key: cord-0968919-671tabx0 authors: El Mezzeoui, S.; Aftissi, F.; Aabdi, M.; bkiyar, H.; Housni, B. title: Guillan barre syndrome in post Covid-19 infection in children date: 2021-06-20 journal: Ann Med Surg (Lond) DOI: 10.1016/j.amsu.2021.102524 sha: bb7abc625fad37b802d71f3ad18101b3e7d76e1e doc_id: 968919 cord_uid: 671tabx0 INTRODUCTION: Guillain-Barre syndrome (GBS) is an inflammatory poly-radiculoneuropathy occurring usually two weeks after a viral infection.Covid-19 infection represent with respiratory symptoms, but it might manifests with extra pulmonary symptoms, and especially neurological including Guillain-Barre syndrom CASE REPORT: A 3 years old female patient admitted to the intensive care unit for an acute symmetric and progressive ascending quadriparesis two weeks after an upper respiratory infection, the diagnosis of post covid GBS was maintained, and the evolution was favorable after intraveneous immunoglobulins. CONCLUSION: This case report suggest the probable causal link between COVID 19 and GBS. J o u r n a l P r e -p r o o f Abstract: Introduction: Guillain-Barre syndrome (GBS) is an inflammatory poly-radiculoneuropathy occurring usually two weeks after a viral infection. Covid-19 infection represent with respiratory symptoms, but it might manifests with extra pulmonary symptoms, and especially neurological including Guillain-Barre syndrom Case report: A 3 years old female patient admitted to the intensive care unit for an acute symmetric and progressive ascending quadriparesis two weeks after an upper respiratory infection, the diagnosis of post covid GBS was maintained, and the evolution was favorable after intraveneous immunoglobulins This case report suggest the probable causal link between COVID 19 and GBS. Covid 19, a new pandemic infection diseases caused by severe acute respiratory Corona Virus-2 [SARS- Cov 2] , manifests usually with respiratory symptoms [1, 2] . But it can manifests with non specific extra-respiratory symptoms especially among children including cardiac, renal and gastro intestinal manifestations [3] . In this paper we will represent the clinical case of a 3 years old girl, admitted to the intensive care unit for Guillan Barre Syndrome, occurring 2 weeks after Covid 19 infection. Importance: GBS post Covid19 infection in children remain rare. A 3 years old girl with non medical history was admitted to emergency department, with progressive and ascending Paresthesia evolving two weeks after respiratory infection. The initial clinical examination was as follows: Pediatric Glasgow coma scale GCS 15/15, power of upper limbs 4/5, and lower limbs 2/5, with no sign of neurological focalization, deep tendon reflexes were absents. We also noted a decrease in sensitivity in the 4 members with swallowing inability. our patient was aperytic, with a body temperature 37,3°, pulse rate 100 BPM; blood pressure 106/67 mmhg, respiratory status was stable with a respiratory rate at 24 breaths/ minutes, and pulse oxymetry of 95% at ambiant air. The initial clinical blood count was as follows: white blood cell count :10990 cells per microliter , hemoglobin 12 g/dl ; C reactive protein were negative: 0,46 mg/l. glucose : 0,9 g/l, sodium 135 Mmol /l, potassium 3,8mmol/l, urea 0,16 g/l, creatinine 3,5 mg/l , alanine amino transferase 17 IU/l, aspartate amono transferase 38 UI/l. The cerebrospinal fluid analysis showed albumino-cytological dissociation, with a White Blood Cell: 1, and high total protein 2,5g/l. Given the pandemic situation serology test of Covid-19 showed IGG antibodies positives. An encephalic and medullar magnetic resonance imaging was performed to rule out differentials diagnosis was normal The diagnosis of Guillan barre syndrome associated with covid 19 was maintained; and the patient was treated with 5 cycles of intravenous immunoglobulin 0,5 g/kg/day, with clinical improvement, and she was referred to the pediatric department after 7 days and discharged after one month. Covid-19 is a new outbreak infection, the lungs are the most affected organs because virus access host cells via angiotensin converting enzyme 2 (ACE2) which is most abundant on type II alveolar cells leading to respiratory symptoms [5] . However extra respiratory manifestations are also observed, such as cardiac, renal and gastro intestinal symptoms. The clinical manifestations are non-specific leading to a delay on the management and potential complications [6] The mechanism of neurological manifestation of Covid-19 can be explained by the presence of ACE-2 receptor in nervous system and the skeletal muscles; or it might be caused by direct infection injury, hypoxic injury or immune response [7] [8] [9] . The most neurological signs are dizziness and headache reported on patients with Covid-19. Other signs are less common including meningoencephalitis and GBS [10 -12] . This later is an acute peripheral neuropathy manifesting with symmetrical, ascending weakness [13] . It's preceded by an infectious disease, and C.Jejuni is the most incriminated Pathogen with 50 % of case [14] [15] . Other pathogens might be identified such as cytomegalovirus, Epstein-Barr virus, Mycoplasma pneumonia, Haemophilus influenzae, and influenza A virus [14] . Covid-19 has been incriminated in severe cases of CBS [16] [17] [18] Few studies reported pediatric neurological symptoms of covid 19 and GBS [19] The recent data of neurological manifestations of covid 19 in children population are insufficient; more cases with epidemiological data should be studied to improve this neuro invasive potential of covid 19 in children. The work has been reported in line with the CARE 2018 criteria [20] . The data used to support the findings of this study are available from the corresponding author. This study was exempt from ethical approval at our institution, as it was an observational finding in regular practice. Written informed consent was obtained from the patient's father for publication of this case report. The authors declare no conflicts of interest. -Sources of funding NONE £ -Research registration . it is a clinical case report -Guarantor EL MEZZEOUI Sanae-AFTISS FATIME ZAHRA Highights : Covid-19, a new outbreaking disease represent mainly with respiratory symptoms Neurological signs might reveal this disease including Guillain Barre syndrome In this paper we will represent the case report of a 3-year-old child presented with guillain barre syndrome after covid-19 infection Outbreak of pneumonia of unknown etiology in Wuhan China: the mystery and the miracle Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China CARE guidelines for case reports: explanation and elaboration document Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus New-Onset Diabetes in Children during COVID-19: Clinical Case Report Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis Evidence of the COVID-19 virus targeting the CNS: tissue distribution, host-virus interaction, and proposed neurotropic mechanisms Nervous system involvement after infection with COVID-19 and other coronaviruses Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China Encephalitis as a clinical manifestation of COVID-19 A first case of meningitis/encephalitis associated with SARS-coronavirus-2 Guillain-Barre Syndrome During the Postpartum Period. Cureus The spectrum of antecedent infections in Guillain-Barre syndrome: a case-control study Guillain-Barré syndrome Guillain-Barre syndrome associated with SARS-CoV-2 infection: causality or coincidence? Guillain-Barré syndrome related to COVID-19 infection Guillain Barre syndrome associated with COVID-19 infection: a case report Neurologic manifestations in an infant with covid-19 Gagnier CARE guidelines for case reports: explanation and elaboration document The following information is required for submission. Please note that failure to respond to these questions/statements will mean your submission will be returned. If you have nothing to declare in any of these categories, then this should be stated. All authors must disclose any financial and personal relationships with other people or organisations that could inappropriately influence (bias) their work. Examples of potential conflicts of interest include employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations, and grants or other funding.The authors state that they have no conflicts of interest for this report Please state any sources of funding for your research All sources of funding should be declared as an acknowledgement at the end of the text. Authors should declare the role of study sponsors, if any, in the collection, analysis and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication. If the study sponsors had no such involvement, the authors should so state.This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Research studies involving patients require ethical approval. Please state whether approval or exemption has been given, name the relevant ethics committee and the state the reference number for their judgement. Please give a statement regarding ethnical approval that will be included in the publication of your article, if the study is exempt from ethnical approval in your institution please state this.The ethical committee approval was not required given the article type (case report) Studies on patients or volunteers require ethics committee approval and fully informed written consent which should be documented in the paper.Authors must obtain written and signed consent to publish a case report from the patient (or, where applicable, the patient's guardian or next of kin) prior to submission. We ask Authors to confirm as part of the submission process that such consent has been obtained, and the manuscript must include a statement to this effect in a consent section at the end of the manuscript, as follows: "Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request".Patients have a right to privacy. Patients' and volunteers' names, initials, or hospital numbers should not be used. Images of patients or volunteers should not be used unless the information is essential for J o u r n a l P r e -p r o o f scientific purposes and explicit permission has been given as part of the consent. If such consent is made subject to any conditions,the Editor in Chiefmust be made aware of all such conditions. Even where consent has been given, identifying details should be omitted if they are not essential. If identifying characteristics are altered to protect anonymity, such as in genetic pedigrees, authors should provide assurance that alterations do not distort scientific meaning and editors should so note.Written informed consent was obtained from the patient's father for publication of this case report and accompanying images. Please specify the contribution of each author to the paper, e.g. study concept or design, data collection, data analysis or interpretation, writing the paper, others, who have contributed in otherways, should be listed as contributors. In accordance with the Declaration of Helsinki 2013, all research involving human participants has to be registered in a publicly accessible database. Please enter the name of the registry and the unique identifying number (UIN) of your study.You can register any type of research at http://www.researchregistry.com to obtain your UIN if you have not already registered. This is mandatory for human studies only. Trials and certain observational research can also be registered elsewhere such as: ClinicalTrials.gov or ISRCTN or numerous other registries.As this manuscript was a case report with no new medical device nor surgical techniques, not prior registration is required The Guarantor is the one or more people who accept full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish