Widespread sensory neuropathy in diabetic patients hospitalized with severe COVID-19 infection

Odriozola, Ariel; Ortega, Lucía; Martínez, Luis Ma Orte; Odriozola, Samantha; Torrens, Ainhoa; Corroleu, David; Martínez, Silvia Calpena; Ponce, M.; Meije, Yolanda; Presas, M. Clemente; Duarte, Alejandra; Odriozola, Maria B; Malik, Rayaz A.

doi:10.1016/j.diabres.2020.108631

Cited by 29 publications

(25 citation statements)

References 38 publications

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“…8 27 It has also been suggested that small fibre neuropathy may underlie long COVID based on a case report of orthostatic cerebral hypoperfusion syndrome and painful small fibre neuropathy in a patient with COVID-19. 28 Odriozola et al 9 have also reported the presence of a widespread sensory neuropathy and small and large fibre dysfunction in diabetic patients who had recovered from severe COVID-19. Although detailed neuromuscular studies are…”

Section: Discussionmentioning

confidence: 95%

“…7 8 Indeed, in our recent study we reported widespread sensory symptoms with loss of taste and smell and abnormal thermal thresholds in patients with diabetes who had recovered from severe COVID-19. 9 Corneal confocal microscopy (CCM) is a realtime, non-invasive, high-resolution imaging technique which allows objective quantification of corneal sub-basal nerve fibres and dendritic cells (DCs). We have previously utilised CCM to show corneal nerve fibre loss in patients with idiopathic small fibre neuropathy, 10 painful diabetic neuropathy 11 and fibromyalgia, 12 and an increase in DCs in patients with diabetic neuropathy 13 and inflammatory and immune mediated nerve damage including multiple sclerosis and chronic inflammatory demyelinating polyneuropathy.…”

Section: Introductionmentioning

confidence: 99%

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Corneal confocal microscopy identifies corneal nerve fibre loss and increased dendritic cells in patients with long COVID

et al. 2021

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Background/AimsLong COVID is characterised by a range of potentially debilitating symptoms which develop in at least 10% of people who have recovered from acute SARS-CoV-2 infection. This study has quantified corneal sub-basal nerve plexus morphology and dendritic cell (DC) density in patients with and without long COVID.MethodsForty subjects who had recovered from COVID-19 and 30 control participants were included in this cross-sectional comparative study undertaken at a university hospital. All patients underwent assessment with the National Institute for Health and Care Excellence (NICE) long COVID, Douleur Neuropathique 4 (DN4) and Fibromyalgia questionnaires, and corneal confocal microscopy (CCM) to quantify corneal nerve fibre density (CNFD), corneal nerve branch density (CNBD), corneal nerve fibre length (CNFL), and total, mature and immature DC density.ResultsThe mean time after the diagnosis of COVID-19 was 3.7±1.5 months. Patients with neurological symptoms 4 weeks after acute COVID-19 had a lower CNFD (p=0.032), CNBD (p=0.020), and CNFL (p=0.012), and increased DC density (p=0.046) compared with controls, while patients without neurological symptoms had comparable corneal nerve parameters, but increased DC density (p=0.003). There were significant correlations between the total score on the NICE long COVID questionnaire at 4 and 12 weeks with CNFD (ρ=−0.436; p=0.005, ρ=−0.387; p=0.038, respectively) and CNFL (ρ=−0.404; p=0.010, ρ=−0.412; p=0.026, respectively).ConclusionCorneal confocal microscopy identifies corneal small nerve fibre loss and increased DCs in patients with long COVID, especially those with neurological symptoms. CCM could be used to objectively identify patients with long COVID.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Corneal confocal microscopy identifies corneal nerve fibre loss and increased dendritic cells in patients with long COVID

et al. 2021

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“…Given the prevalence of diabetic neuropathy and the relative immune suppression common in those who have diabetes mellitus, it is likely that cases of AIDP-type GBS secondary to SARS-CoV-2 infection have already and will continue to be misdiagnosed or underdiagnosed. Additionally, a recent study published in Diabetic Research and Clinical Practice found that four diabetic patients admitted to a Barcelona hospital for severe SARS-CoV-2 pneumonia reported new-onset, lower extremity sensory neuropathy following the infection, indicating that serious SARS-CoV-2 infections may provoke a widespread sensory neuropathy in patients with diabetes [ 9 ]. In contrast to the case discussed in this report, these four patients did not experience rapid progression of their neuropathic symptoms and continued to exhibit normal deep tendon reflexes.…”

Section: Discussionmentioning

confidence: 99%

SARS-CoV-2-Associated Guillain-Barre Syndrome Obscured by Diabetes Mellitus Peripheral Neuropathy

Brown¹,

Petrassi²,

Bureau³

et al. 2021

Cureus

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Multiple neurological complications, including Guillain-Barre syndrome (GBS), have been reported in association with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak. GBS has well-known associations with viruses such as influenza, human immunodeficiency virus, Zika, severe acute respiratory syndrome, Middle East respiratory syndrome, Epstein-Barr virus, and cytomegalovirus. Till date, there have been around 50 distinct published cases of GBS occurring concurrently or shortly after SARS-CoV-2 infection. This report describes the case of a 53-year-old male who presented with bilateral extremity paresthesias two weeks after a positive SARS-CoV-2 test. His symptoms were originally thought to be due to underlying diabetic peripheral neuropathy, but as they progressed, he was eventually diagnosed with SARS-CoV-2-associated GBS. Though GBS may not be a common sequelae of SARS-CoV-2 infection, the prevalence of diabetes mellitus-associated peripheral neuropathy is high enough to warrant awareness and prompt recognition of neurological symptoms that deviate from the baseline in individuals with recent, confirmed SARS-CoV-2 infection.

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“…Development of severe COVID-19 infection with hypoxemia requiring non-invasive ventilation has been shown to be associated with the development of neuropathic symptoms and widespread sensory dysfunction in diabetes patients without previous evidence of clinical neuropathic abnormalities ( Odriozola et al, 2021 ). Studies exploring the presence of diabetic neuropathy on COVID-19 outcomes are unavailable presently, partly due to the challenging nature of diagnostic certainty as well as the lack of routine characterisation of neuropathic deficits, apart from foot ulcer risk, in people with diabetes.…”

Section: Microvascular Complications Of Diabetes As a Risk Factor For Severe Covid-19mentioning

confidence: 99%

What is the impact of microvascular complications of diabetes on severe COVID-19?

Basra

Whyte

Karalliedde

et al. 2022

Microvascular Research

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Evidence suggests severe coronavirus disease-19 (COVID-19) infection is characterised by pulmonary and systemic microvasculature dysfunction, specifically, acute endothelial injury, hypercoagulation and increased capillary permeability. Diabetes, which is also characterised by vascular injury in itself, confers an increased risk of adverse COVID-19 outcomes. It has been suggested that pre-existing endothelial dysfunction and microvascular disease in diabetes will exacerbate the vascular insults associated with COVID-19 and thus lead to increased severity of COVID-19 infection. In this article, we evaluate the current evidence exploring the impact of microvascular complications, in the form of diabetic retinopathy and nephropathy, in individuals with COVID-19 and diabetes. Future insights gained from exploring the microvascular injury patterns and clinical outcomes may come to influence care delivery algorithms for either of these conditions.

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Widespread sensory neuropathy in diabetic patients hospitalized with severe COVID-19 infection

Cited by 29 publications

References 38 publications

Corneal confocal microscopy identifies corneal nerve fibre loss and increased dendritic cells in patients with long COVID

Corneal confocal microscopy identifies corneal nerve fibre loss and increased dendritic cells in patients with long COVID

SARS-CoV-2-Associated Guillain-Barre Syndrome Obscured by Diabetes Mellitus Peripheral Neuropathy

What is the impact of microvascular complications of diabetes on severe COVID-19?

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