence. PROSPERO Registration Number CRD42020201673.

Guillain–Barré Syndrome Associated with SARS-CoV-2 Infection

“…Four children have been reported so far [1,3]. The first series from India reported four adults; to our knowledge, this is the first child to be reported [4].…”

“…To the Editor: Paucity of reports of Guillain-Barré syndrome (GBS) in association with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from low-middle income countries (LMIC) is intriguing [1]. A causal relationship awaits definitive evidence [2].…”

“…Increasing incidence of GBS in the SARS-CoV-2 pandemic lead to suspicion of causation [1]. Suspected mechanisms include neurotropism and post-infectious aberrant immune response.…”

“…Suspected mechanisms include neurotropism and post-infectious aberrant immune response. A recent systematic review reported 61 cases; majority had the classical sensorimotor presentation [1]. Acute inflammatory demyelinating polyneuropathy (AIDP) was the commonest variant (75%), followed by acute motor axonal neuropathy (AMAN) in 11.3% and acute motor and sensory neuronal axonopathy (AMSAN) in 9.4% [1].…”

“…Like the index patient, 10% had a negative PCR but were positive for serology. Despite large numbers of infected populations in LMIC, reports of GBS have been strikingly scarce [1]. This has been attributed to under-reporting and nonavailability of serology testing, despite widespread availability of PCR.…”