key: cord-0966860-rxv9batt
authors: Gigli, Gian Luigi; Bax, Francesco; Marini, Alessandro; Pellitteri, Gaia; Scalise, Anna; Surcinelli, Andrea; Valente, Mariarosaria
title: Guillain-Barré syndrome in the COVID-19 era: just an occasional cluster?
date: 2020-05-19
journal: J Neurol
DOI: 10.1007/s00415-020-09911-3
sha: b5ee10ff77fe4a876afb89dea65086dae001d22d
doc_id: 966860
cord_uid: rxv9batt

nan

The total number of GBS in the March-April interval of the previous three years is four. In 2020, from March 1st to April 15th, we observed instead seven new cases diagnosed as GBS, in addition to a relapse in one more patient. This means 0.67 cases/month of observation (four cases in six months) in the previous three years, compared to 3.5 cases/month (seven cases in two months) during the current year, which increases to 4 cases/month (eight cases in two months), if we consider also the patient with relapse. Considering a population of 535,516 inhabitants in the province of Udine (2017 census), the monthly incidence in March-April period of previous years was 0.12 new cases/100.000 inhabitants per month (in line with the epidemiological literature [1, 2] ) versus 0.65 cases/100.000 inhabitants per month during the ongoing pandemic. Accordingly, compared to years 2017-2019, the increase of GBS cases in 2020 is 5.41-fold.

The suspicion that this striking difference could be due to the pandemic curve in our region is, therefore, legitimate. In fact, it is well known that GBS and related syndromes are often post-infectious (as for the influenza epidemics and more recently for Zika virus [5] ), with an usual latency of 10-14 days after infection [2] . However, in our series, only one patient (twice negative at swab test) had positive serology and thorax CT scan. Despite the serologic and swab negativity of the others, we think that the association with the descending slope of SARS-CoV-2 infection should still be evaluated, since the specificity and sensitivity of these tests are not yet completely assessed and the exact slope of the humoral immune response curve to this new virus is still unknown. It could also be possible that asymptomatic or paucisymptomatic infections may not develop an antibody response sufficient enough to be detected, especially considering that the available test is only qualitative.

We wonder if similar clusters have been observed elsewhere. 

Author contributions Data access, responsibility, and analysis: AM had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Funding None.

Conflicts of interest On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical standard statement This study followed the tenets of the Declaration of Helsinki and was performed according to the guidelines of the Institutional Review Board of University of Udine Medical School.

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PCR polymerase chain reaction, CSF cerebrospinal fluid, NA not available, CMV Cytomegalovirus, EBV Epstein-Barr virus, HSV-1 Herpes simplex virus 1, HSV-2 Herpes simplex virus 2, HHV-6 Human herpes virus 6, HPeV Human parechovirus, VZV Varicella-zoster virus, TBE Tick-borne encephalitis, WNV West-Nile virus a We intend symptoms such as fever