key: cord-0821734-igk9bt1k authors: Pawar, Shweta; Juman, Charlotte; Turner, Nicholas title: COVID-19 Associated Facial Palsy, A Clinical Dilemma date: 2021-11-26 journal: J Glob Infect Dis DOI: 10.4103/jgid.jgid_91_21 sha: ac61163e5814ff5a9e4dfec6c7a9c8ba1993065e doc_id: 821734 cord_uid: igk9bt1k nan Admission blood tests revealed mildly elevated C-reactive protein (8 mg/dl) and a nonfasted plasma glucose of 7.9 mmol/L. Both computer tomography and magnetic resonance imaging of the head were normal. Lumbar puncture showed normal cell count and ruled out bacterial infection on culture and viral infection on polymerase chain reaction assay. Stapedial reflex showed an elevated threshold on the right side, while pure tone audiometry was within the normal range. Benefits of commencing steroids for facial palsy were considered, weighed against detrimental effects on blood sugars, and unproven benefit in COVID-19 infection. He was treated with 50 mg prednisolone daily with careful monitoring of blood glucose levels for 10 days, and eye lubricants. Upon follow-up, there was a great improvement in facial palsy to Grade II on the House-Brackman scale. COVID-19 continues to surprise and challenge with new presentations. One such symptom is possibly that of unilateral facial paralysis as shown by our case. Various central and peripheral nervous system manifestations of COVID-19 have been reported, [1, 2] although not including facial palsy, and are sometimes the only presenting symptom. This is of immense value as we must have a high index of suspicion to manage the case appropriately and prevent further spread of infection. It remains unclear whether COVID-19 is neurotropic, [2] yet it has been linked to various nervous system manifestations. Aberrant immune response to COVID-19 may be responsible for polyneuritis cranialis [3] which could explain the involvement of cranial nerves in COVID-19 despite being not found in cerebrospinal fluid. A possible association between isolated cranial neuropathies and COVID-19 has been suggested in several case reports, which need further analysis to support causality. [4] Prakash and Raymond inferred that diabetes and hypertension do not influence the outcome of Bell's palsy. [5] Our case has considerable partial recovery and timely steroid intervention seems to have supported this. Although diabetes is associated with facial palsy, in these times, we have to approach any case with COVID-19 with an open mind to the neurological manifestations the virus can cause. We believe that facial palsy must be considered as one of the presentations of COVID-19 infection and keep your guard up with respect to the prevention of spread of the infection. Thanking you, The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed. Nil. There are no conflicts of interest. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the etiological agent of COVID-19 transmits through aerosols, body fluid or by the fomites present around the infected individuals. [1] The ultraviolet (UV) radiation may be effectively used to limit the transmission of COVID-19. However, it must be maintained and monitored regularly to provide sufficient lethal dose. The bacteriophages may be used as indicator to monitor the lethal intensity of UV source for viruses. In the present study, Acinetobacter phage AIIMS-Ab6 [ Figure 1a ] active against multidrug-resistant Acinetobacter baumannii and Staphylococcus phage BHU-22, active against methicillin-resistant Staphylococcus aureus were used. These phages (10 6 plaque-forming units/ml) were exposed to UV of 254 wavelength, 400 mW/m 2 intensity for 0, 5, 10, and 15 min and spotted on their respective bacterial lawn, and incubated overnight at 37°C to observe the lytic zones. The AIIMS-Ab6 and BHU-22 phages showed inactivation on 10 min and 5 min of UV exposure, respectively [ Figure 1b and c]. The UV radiation does not produce any physical or chemical damage to the objects. [2] The combined UVA and UVC exposure completely inactivated the SARS-CoV-2 viral stock, [3] and UV light was also found suitable to disinfect the high touch area of the hospital surfaces. [4] Therefore, we conclude that UV radiation is an effective mean to deactivate the model viruses; bacteriophage and strongly propose to apply the UV radiation of 254 wavelength, Neurological manifestations and complications of COVID-19: A literature review Neurologic manifestations of hospitalized patients with coronavirus disease Miller Fisher syndrome and polyneuritis cranialis in COVID-19 Pearls and Oy-sters: Facial nerve palsy in COVID-19 infection The use of nerve conduction studies in determining the short-term outcome of Bell's palsy This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.