key: cord-1030950-2klyosh9
authors: Finsterer, Josef
title: Unvaccinated patients may still experience SARS-CoV-2 associated polyradiculitis
date: 2022-02-16
journal: J Family Med Prim Care
DOI: 10.4103/jfmpc.jfmpc_1960_21
sha: fef81661ee776a2a7afffd62f1d6a79c0b22fcf4
doc_id: 1030950
cord_uid: 2klyosh9

nan

We do not agree with the statement in the discussion that most SARS-CoV-2 associated GBS cases were aged over 50 years. [1] In a study of SARS-CoV-2 associated GBS patients published between January 2021 and the end of June 2021, at least 20 of 75 patients were under age 50 years [Finsterer, submitted] . Four of the 75 included patients were even below 20 years of age. In a study of 220 SARS-CoV-2 associated GBS patients, at least 32 patients were under age 50 years. [2] From these data it can be concluded that all age groups can be affected by SARS-CoV-2 associated GBS.

We do not agree with the conclusion that the increased frequency of respiratory failure in SARS-CoV-2 associated GBS compared to non-COVID-19 GBS is due to affection of both, lungs and the nerve roots. [1] Since it is difficult to differentiate to which degree respiratory failure is due to GBS or due to COVID-19 pneumonia and no studies about this issue are available, the influence of both conditions on respiratory functions remains speculative. However, since some patients with SARS-CoV-2 associated GBS experience only subclinical or mild COVID-19 infection and do not have pneumonia, it is conceivable that respiratory failure is entirely due affection of the respiratory muscles in GBS at least in some patients. The authors themselves suggest that GBS should be considered even if the lung computed tomography is normal. [1] It is crucial to stress that mechanically ventilated patients on the ICU with a weaning difficulty should be investigated for GBS. Diagnosing GBS in ventilated patients is a challenge unless they are regularly seen by a neurologist but even then GBS may be missed if not investigated further by CSF investigations and nerve conduction studies.

It is also important to stress that various differentials have to be excluded before diagnosing GBS. The most frequent of these differentials are toxic neuropathies resulting from the anti-COVID-19 medication, critical ill neuropathy, and pressure palsies due to non-physiological bedding on the intensive care unit. [3] A limitation of Table 1 is that no reference limits were provided for the parameters listed, why it is difficult to interpret if the given values are inside or outside the normal range.

Thrombocyte counts are highly variable in Table 1 . [1] We should be told if thrombocytopenia of 10,600 was due to immune mechanisms and complicated by bleeding. Is it conceivable that the low thrombocyte counts are writing errors?

Overall, the study has some limitations which challenge the results and their interpretation. These issues should be addressed not to draw unsupported conclusions.

Getting paralysed after COVID: Guillain-Barre syndrome

Guillain-Barre syndrome in 220 patients with COVID-19

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