key: cord-0741076-tsvkfh0m
authors: Gupta, Ankit; Paliwal, Vimal Kumar; Garg, Ravinder Kumar
title: Is COVID-19-related Guillain-Barré Syndrome Different?
date: 2020-05-20
journal: Brain Behav Immun
DOI: 10.1016/j.bbi.2020.05.051
sha: 1f8e80f414de81725f5e83f67232d303905c9f23
doc_id: 741076
cord_uid: tsvkfh0m

nan

We read with interest the report of Guillain-Barré syndrome secondary to infection (Coen M et al. 2020) . Recently, there have been multiple reports of Guillain-Barré syndrome (GBS) associated with the COVID-19 infection (Sedaghat Z et al., 2020 , Toscano G et al., 2020 , Zhao H., 2020 . Most COVID-19-related GBS presented with acute onset of areflexic quadriparesis. However, there are some important differences to highlight (table   1) . (Garg RK et al., 2018) . Most patients with COVID-19-related GBS were elderly. Preceding symptoms like ageusia and hyposmia were unique for COVID-19 infection. Patients with COVID-19-related GBS had a severe disease with respiratory failure due to lobar pneumonia and interstitial pneumonitis. They showed ground-glass appearance of lungs on chest computerized tomography. Increased severity of disease is also evident from the electrophysiology study. Where demyelinating neuropathy is more common with typical GBS and GBS related to dengue and Zika virus, majority of COVID-19-related GBS patients had axonal motor (AMAN) and axonal motor-sensory polyneuropathy (AMSAN). A few of these patients showed enhancement of caudal nerve roots on Gadolinium-enhanced MRI of spine. Most COVID-19 patients received hydroxychloroquine, azithromycin, lopinavir and ritonavir in addition to intravenous immunoglobulin (IVIG). However, more than half of patients showed poor outcome in the form of long ICU stay, residual paresis and dysphagia.

Is COVID-19-related GBS has a different pathogenesis? The polyneuropathy in GBS is believed to be due to cross-immunity against epitopes of peripheral nerve components that it shares with the epitopes on the cell surface of bacteria that produces an antecedent infection. This mechanism of "molecular mimicry" is best understood with the Campylobacter jejuni -related GBS. C. jejuni expresses various gangliosides antigen on its outer core. Antecedent infection with C. jejuni results in antibody formation against specific gangliosides present on axonal membrane (GM1, GD1a, GalNac-GD1a, GD1b and GQ1b).

Presence of these anti-ganglioside antibodies a is strongly associated with AMAN, AMSAN and Miller-Fischer variants of GBS (Ogawara K et al., 2000) . Recently, a good clinical response in pneumonia has been seen in COVID-19 patients with plasma therapy. Does plasma therapy produce good recovery in COVID-19-related GBS is yet to be seen. 

Guillain-Barré syndrome as a complication of SARS-CoV-2 infection

Guillain Barre syndrome associated with COVID-19 infection: a case report

Guillain-Barré Syndrome Associated with SARS-CoV-2

Guillain-Barré syndrome associated with SARS-CoV-2 infection: causality or coincidence? The Lancet Neurology

Guillain-Barré syndrome caused by Zika virus: A wake-up call for India

Axonal Guillain-Barré syndrome: relation to anti-ganglioside antibodies and Campylobacter jejuni infection in Japan

Early Guillain-Barré Syndrome associated with acute dengue fever

Guillain-Barré Syndrome outbreak associated with Zika virus infection in French Polynesia: a case-control study

Conflict of Interest: Authors report no conflict of interest.Funding: The work did not receive any funding.