key: cord-0865657-d5jhsts0
authors: Aquino Ferraz, Lorena D.; Marques, Nelson P.; Silveira, Denise M.M.; de Magalhães, Marcelo J.S.; Oliveira, Eduardo A.; Martelli Júnior, Hercílio
title: Assessment of Guillain-Barre Syndrome Cases in Brazil in the COVID-19 Era
date: 2022-03-29
journal: Neurologist
DOI: 10.1097/nrl.0000000000000406
sha: 91b98e5f7b796f3d46dc9a8d1f00991292442639
doc_id: 865657
cord_uid: d5jhsts0

nan

diseases are linked to a deregulated immune system, this dysregulation can lead to damage and dysfunction in target organs. Autoimmune and immune-mediated diseases can play a pathogenic role in COVID-19 and some patients have reported the appearance of autoimmune diseases such as GBS and lupus erythematosus after coronavirus infection. 5 To investigate the impact of the pandemic of COVID-19 in the GBS diagnosis in Brazil, the main goal of this study was compare data from the Brazilian Unified Health System (SUS) on the number of annual GBS cases between the prepandemic period (March 2018 to May 2019) and the pandemic (March 2020 to May 2021), from the 5 Macroregions of Brazil (North, Northeast, Southeast, South, and Midwest), representing the Brazilian States (26 States and the Federal District), through data extracted and analyzed from the public database of SUS (http://tabnet.datasus.gov. br/cgi/tabcgi.exe?sia/cnv/qauf.def). Table 1 shows the increase in GBS diagnosis in all five Brazilian Macroregions since the pandemic period began, ranging from +27.5% in the North region and +1.6% in the Midwest region. In Brazil the rise reached +15,8% diagnosis of GBS, representing more than 240 cases during COVID-19 pandemic compared with the prepandemic period. Table 2 shows the comparison between the mean incident rates of GBS in the prepandemic and transpandemic periods, across Brazilian geographic macroregions and for the country as a whole. The incident rates of GBS diagnoses significantly increased in the pandemic period throughout Brazil (incidence rate ratio = 1.16, 95% confidence interval: 1.08-1.24, P < 0.0001), especially in regions Northeast and Southeast.

The literature also includes reports on the correlation between COVID-19 and GBS. 3 A systematic review analyzed 73 cases of GBS that included only patients who had a laboratory test confirming the COVID-19 infection. 6 The authors revealed that most patients showed respiratory and systemic symptoms, and developed GBS manifestations after COVID-19. 6 Vaccination has been investigated as a possible trigger for GBS. 7 A study carried out in United Kingdom in the first wave of COVID-19, did not show a significant increase on GBS cases and, therefore, no relation between the diseases, 8 which differs from this present data, that shows a significant increase in the A recent study reported the time to onset of GBS symptoms in patients with COVID-19 was 5 to 10 days, similar interval observed when GBS occurs during or after other infections. 9 In contrast, cerebrospinal fluid protein levels appear higher in COVID-19 patients. 10 The treatment given for these cases used immunoglobulin IV or plasmapheresis, supportive care, and antiviral drugs. 4 The pandemic period has significantly increased the number of GBS diagnoses in Brazil, and measures to raise the control of this disease must be carried out. In addition, physicians and patients who have already undergone COVID-19 should be aware of this this possible relation between COVID-19 and GBS increased cases.

Lorena D. 

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