COVID-19 and Guillain-Barre Syndrome: a systematic review of case reports

• Type of Material: Article
• Authors: Rodrigo M Carrillo-Larco, Imperial College London, London; Carlos Altez-Fernandez, Universidad Peruana Cayetano Heredia; Sabrina Ravaglia, IRCCS C., Mondino Foundation, Pavia; Joaquín A Vizcarra, Emory University
• Language: English
• Date: 2020-09-21
• Publisher: F1000Research
• Publication Version: Final Published Version
• Copyright Statement: © 2020 de Oliveira MRF
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.12688/wellcomeopenres.15987.2
• Title of Journal or Parent Work: Wellcome Open Research
• Volume: 5
• Grant/Funding Information: This work is supported by Wellcome [214185; International Training Fellowship to RMC-L].
• Keywords: Guillain-Barre Syndrome; neurological complications; COVID-19; pandemic
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology

Abstract

Background: Guillain-Barre Syndrome (GBS) is a neurological autoimmune disease that can lead to respiratory failure and death. Whether COVID-19 patients are at high risk of GBS is unknown. Through a systematic review of case reports, we aimed to summarize the main features of patients with GBS and COVID-19. Methods: Without any restrictions, we searched MEDLINE, Embase, Global Health, Scopus, Web of Science and MedXriv (April 23 rd, 2020). Two reviewers screened and studied titles, abstracts and reports. We extracted information to characterize sociodemographic variables, clinical presentation, laboratory results, treatments and outcomes. Results: Eight reports (n=12 patients) of GBS and COVID-19 were identified; one was a Miller Fisher case. The age ranged between 23 and 77 years, and there were more men (9/102). GBS symptoms started between 5 and 24 days after those of COVID-19. The protein levels in cerebrospinal fluid samples ranged between 40 and 193 mg/dl. None of the cerebrospinal fluid samples tested positive for COVID-19. Six patients debuted with ascendant weakness and three with facial weakness. Five patients had favourable evolution, four remained with relevant symptoms or required critical care and one died; the Miller Fisher case had successful resolution. Conclusions: GBS is emerging as a disease that may appear in COVID-19 patients. Although limited, preliminary evidence appears to suggest that GBS occurs after COVID-19 onset. Practitioners and investigators should have GBS in mind as they look after COVID-19 patients and conduct research on novel aspects of COVID-19. Comparison with GBS patients in the context of another viral outbreak (Zika), revealed similarities and differences that deserves further scrutiny and epidemiological studies.