Guillain-Barré syndrome: SARS-CoV-2 can trigger rare autoimmune disease
For many people who are infected with the Coronavirus SARS-CoV-2, there is only a slight or no symptoms. In some cases, the disease takes a severe course. In addition, researchers have found at the end of frequently neurological complaints at COVID-19. And as now reported, may cause of novel pathogens, even the dreaded Guillain-Barré syndrome.
As the public health portal of Austria’s “health.gv.at“ is stated, is disease, the Guillain-Barré syndrome (GBS), a very rare auto-immune. In this case, the immune system of the body attacks its own peripheral, i.e. outside of the brain and spine located in the nerve cells and destroys their insulating myelin layer. The “acute idiopathic Polyneuritis” is called the disease may also be due to the new Coronavirus triggered.
In the case of SARS-CoV-2 infection, it is faster to severe neurological complication
According to a recent statement by the German society of neurology e. V. (DGN) was the beginning of April, discussed in the journal “Lancet Neurology” for the first time, the possibility of a SARS-CoV-2-associated Guillain-Barré syndrome (GBS).
Shortly thereafter, magazines, “the New England Journal of Medicine” and “Neurology”, two other publications from Europe that describe a GBS or a GBS variant in COVID-19-patients and in-patients followed in the specialized.
The GBS is often a result of infections, for example, bacterial intestinal infection, or infection with the cytomegalovirus.
Now, the Coronavirus SARS-CoV-2 is the latest in the series of the GBS-triggering pathogens. A special feature: While it often takes two to four weeks, until an infection occurs associated GBS, it came in the case of the SARS-CoV-2 infection after five to ten days of this severe neurological complication.
Respiratory muscles can be affected
How the DGN explains, is the Guillain-Barré syndrome (GBS), a severe neurological disease. By an excessive auto immune reaction, often a result of infections, injury to the Myelin sheath of the peripheral nerve so that the nerve fibers can transmit stimuli more.
Detectable auto-antibodies against Components of the neural membranes (gangliosides) are with the GBS, often in the blood. Are the consequences of paralysis (paresis), most of both sides in the legs and then the arms and the face concern.
In some patients even the respiratory muscles can be affected, so that they have to be ventilated.
According to the DGN, the individuals receive the therapy either high intravenous doses of immunoglobulins or plasmapheresis, an extracorporeal blood purification method, in which the disease-causing auto-antibodies are filtered out.
There are many weeks often, until the symptoms regress in some patients remain permanently neurological symptoms are present.
Patient without respiratory symptoms, fever, or diarrhea
It is known that about three-quarters of all GBS cases occur as a result of infections, be it through a bacterial inflammation of the intestine with Campylobacter jejuni, or an upper respiratory infection with cytomegalovirus or other viruses. Now, it was reported in the above-mentioned magazines for the first time on SARS-CoV-2-associated GBS cases:
The first case report of a presumably SARS-CoV-2-associated GBS relates to a 61-year-old woman from China, who was taken with palsy (paralysis) of the lower extremities in the clinic, but no respiratory symptoms, fever, or diarrhea had been before. In the following three days the palsy spread.
The data suggest that the therapy was carried out with i. v. immunoglobulins. On day eight, the patient cough, fever developed and reported in the thoracic CT signs of a viral pneumonia. The SARS-CoV-19-throat swab was positive.
The authors discuss a SARS-CoV-2-associated GBS, because the classical respiratory COVID-19 symptoms were added, but only a week after the start of the GB, it must also be the possibility of an accidental coincident occurrence of the two diseases considered.
Patients had SARS-CoV-2-positive pharyngeal swabs
But two weeks later, a case series was published with GBS in five Italian SARS-CoV-2-patients. From 1,000 to 1,200 Covid-19-Affected five patients within five to ten days after the onset of symptoms of COVID-19 on a GBS, three of these people had to be mechanically ventilated.
However, could not be delineated in the study, whether the ventilation was because of the GBS or the respiratory infection is necessary.
A third work, from Madrid, presents two Case reports of Covid-19-patients with the GBS variant Miller Fisher syndrome (MFS). In the Serum of MFS-causing ganglioside antibodies were undetectable, and both men had to compromise SARS-CoV-2-positive Revenge.
The classic GBS or MFS typically occur ten days to four weeks after the underlying infection, so usually, after the Affected by the infection disease recover.
In the case of SARS-CoV-2 infections, however, the interval is much shorter. All previously reported patients sufferers already five to ten days after symptom onset, the COVID-19-disease.
Cause of the Ventilation liability
“In the case of ventilated patients in the intensive care unit of the GBS represents an important differential diagnosis for the so-called Critical Illness neuropathy, peripheral nerve damage, which usually occurs later in the disease course in patients on the intensive care unit,” explains Prof. Dr. Helmar Lehmann of the Neurological University clinic Cologne.
“The distinction is not relevant to miss the treatment with immunoglobulins,” adds Prof. Dr. Peter Berlit, Secretary-General of the German society for neurology.
It is important, therefore, that in the case of patients with Guillain-Barré syndrome (or Miller-Fisher syndrome) will determine whether a SARS-CoV-2 infection. Vice versa needs to be investigated sequences in individuals with severe COVID-19-the respiration must be, whether or not a GBS/MFS could be the actual cause of the Breathing responsibility.
This does not apply to the DGN, particularly if the image indicates imaging findings of lung and organ damage, which make mechanical ventilation necessary. (ad)