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Gulišija J, Čapkun V, Golic S, Stojanović Stipić S. Vitamin D Serum Levels and the Development of Intensive Care Unit-Acquired Weakness: Insights from a COVID-19 Intensive Care Cohort. PATHOPHYSIOLOGY 2025; 32:21. [PMID: 40407601 PMCID: PMC12101332 DOI: 10.3390/pathophysiology32020021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2025] [Revised: 04/22/2025] [Accepted: 05/06/2025] [Indexed: 05/26/2025] Open
Abstract
Background/Objectives: The pathogenesis of intensive care unit-acquired weakness (ICU-AW) is multi-factorial, with some of the main risk factors being sepsis, multiorgan failure, and the inflammatory response related to critical illness. Vitamin D is crucial for muscle function, the immune response, and inflammation, and has been identified as a predictor of negative outcomes in intensive care unit (ICU) patients with COVID-19. The objective of this preliminary study was to examine the relationship between vitamin D serum levels and the incidence of ICU-AW in a cohort from the University Hospital of Split. Methods: A prospective observational cohort study was conducted in the University Hospital of Split in ICU from December 2021 to March 2022. The inclusion criteria were as follows: patients over 18 years old who had a confirmed severe acute respiratory coronavirus disease 2 (SARS-CoV-2) infection, patients who were mechanically ventilated for more than 48 h, and patients who were weaned from a ventilator over at least 24 h. The exclusion criteria were a history of neurological or musculoskeletal disorders and a pre-existing poor functional status. Vitamin D was detected in the first routine blood sample. Results: A total of 77 patients were observed, with 36 patients who were successfully weaned from a ventilator over at least 24 h and 1 patient who could not be examined because of impaired consciousness (this patient was excluded from further analysis), and thus a total of 35 patients were analyzed. Of these 35 patients, 12 (34%) developed ICU-AW. The median vitamin D serum level in the ICU-AW group was 17 (7.5-73.3), while that in the non-ICU-AW group was 25.2 (12.3-121). The difference in vitamin D serum levels between the groups was not significantly different from zero (p = 0.567). All patients, except for one, were vitamin D insufficient. Conclusions: Vitamin D serum levels in the ICU-AW group were not statistically different from the non-ICU-AW group, possibly due to the small sample size. Given the known roles of vitamin D in muscle function, immune modulation, and inflammation, a potential etiopathogenetic role in ICU-AW cannot be excluded without additional studies. Therefore, further studies with larger sample sizes than ours are necessary to determine whether vitamin D deficiency contributes to the development of ICU-AW and whether supplementation could have preventive or therapeutic value.
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Affiliation(s)
- Jelena Gulišija
- Department of Neurology, University Hospital of Split, 21000 Split, Croatia
| | - Vesna Čapkun
- Department of Nuclear Medicine, University Hospital of Split, 21000 Split, Croatia;
| | - Stefan Golic
- School of Medicine, University of Split, 21000 Split, Croatia;
| | - Sanda Stojanović Stipić
- Department of Anesthesiology and Intensive Care Unit, University Hospital of Split, 21000 Split, Croatia;
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Zhai X, Wu W, Zeng S, Miao Y. Advance in the mechanism and clinical research of myalgia in long COVID. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL IMMUNOLOGY 2024; 13:142-164. [PMID: 39310121 PMCID: PMC11411160 DOI: 10.62347/txvo6284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 07/18/2024] [Indexed: 09/25/2024]
Abstract
As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to evolve, mortality rates of coronavirus disease 2019 (COVID-19) have significantly decreased. However, a variable proportion of patients exhibit persistent prolonged symptoms of COVID-19 infection (long COVID). This virus primarily attacks respiratory system, but numerous individuals complain persistent skeletal muscle pain or worsening pre-existing muscle pain post COVID-19, which severely affects the quality of life and recovery. Currently, there is limited research on the skeletal muscle pain in long COVID. In this brief review, we review potential pathological mechanisms of skeletal muscle pain in long COVID, and summarize the various auxiliary examinations and treatments for skeletal muscle pain in long COVID. We consider abnormal activation of inflammatory response, myopathy, and neurological damages as pivotal pathological mechanisms of skeletal muscle pain in long COVID. A comprehensive examination is significantly important in order to work out effective treatment plans and relieve skeletal muscle pain. So far, rehabilitation interventions for myalgia in long COVID contain but are not limited to drug, nutraceutical therapy, gut microbiome-targeted therapy, interventional therapy and strength training. Our study provides a potential mechanism reference for clinical researches, highlighting the importance of comprehensive approach and management of skeletal muscle pain in long COVID. The relief of skeletal muscle pain will accelerate rehabilitation process, improve activities of daily living and enhance the quality of life, promoting individuals return to society with profound significance.
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Affiliation(s)
- Xiuyun Zhai
- Department of Rehabilitation, Shanghai General Hospital, Shanghai Jiaotong UniversityNo. 100, Haining Road, Shanghai 200080, China
| | - Weijun Wu
- Department of Rehabilitation, Shanghai General Hospital, Shanghai Jiaotong UniversityNo. 100, Haining Road, Shanghai 200080, China
| | - Siliang Zeng
- Department of Rehabilitation Therapy, School of Health, Shanghai Normal University Tianhua CollegeNo. 1661, North Shengxin Road, Shanghai 201815, China
| | - Yun Miao
- Department of Rehabilitation, Shanghai General Hospital, Shanghai Jiaotong UniversityNo. 100, Haining Road, Shanghai 200080, China
- Department of Rehabilitation, School of International Medical Technology, Shanghai Sanda UniversityNo. 2727, Jinhai Road, Shanghai 201209, China
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3
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Dye M, Lantz R. Profound Rhabdomyolysis and Viral Myositis Due to SARS-CoV-2: A Case Report. Cureus 2024; 16:e61172. [PMID: 38933630 PMCID: PMC11200312 DOI: 10.7759/cureus.61172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
The novel SARS-CoV-2 introduced several new inflammatory conditions including SARS-CoV-2-associated rhabdomyolysis and viral myositis. We present a 22-year-old man who noted a week of cough followed by myalgias, dark-colored urine, and decreased oral intake. He was found to have acute nontraumatic rhabdomyolysis after an acutely positive SARS-CoV-2 test. Initial creatine kinase (CK) level was above the reference range as were liver enzymes reflective of muscle breakdown. Treatment involved fluid resuscitation and pain control, with close monitoring of kidney, liver, and skeletal markers over five days of hospitalization till there was clinical and symptomatic improvement.
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Affiliation(s)
- Makenzie Dye
- School of Medicine, Wright State University Boonshoft School of Medicine, Fairborn, USA
| | - Rebekah Lantz
- Hospital Medicine, Miami Valley Hospital, Dayton, USA
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4
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Kiyak C, Ijezie OA, Ackah JA, Armstrong M, Cowen J, Cetinkaya D, Burianová H, Akudjedu TN. Topographical Distribution of Neuroanatomical Abnormalities Following COVID-19 Invasion : A Systematic Literature Review. Clin Neuroradiol 2024; 34:13-31. [PMID: 37697012 PMCID: PMC10881816 DOI: 10.1007/s00062-023-01344-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/14/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE This systematic review is aimed at synthesising the literature base to date on the frequency and topographical distribution of neuroanatomical changes seen on imaging following COVID-19 invasion with a focus on both the acute and chronic phases of the disease. METHODS In this study, 8 databases were systematically searched to identify relevant articles published from December 2019 to March 2022 and supplemented with a manual reference search. Data were extracted from the included studies and narrative synthesis was employed to integrate the findings. RESULTS A total of 110 studies met the inclusion criteria and comprised 119,307 participants (including 31,073 acute and 143 long COVID-19 patients manifesting neurological alterations) and controls. Considerable variability in both the localisation and nature of neuroanatomical abnormalities are noted along the continuum with a wide range of neuropathologies relating to the cerebrovascular/neurovascular system, (sub)cortical structures (including deep grey and white matter structures), brainstem, and predominant regional and/or global alterations in the cerebellum with varying degrees of spinal involvement. CONCLUSION Structural regional alterations on neuroimaging are frequently demonstrated in both the acute and chronic phases of SARS-CoV‑2 infection, particularly prevalent across subcortical, prefrontal/frontal and cortico-limbic brain areas as well as the cerebrovascular/neurovascular system. These findings contribute to our understanding of the acute and chronic effects of the virus on the nervous system and has the potential to provide information on acute and long-term treatment and neurorehabilitation decisions.
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Affiliation(s)
- Ceyda Kiyak
- Faculty of Science and Technology, Bournemouth University, Bournemouth, UK
- School of Psychology, University of East Anglia, Norwich, UK
| | | | - Joseph A Ackah
- Institute of Medical Imaging and Visualisation, Faculty of Health and Social Sciences, Bournemouth University, 8 8GP, Bournemouth, UK
| | - Matthew Armstrong
- Department of Rehabilitation & Sports Sciences, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Jake Cowen
- Department of Radiology, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Deniz Cetinkaya
- Faculty of Science and Technology, Bournemouth University, Bournemouth, UK
| | - Hana Burianová
- Faculty of Science and Technology, Bournemouth University, Bournemouth, UK
| | - Theophilus N Akudjedu
- Institute of Medical Imaging and Visualisation, Faculty of Health and Social Sciences, Bournemouth University, 8 8GP, Bournemouth, UK.
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5
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Błażejewski G, Witkoś J, Hartman-Petrycka M. Changes in sensitivity and hedonic rating to transcutaneous electrical nerve stimulation following COVID-19. Sci Rep 2024; 14:1233. [PMID: 38216666 PMCID: PMC10786926 DOI: 10.1038/s41598-024-51596-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/07/2024] [Indexed: 01/14/2024] Open
Abstract
COVID-19 affects not only the respiratory system but also other biological systems such as the nervous system. Usually, these changes are reported based on the patient's subjective description. The aim of our study, therefore, was to objectively determine the effect that the SARS-CoV-2 virus and COVID-19 disease has on sensory threshold and the hedonic and subjective perception of an electrical stimulus. The sensory threshold was tested on the inner forearm by applying non-invasive transcutaneous electrical nerve stimulation (TENS) with 100 Hz and 100 µs parameters and a biphasic current waveform. The study involved 211 participants, aged 22-79 years, with a mean age of 56.9 ± 12.1 years. There were 131 subjects in the COVID group, while the NON-COVID group, the control group, was matched to the COVID group in terms of gender, age, body mass index and presence of chronic diseases. The research was carried out in 2022. Sensory sensitivity was highest in the group that had suffered with COVID-19. The median sensory sensitivity was 11 mA in the COVID group and 14 mA (p < 0.001) in the NON-COVID group, however, the current sensitivity threshold decreased over time (R = 0.52, p < 0.001). Post COVID-19, the electrical stimulus was more often perceived as unpleasant: COVID versus NON-COVID (23% vs. 3%, p < 0.001) and as a different sensation to tingling (27% vs. 2%, p < 0.001). Post-COVID-19 patients have a lower sensory threshold, the electrical stimulus is more often described as unpleasant and in subjective feelings it is more often described as pinching. The differences between COVID and NON-COVID decrease with time since the onset of COVID symptoms.
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Affiliation(s)
- Grzegorz Błażejewski
- Faculty of Medicine and Health Science, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland.
| | - Joanna Witkoś
- Faculty of Medicine and Health Science, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
| | - Magdalena Hartman-Petrycka
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland
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Sathu S, Kumar R, Maley DK, Eppakayala S, Kashyap A, NynaSindhu A, Madhu Latha K, Lakkireddy M. Increased Frequency of Low Back Pain in Recent Times: Does the Answer Lie in COVID-19? Cureus 2023; 15:e50021. [PMID: 38186417 PMCID: PMC10767474 DOI: 10.7759/cureus.50021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2023] [Indexed: 01/09/2024] Open
Abstract
Background The COVID-19 pandemic has impacted many people's activities of daily living and health. It has also created economic burdens and caused mental turmoil across the world. Musculoskeletal symptoms, especially low back pain, have been observed in subjects of post-COVID-19 infection and post-vaccination. Aim In this study, we aimed to investigate the relationship between low back pain and COVID-19 infection and vaccination, as well as associated factors and characteristics. Methods We conducted a questionnaire-based cross-sectional observational study at All India Institute of Medical Science (AIIMS) Bibinagar between September 2021 and March 2022. We collected data from individuals through physical and Google Forms (Google, Mountain View, California). Results We included a total of 535 individuals in the study: 274 (51.2%) were previously positive for COVID-19 infection (group A), and 261 (48.8%) were vaccinated against COVID-19 without a history of COVID-19 infection (group B). Each group was divided into two categories based on whether they had low back pain before COVID-19 infection or vaccination. In group A, 90.1% of individuals experienced an aggravation of low back pain after COVID-19 infection, which was found to be significant (p<0.001). In group B, there was an insignificant increase in low back pain following COVID-19 vaccination (p=0.275). The study also revealed a significant association between comorbidities and low back pain in both groups (p<0.001). Additionally, several differences were observed between the two groups, including duration (p<0.001), severity (p=0.012), and intensity (p<0.001) of low back pain, usage of a back support or brace (p=0.043), and intake of vitamin D (p=0.002). Conclusion Low back pain is an ignored feature of one of the musculoskeletal symptoms of COVID-19 and was aggravated by COVID-19 infection in our patients compared to those who received the vaccination. The findings of this study have implications for raising awareness, improving management and rehabilitation, and guiding future research in this area.
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Affiliation(s)
- Sreedhar Sathu
- Department of Orthopedics, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
| | - Ravi Kumar
- Department of Orthopedics, All India Institute of Medical Sciences, Rajkot, Rajkot, IND
| | - Deepak K Maley
- Department of Orthopedics, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
| | - Srikanth Eppakayala
- Department of Orthopedics, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
| | - Adinarayana Kashyap
- Department of Orthopedics, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
| | - Akula NynaSindhu
- Department of General Surgery, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
| | - Karra Madhu Latha
- Department of Biochemistry, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
| | - Maheshwar Lakkireddy
- Department of Orthopedics, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
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7
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Rajput SS, Aghoram R, Wadwekar V, Nanda N. Skeletal muscle injury in COVID infection: Frequency and patterns. Muscle Nerve 2023; 68:873-878. [PMID: 37863811 DOI: 10.1002/mus.27990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 09/25/2023] [Accepted: 10/04/2023] [Indexed: 10/22/2023]
Abstract
INTRODUCTION/AIMS Little is known about skeletal muscle injury with coronavirus disease 2019 (COVID-19). We estimate the frequency and explore the patterns of skeletal muscle injury in acute COVID-19. METHODS A cohort of COVID patients with mild to moderate symptoms were evaluated in a COVID-designated hospital between May and December 2021 and followed for 2 weeks. Skeletal muscle injury was assessed according to creatine kinase (CK) levels, Manual Muscle Test-8 (MMT-8) score, and the Health Assessment Questionnaire (HAQ) score. Injury was defined as CK >200 IU/L with an MMT-8 score < 76. The association between such injury and severity and outcomes were evaluated using cross-tabulations. RESULTS Two hundred fifty participants with a mean age of 50.2 years (SD: 17.2) were included. One hundred nine (43.6%) were women; 84 (34%) developed severe disease. Median CK levels were 91 IU/L (IQR 56-181). [Correction added on 17 November 2023, after first online publication: In the preceding sentence, the IQR was corrected from '56,181'.] Patients with weakness on the MMT-8 (n = 247, 98.8%) and disability on the HAQ (n = 107; 42.8%) were common. Neck flexor muscles were prominently affected. Skeletal muscle injury was seen in 22.4% (95% CI: 17.4-28.1). There was no significant association between skeletal muscle injury and maximal severity of illness or short-term outcomes. Disability increased over 14 days in most survivors (n = 172, 72.3%) and this was not seen in those with mild disease (OR: 0.4, 95% CI: 0.22-0.70). DISCUSSION Skeletal muscle injury appears to be common in people presenting with mild to moderate COVID infection.
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Affiliation(s)
- Saurabh Singh Rajput
- Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Rajeswari Aghoram
- Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Vaibhav Wadwekar
- Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Nivedita Nanda
- Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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8
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Zaa CA, Espitia C, Reyes-Barrera KL, An Z, Velasco-Velázquez MA. Neuroprotective Agents with Therapeutic Potential for COVID-19. Biomolecules 2023; 13:1585. [PMID: 38002267 PMCID: PMC10669388 DOI: 10.3390/biom13111585] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 11/26/2023] Open
Abstract
COVID-19 patients can exhibit a wide range of clinical manifestations affecting various organs and systems. Neurological symptoms have been reported in COVID-19 patients, both during the acute phase of the illness and in cases of long-term COVID. Moderate symptoms include ageusia, anosmia, altered mental status, and cognitive impairment, and in more severe cases can manifest as ischemic cerebrovascular disease and encephalitis. In this narrative review, we delve into the reported neurological symptoms associated with COVID-19, as well as the underlying mechanisms contributing to them. These mechanisms include direct damage to neurons, inflammation, oxidative stress, and protein misfolding. We further investigate the potential of small molecules from natural products to offer neuroprotection in models of neurodegenerative diseases. Through our analysis, we discovered that flavonoids, alkaloids, terpenoids, and other natural compounds exhibit neuroprotective effects by modulating signaling pathways known to be impacted by COVID-19. Some of these compounds also directly target SARS-CoV-2 viral replication. Therefore, molecules of natural origin show promise as potential agents to prevent or mitigate nervous system damage in COVID-19 patients. Further research and the evaluation of different stages of the disease are warranted to explore their potential benefits.
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Affiliation(s)
- César A. Zaa
- School of Biological Sciences, Universidad Nacional Mayor de San Marcos (UNMSM), Lima 15081, Peru;
| | - Clara Espitia
- Department of Immunology, Institute of Biomedical Research, Universidad Nacional Autónoma de México (UNAM), Mexico City 04510, Mexico; (C.E.); (K.L.R.-B.)
| | - Karen L. Reyes-Barrera
- Department of Immunology, Institute of Biomedical Research, Universidad Nacional Autónoma de México (UNAM), Mexico City 04510, Mexico; (C.E.); (K.L.R.-B.)
| | - Zhiqiang An
- Texas Therapeutics Institute, Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center, Houston, TX 77030, USA;
| | - Marco A. Velasco-Velázquez
- Texas Therapeutics Institute, Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center, Houston, TX 77030, USA;
- School of Medicine, Universidad Nacional Autónoma de México (UNAM), Mexico City 04510, Mexico
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9
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Copley M, Kozminski B, Gentile N, Geyer R, Friedly J. Postacute Sequelae of SARS-CoV-2: Musculoskeletal Conditions and Pain. Phys Med Rehabil Clin N Am 2023; 34:585-605. [PMID: 37419534 DOI: 10.1016/j.pmr.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
Musculoskeletal and pain sequelae of COVID-19 are common in both the acute infection and patients experiencing longer term symptoms associated with recovery, known as postacute sequelae of COVID-19 (PASC). Patients with PASC may experience multiple manifestations of pain and other concurrent symptoms that complicate their experience of pain. In this review, the authors explore what is currently known about PASC-related pain and its pathophysiology as well as strategies for diagnosis and management.
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Affiliation(s)
- Michelle Copley
- Department of Rehabilitation Medicine, University of Washington, 325 Ninth Avenue, Seattle, WA 98104, USA
| | - Barbara Kozminski
- Department of Rehabilitation Medicine, University of Washington, 325 Ninth Avenue, Seattle, WA 98104, USA
| | - Nicole Gentile
- Department of Family Medicine, University of Washington, 1959 Northeast Pacific Street, Box 356390, Seattle, WA 98195-6390, USA; Department of Laboratory Medicine and Pathology, University of Washington, 1959 Northeast Pacific Street Seattle, WA 98195-6390, USA
| | - Rachel Geyer
- Department of Family Medicine, University of Washington, 1959 Northeast Pacific Street, Box 356390, Seattle, WA 98195-6390, USA
| | - Janna Friedly
- Department of Rehabilitation Medicine, University of Washington, 325 Ninth Avenue, Seattle, WA 98104, USA.
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10
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Tiwari S, Garg PK, Panda S, Gupta A, Hegde A, Kumar D, Khera D, Bhatia PK, Garg M, Yadav T. Neuroimaging Spectrum in COVID-19 Infection: A Single-Center Experience. Indian J Radiol Imaging 2023; 33:351-360. [PMID: 37362355 PMCID: PMC10289858 DOI: 10.1055/s-0043-1768060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Background and Purpose The ongoing coronavirus disease 2019 (COVID-19) pandemic is a multisystemic disease and involvement of the nervous system is well established. The neurological and neuroimaging features of the disease have been extensively evaluated. Our study aimed to elucidate the neuroradiological findings in COVID-19 infected patients admitted to our institute during the first and second waves of the pandemic in India. Methods This was a single-center retrospective study of all COVID-19 positive patients who underwent neuroimaging between March 2020 and May 2021. The presenting neurological complaints, the imaging findings in computed tomography (CT) imaging, and/or magnetic resonance imaging (MRI) were recorded. They recorded the findings in the subheadings of ischemic stroke, hemorrhagic stroke, parainfectious demyelination, acute encephalitis syndrome, and changes of global hypoxic changes. Patients with age-related, chronic, and incidental findings were excluded. Results The study comprised of 180 COVID-19 positive patients who underwent neuroimaging. CT scan was performed for 169 patients, MRI for 28, and a combination of both CT and MRI was performed for 17 patients. Seventy percent of patients were males, and median age was 61.5 years (interquartile range: 48.25-70.75). Out of the 180 patients, 66 patients had nonspecific findings that could not be attributed to COVID-19 infection. In the remaining 114 patients, 77 (42.7%) had ischemic findings, while 22 (12.2%) had hemorrhagic stroke. Hypoxic ischemic changes were noted in five patients. The rest of the patients had a spectrum of changes including, cerebellitis (3), tumefactive demyelination (1), COVID-19-associated encephalitis (1), hemorrhagic acute demyelinating encephalomyelitis (1), transverse myelitis (1), cytotoxic lesions of corpus callosum (1), Guillain-Barre syndrome (1), and COVID-19-associated microhemorrhages (1). Conclusion Neurological manifestations of COVID-19 infection are not uncommon, and our understanding of this topic is expanding. A complex interplay of neurotropism and direct central nervous system invasion, immune activation and cytokine storm, vasculitis, and parainfectious processes are implicated in the pathophysiology. While the most common imaging finding was ischemic stroke, followed by hemorrhagic stroke, a diverse range of parainfectious findings was also noted in our study.
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Affiliation(s)
- Sarbesh Tiwari
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pawan Kumar Garg
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Samhita Panda
- Department of Neurology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Aanchal Gupta
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Adarsh Hegde
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Deepak Kumar
- Department of General Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Daisy Khera
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pradeep Kumar Bhatia
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mayank Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Taruna Yadav
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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11
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Morgan L, Hollist M, Au K, Ayari L, Betts C, Kirmani BF. Neuromuscular Disorders Associated With COVID-19. Neurosci Insights 2023; 18:26331055231176251. [PMID: 37255741 PMCID: PMC10225906 DOI: 10.1177/26331055231176251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/01/2023] [Indexed: 06/01/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has had an enormous impact on practically every aspect of daily life, and those with neuromuscular disorders have certainly not been spared. The effects of COVID-19 infection are far-reaching, going well beyond respiratory symptoms alone. From simple myalgias to debilitating critical illness neuromyopathies, we continue to learn and catalog the diverse pathologies presented by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as it relates to the neuromuscular system. Complications have been documented both as a direct result of primary infection but also in those with pre-existing neuromuscular disorders from myasthenia gravis to devastating critical illness neuromyopathies. In this review, we will discuss the relationship between COVID-19 infection and critical illness neuromyopathy, peripheral nerve palsies, myalgias, positional compressive neuropathy, myasthenia gravis, and Guillain-Barré syndrome.
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Affiliation(s)
| | | | | | - Lena Ayari
- Texas A&M University School of
Medicine, Bryan, TX, USA
| | - Colton Betts
- Texas A&M University School of
Medicine, Bryan, TX, USA
| | - Batool F Kirmani
- Texas A&M University School of
Medicine, Bryan, TX, USA
- Department of Neurology, CHI St. Joseph
Health, Bryan, TX, USA
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12
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Galluzzo C, Chiapparoli I, Corrado A, Cantatore FP, Salvarani C, Pipitone N. Rare forms of inflammatory myopathies - part I, generalized forms. Expert Rev Clin Immunol 2023; 19:169-183. [PMID: 36469633 DOI: 10.1080/1744666x.2023.2154656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The idiopathic inflammatory myopathies traditionally comprise dermatomyositis, polymyositis, immune-mediated necrotizing myopathy, anti-synthetase syndrome, and inclusion body myositis. In this review, we aimed to cover the less common forms of generalized myositis. AREAS COVERED We identified rare forms of widespread myositis on the basis of list provided by the homepage of the Neuromuscular disease center of Washington University, USA and on the basis of the authors' knowledge. We searched PubMed® and EMBASE® for relevant articles on these forms with the aim of providing as much as possible information on their clinical manifestations as well as guidance on their work-up and treatment. EXPERT OPINION There is substantial heterogeneity among the various rare forms of generalized myositis in terms of their frequency and characterization. Some forms are reasonably well defined, while others may not represent truly well-defined diseases, but rather variants of other myopathies. The landscape of rare forms appears to have evolved over time, with some forms now being better characterized, while others, such as SARS-Cov-2- and immune checkpoint inhibitor-related myositis have come to the fore only in recent years. Knowledge about rare forms of myositis can aid in their recognition and treatment.
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Affiliation(s)
- Claudio Galluzzo
- Department of internal Medicine, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ilaria Chiapparoli
- Department of internal Medicine, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ada Corrado
- Rheumatology Clinic, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Francesco Paolo Cantatore
- Rheumatology Clinic, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Carlo Salvarani
- Department of internal Medicine, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Università di Modena e Reggio Emilia, Modena, Italy
| | - Nicolò Pipitone
- Department of internal Medicine, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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13
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Yepes M. Neurological Complications of SARS-CoV-2 Infection and COVID-19 Vaccines: From Molecular Mechanisms to Clinical Manifestations. Curr Drug Targets 2022; 23:1620-1638. [PMID: 36121081 DOI: 10.2174/1389450123666220919123029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/31/2022] [Accepted: 07/26/2022] [Indexed: 01/25/2023]
Abstract
Coronavirus Disease 2019 (COVID-19) is an infectious disease, caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), that reached pandemic proportions in 2020. Despite the fact that it was initially characterized by pneumonia and acute respiratory distress syndrome, it is now clear that the nervous system is also compromised in one third of these patients. Indeed, a significant proportion of COVID-19 patients suffer nervous system damage via a plethora of mechanisms including hypoxia, coagulopathy, immune response to the virus, and the direct effect of SARS-CoV-2 on endothelial cells, neurons, astrocytes, pericytes and microglia. Additionally, a low number of previously healthy individuals develop a variety of neurological complications after receiving COVID-19 vaccines and a large proportion of COVID-19 survivors experience longlasting neuropsychiatric symptoms. In conclusion, COVID-19 is also a neurological disease, and the direct and indirect effects of the virus on the nervous system have a significant impact on the morbidity and mortality of these patients. Here we will use the concept of the neurovascular unit, assembled by endothelial cells, basement membrane, perivascular astrocytes, neurons and microglia, to review the effects of SARS-CoV-2 in the nervous system. We will then use this information to review data published to this date on the neurological manifestations of COVID-19, the post- COVID syndrome and COVID-19 vaccines.
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Affiliation(s)
- Manuel Yepes
- Division of Neuropharmacology and Neurologic Diseases, Yerkes National Primate Research Center, Atlanta, GA, USA.,Department of Neurology & Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA.,Department of Neurology, Veterans Affairs Medical Center, Atlanta, GA, USA
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14
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Manousakis G. Inflammatory Myopathies. Continuum (Minneap Minn) 2022; 28:1643-1662. [PMID: 36537973 DOI: 10.1212/con.0000000000001179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW This article outlines the salient clinical, serologic, electrophysiologic, imaging, and histopathologic findings and treatment options for the idiopathic inflammatory myopathies, including those related to immune checkpoint inhibitors and SARS-CoV-2. RECENT FINDINGS The classification of idiopathic inflammatory myopathies has improved with the integration of myositis-specific antibodies and histopathologic findings. Characteristic features of immune checkpoint inhibitor-related myositis have been identified, allowing early recognition and treatment of the syndrome. The COVID-19 pandemic has had a profound impact on the care of patients with idiopathic inflammatory myopathies, and several mechanisms of virus-related muscle injury have been proposed. SUMMARY A comprehensive evaluation including clinical examination, EMG, imaging, antibody testing, muscle biopsy, and cancer screening, when appropriate, can lead to an earlier accurate diagnosis and an individualized treatment approach for patients with idiopathic inflammatory myopathies.
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15
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Pavel B, Moroti R, Spataru A, Popescu MR, Panaitescu AM, Zagrean AM. Neurological Manifestations of SARS-CoV2 Infection: A Narrative Review. Brain Sci 2022; 12:1531. [PMID: 36421855 PMCID: PMC9688734 DOI: 10.3390/brainsci12111531] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 08/30/2023] Open
Abstract
The COVID-19 virus frequently causes neurological complications. These have been described in various forms in adults and children. Headache, seizures, coma, and encephalitis are some of the manifestations of SARS-CoV-2-induced neurological impairment. Recent publications have revealed important aspects of viral pathophysiology and its involvement in nervous-system impairment in humans. We evaluated the latest literature describing the relationship between COVID-19 infection and the central nervous system. We searched three databases for observational and interventional studies in adults published between December 2019 and September 2022. We discussed in narrative form the neurological impairment associated with COVID-19, including clinical signs and symptoms, imaging abnormalities, and the pathophysiology of SARS-CoV2-induced neurological damage.
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Affiliation(s)
- Bogdan Pavel
- Department of Functional Sciences, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Clinical Emergency Hospital of Plastic, Reconstructive Surgery and Burns, 010713 Bucharest, Romania
| | - Ruxandra Moroti
- Clinical Department 2, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Matei Bals National Institute of Infectious Diseases, 021105 Bucharest, Romania
| | - Ana Spataru
- Department of Critical Care, King’s College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Mihaela Roxana Popescu
- Cardiothoracic Medicine Department, University of Medicine and Pharmacy Carol Davila, 020021 Bucharest, Romania
- Department of Cardiology, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Anca Maria Panaitescu
- Department of Obstetrics and Gynecology Filantropia Clinical Hospital Bucharest, 011171 Bucharest, Romania
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Ana-Maria Zagrean
- Department of Functional Sciences, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
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16
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Omar IM, Weaver JS, Samet JD, Serhal AM, Mar WA, Taljanovic MS. Musculoskeletal Manifestations of COVID-19: Currently Described Clinical Symptoms and Multimodality Imaging Findings. Radiographics 2022; 42:1415-1432. [PMID: 35867593 PMCID: PMC9341171 DOI: 10.1148/rg.220036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
COVID-19, the clinical syndrome produced by infection with SARS-CoV-2, can result
in multisystem organ dysfunction, including respiratory failure and
hypercoagulability, which can lead to critical illness and death.
Musculoskeletal (MSK) manifestations of COVID-19 are common but have been
relatively underreported, possibly because of the severity of manifestations in
other organ systems. Additionally, patients who have undergone sedation and who
are critically ill are often unable to alert clinicians of their MSK symptoms.
Furthermore, some therapeutic measures such as medications and vaccinations can
worsen existing MSK symptoms or cause additional symptoms. Symptoms may persist
or occur months after the initial infection, known as post-COVID condition or
long COVID. As the global experience with COVID-19 and the vaccination effort
increases, certain patterns of MSK disease involving the bones, muscles,
peripheral nerves, blood vessels, and joints have emerged, many of which are
likely related to a hyperinflammatory host response, prothrombotic state, or
therapeutic efforts rather than direct viral toxicity. Imaging findings for
various COVID-19–related MSK pathologic conditions across a variety of
modalities are being recognized, which can be helpful for diagnosis, treatment
guidance, and follow-up. The online slide presentation from the RSNA Annual Meeting is
available for this article. ©RSNA, 2022
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Affiliation(s)
- Imran M Omar
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair St, Suite 800, Chicago, IL 60611 (I.M.O., A.M.S.); Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, N.M. (J.S.W., M.S.T.); Department of Medical Imaging, Ann & Robert Lurie Children's Hospital, Chicago, Ill (J.D.S.); Department of Radiology, University of Illinois at Chicago College of Medicine, Chicago, Ill (W.A.M.); and Departments of Medical Imaging and Orthopaedics, University of Arizona College of Medicine, Tucson, Ariz (M.S.T.)
| | - Jennifer S Weaver
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair St, Suite 800, Chicago, IL 60611 (I.M.O., A.M.S.); Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, N.M. (J.S.W., M.S.T.); Department of Medical Imaging, Ann & Robert Lurie Children's Hospital, Chicago, Ill (J.D.S.); Department of Radiology, University of Illinois at Chicago College of Medicine, Chicago, Ill (W.A.M.); and Departments of Medical Imaging and Orthopaedics, University of Arizona College of Medicine, Tucson, Ariz (M.S.T.)
| | - Jonathan D Samet
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair St, Suite 800, Chicago, IL 60611 (I.M.O., A.M.S.); Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, N.M. (J.S.W., M.S.T.); Department of Medical Imaging, Ann & Robert Lurie Children's Hospital, Chicago, Ill (J.D.S.); Department of Radiology, University of Illinois at Chicago College of Medicine, Chicago, Ill (W.A.M.); and Departments of Medical Imaging and Orthopaedics, University of Arizona College of Medicine, Tucson, Ariz (M.S.T.)
| | - Ali M Serhal
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair St, Suite 800, Chicago, IL 60611 (I.M.O., A.M.S.); Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, N.M. (J.S.W., M.S.T.); Department of Medical Imaging, Ann & Robert Lurie Children's Hospital, Chicago, Ill (J.D.S.); Department of Radiology, University of Illinois at Chicago College of Medicine, Chicago, Ill (W.A.M.); and Departments of Medical Imaging and Orthopaedics, University of Arizona College of Medicine, Tucson, Ariz (M.S.T.)
| | - Winnie A Mar
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair St, Suite 800, Chicago, IL 60611 (I.M.O., A.M.S.); Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, N.M. (J.S.W., M.S.T.); Department of Medical Imaging, Ann & Robert Lurie Children's Hospital, Chicago, Ill (J.D.S.); Department of Radiology, University of Illinois at Chicago College of Medicine, Chicago, Ill (W.A.M.); and Departments of Medical Imaging and Orthopaedics, University of Arizona College of Medicine, Tucson, Ariz (M.S.T.)
| | - Mihra S Taljanovic
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair St, Suite 800, Chicago, IL 60611 (I.M.O., A.M.S.); Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, N.M. (J.S.W., M.S.T.); Department of Medical Imaging, Ann & Robert Lurie Children's Hospital, Chicago, Ill (J.D.S.); Department of Radiology, University of Illinois at Chicago College of Medicine, Chicago, Ill (W.A.M.); and Departments of Medical Imaging and Orthopaedics, University of Arizona College of Medicine, Tucson, Ariz (M.S.T.)
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17
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Galassi G, Marchioni A. Acute neuromuscular syndromes with respiratory failure during COVID-19 pandemic: where we stand and challenges ahead. J Clin Neurosci 2022; 101:264-275. [PMID: 35660960 PMCID: PMC9050587 DOI: 10.1016/j.jocn.2022.03.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 03/15/2022] [Accepted: 03/29/2022] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 2019 (COVID-19), a disease caused by the novel betacoronavirus SARS-COV-2, has become a global pandemic threat. SARS- COV-2 is structurally similar to SARS-COV, and both bind to the angiotensin-converting enzyme 2 (ACE2) receptor to enter human cells. While patients typically present with fever, shortness of breath, sore throat, and cough, in some cases neurologic manifestations occur due to both direct and indirect involvement of the nervous system. Case reports include anosmia, ageusia, central respiratory failure, stroke, acute necrotizing hemorrhagic encephalopathy, toxic-metabolic encephalopathy, headache, myalgia, myelitis, ataxia, and various neuropsychiatric manifestations. Some patients with COVID-19 may present with concurrent acute neuromuscular syndromes such as myasthenic crisis (MC), Guillain–Barré syndrome (GBS) and idiopathic inflammatory myopathies (IIM); these conditions coupled with respiratory failure could trigger a life-threatening condition. Here, we review the current state of knowledge on acute neuromuscular syndromes with respiratory failure related to COVID-19 infection in an attempt to clarify and to manage the muscle dysfunction overlapping SARS-COV-2 infection.
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18
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An H, Eun M, Yi J, Park J. CRESSP: a comprehensive pipeline for prediction of immunopathogenic SARS-CoV-2 epitopes using structural properties of proteins. Brief Bioinform 2022; 23:6539139. [PMID: 35226074 DOI: 10.1093/bib/bbac056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/04/2022] [Accepted: 02/03/2022] [Indexed: 12/16/2022] Open
Abstract
The development of autoimmune diseases following SARS-CoV-2 infection, including multisystem inflammatory syndrome, has been reported, and several mechanisms have been suggested, including molecular mimicry. We developed a scalable, comparative immunoinformatics pipeline called cross-reactive-epitope-search-using-structural-properties-of-proteins (CRESSP) to identify cross-reactive epitopes between a collection of SARS-CoV-2 proteomes and the human proteome using the structural properties of the proteins. Overall, by searching 4 911 245 proteins from 196 352 SARS-CoV-2 genomes, we identified 133 and 648 human proteins harboring potential cross-reactive B-cell and CD8+ T-cell epitopes, respectively. To demonstrate the robustness of our pipeline, we predicted the cross-reactive epitopes of coronavirus spike proteins, which were recognized by known cross-neutralizing antibodies. Using single-cell expression data, we identified PARP14 as a potential target of intermolecular epitope spreading between the virus and human proteins. Finally, we developed a web application (https://ahs2202.github.io/3M/) to interactively visualize our results. We also made our pipeline available as an open-source CRESSP package (https://pypi.org/project/cressp/), which can analyze any two proteomes of interest to identify potentially cross-reactive epitopes between the proteomes. Overall, our immunoinformatic resources provide a foundation for the investigation of molecular mimicry in the pathogenesis of autoimmune and chronic inflammatory diseases following COVID-19.
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Affiliation(s)
- Hyunsu An
- School of Life Sciences, Gwangju Institute of Science and Technology (GIST), Republic of Korea
| | - Minho Eun
- School of Life Sciences, Gwangju Institute of Science and Technology (GIST), Republic of Korea
| | - Jawoon Yi
- School of Life Sciences, Gwangju Institute of Science and Technology (GIST), Republic of Korea
| | - Jihwan Park
- School of Life Sciences, Gwangju Institute of Science and Technology (GIST), Republic of Korea.,Anti-Virus Research Center, Gwangju Institute of Science and Technology (GIST), Republic of Korea.,Laboratory for cell mechanobiology, Gwangju Institute of Science and Technology (GIST), Republic of Korea
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19
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Taga A, Lauria G. COVID-19 and the Peripheral Nervous System. A 2-year review from the pandemic to the vaccine era. J Peripher Nerv Syst 2022; 27:4-30. [PMID: 35137496 PMCID: PMC9115278 DOI: 10.1111/jns.12482] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 01/31/2022] [Accepted: 01/31/2022] [Indexed: 11/29/2022]
Abstract
Increasing literature has linked COVID‐19 to peripheral nervous system (PNS) diseases. In addition, as we move from the pandemic to the vaccination era, literature interest is shifting towards the potential association between COVID‐19 vaccines and PNS manifestations. We reviewed published literature on COVID‐19, COVID‐19 vaccines and PNS manifestations between 1 January 2020 and 1 December 2021. For Guillain‐Barré syndrome (GBS), isolated cranial neuropathy (ICN) and myositis associated with COVID‐19, the demographic, clinical, laboratory, electrophysiological and imaging features were included in a narrative synthesis. We identified 169 studies on COVID‐19‐associated complications, including 63 papers (92 patients) on GBS, 29 papers (37 patients) on ICN and 11 papers (18 patients) on myositis. Additional clinical phenotypes included chronic inflammatory demyelinating polyneuropathy, vasculitic neuropathies, neuralgic amyotrophy, critical care‐related complications, and myasthenia gravis. PNS complications secondary to COVID‐19 vaccines have been reported during randomized clinical trials, in real‐world case reports, and during large‐scale surveillance programs. These mainly include cases of GBS, Bell's palsy, and cases of neuralgic amyotrophy. Based on our extensive review of the literature, any conclusion about a pathophysiological correlation between COVID‐19 and PNS disorders remains premature, and solely supported by their temporal association, while epidemiological and pathological data are insufficient. The occurrence of PNS complications after COVID‐19 vaccines seems limited to a possible higher risk of facial nerve palsy and GBS, to a degree that widespread access to the ongoing vaccination campaign should not be discouraged, while awaiting for more definitive data from large‐scale surveillance studies.
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Affiliation(s)
- Arens Taga
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Giuseppe Lauria
- Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan.,Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
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20
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Makhdoomi R, Malik N, Charan J, Malik A, Singh S. Spinal aspergillosis: a rare complication of COVID-19 infection. EGYPTIAN JOURNAL OF NEUROSURGERY 2022; 37:6. [PMID: 35106065 PMCID: PMC8793326 DOI: 10.1186/s41984-021-00140-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/28/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Several complications have been reported in COVID-19 infection. Most of the complications include secondary infection. CASE PRESENTATION We report an 85-year-old male who presented with cauda equina syndrome 7-months after contracting COVID-19 infection. We excised an extradural mass which on examination proved to be Spinal Aspergillosis. CONCLUSIONS Spinal Aspergillosis should be kept in mind in patients who present with local spinal pain with or without neurological deficit after COVID-19 infection.
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Affiliation(s)
- Rumana Makhdoomi
- Department of Pathology, Sheri-Kashmir-Institute of Medical Sciences, Srinagar, Kashmir 190011 India
| | - Nayil Malik
- Department of Neurosurgery, Sheri-Kashmir-Institute of Medical Sciences, Srinagar, Kashmir 190011 India
| | - Jagdish Charan
- Department of Neurosurgery, Sheri-Kashmir-Institute of Medical Sciences, Srinagar, Kashmir 190011 India
| | - Azhar Malik
- Department of Neurosurgery, Sheri-Kashmir-Institute of Medical Sciences, Srinagar, Kashmir 190011 India
| | - Sarbjit Singh
- Department of Neurosurgery, Sheri-Kashmir-Institute of Medical Sciences, Srinagar, Kashmir 190011 India
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21
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Farooq M, Mohammed Y, Zafar M, Dharmasena D, Rana UI, Kankam O. COVID-19 Vaccine-Induced Pneumonitis, Myositis and Myopericarditis. Cureus 2022; 14:e20979. [PMID: 35004093 PMCID: PMC8733846 DOI: 10.7759/cureus.20979] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 12/26/2022] Open
Abstract
A 63-year-old male, with no significant past history and not on any regular medications previously, had mild respiratory symptoms post the first dose of the AstraZeneca (Cambridge, England) coronavirus disease 2019 (COVID-19) vaccine, which were self-limiting. Following the second dose of the vaccine, he arrived at the emergency department (ED) with worsening shortness of breath. During this admission, he was assumed to have interstitial lung disease due to a possible past history of occupational exposure. He responded to a short-term course of corticosteroids and antibiotics and was discharged home. However, he reported again to the emergency department three weeks later, with persistent dyspnoea along with myalgia. His blood tests and imaging from scans suggested myositis, pneumonitis, and myopericarditis. Since he recently had the COVID-19 AstraZeneca vaccine, it was postulated as the most likely cause of the symptoms. He was managed with intravenous (IV) corticosteroids followed by oral corticosteroids with symptom resolution.
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22
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Kızıltunç PB, Seven MY, Atilla H. Diplopia due to acquired Brown syndrome after COVID-19 infection. J AAPOS 2021; 25:366-368. [PMID: 34314860 PMCID: PMC8305294 DOI: 10.1016/j.jaapos.2021.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 06/29/2021] [Accepted: 07/10/2021] [Indexed: 12/25/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is a multisystem, inflammatory condition usually presenting with respiratory symptoms, such as fever, shortness of breath, and severe cough. It may also present with ocular, neurological, and musculoskeletal manifestations. However, since the emergence of the disease in 2019, only a few cases with ocular involvement have been reported in the literature. We present a case of acquired Brown syndrome secondary to COVID-19.
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Affiliation(s)
| | | | - Huban Atilla
- Department of Ophthalmology, Ankara University, School of Medicine, Ankara, Turkey
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23
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Wan D, Du T, Hong W, Chen L, Que H, Lu S, Peng X. Neurological complications and infection mechanism of SARS-COV-2. Signal Transduct Target Ther 2021; 6:406. [PMID: 34815399 PMCID: PMC8609271 DOI: 10.1038/s41392-021-00818-7] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 09/27/2021] [Accepted: 11/02/2021] [Indexed: 02/05/2023] Open
Abstract
Currently, SARS-CoV-2 has caused a global pandemic and threatened many lives. Although SARS-CoV-2 mainly causes respiratory diseases, growing data indicate that SARS-CoV-2 can also invade the central nervous system (CNS) and peripheral nervous system (PNS) causing multiple neurological diseases, such as encephalitis, encephalopathy, Guillain-Barré syndrome, meningitis, and skeletal muscular symptoms. Despite the increasing incidences of clinical neurological complications of SARS-CoV-2, the precise neuroinvasion mechanisms of SARS-CoV-2 have not been fully established. In this review, we primarily describe the clinical neurological complications associated with SARS-CoV-2 and discuss the potential mechanisms through which SARS-CoV-2 invades the brain based on the current evidence. Finally, we summarize the experimental models were used to study SARS-CoV-2 neuroinvasion. These data form the basis for studies on the significance of SARS-CoV-2 infection in the brain.
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Affiliation(s)
- Dandan Wan
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy, National Clinical Research Center for Geriatricts, West China Hospital, Sichuan University, No. 17, Block 3, Southern Renmin Road, 610041, Chengdu, Sichuan, PR China
| | - Tingfu Du
- National Kunming High-level Biosafety Primate Research Center, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Yunnan, China
| | - Weiqi Hong
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy, National Clinical Research Center for Geriatricts, West China Hospital, Sichuan University, No. 17, Block 3, Southern Renmin Road, 610041, Chengdu, Sichuan, PR China
| | - Li Chen
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy, National Clinical Research Center for Geriatricts, West China Hospital, Sichuan University, No. 17, Block 3, Southern Renmin Road, 610041, Chengdu, Sichuan, PR China
| | - Haiying Que
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy, National Clinical Research Center for Geriatricts, West China Hospital, Sichuan University, No. 17, Block 3, Southern Renmin Road, 610041, Chengdu, Sichuan, PR China
| | - Shuaiyao Lu
- National Kunming High-level Biosafety Primate Research Center, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Yunnan, China.
| | - Xiaozhong Peng
- National Kunming High-level Biosafety Primate Research Center, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Yunnan, China.
- State Key Laboratory of Medical Molecular Biology, Department of Molecular, Biology and Biochemistry, Institute of Basic Medical Sciences, Medical Primate Research Center, Neuroscience Center, Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China.
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24
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Wong AMC, Toh CH. Spectrum of neuroimaging mimics in children with COVID-19 infection. Biomed J 2021; 45:50-62. [PMID: 34793991 PMCID: PMC8591861 DOI: 10.1016/j.bj.2021.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/21/2021] [Accepted: 11/07/2021] [Indexed: 12/17/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has affected over 200 million people globally (including over 30 million people in the United States), with children comprising 12.9% of reported cases in the United States. In children, COVID-19 infection appears to be associated with mild respiratory symptoms; however, serious neurological complications may occur in conjunction with multisystem inflammatory syndrome. A wide spectrum of neurological diseases have been observed in children with COVID-19 infection including encephalitis, acute necrotizing encephalopathy, acute disseminated encephalomyelitis, cytotoxic lesion of the callosal splenium, posterior reversible encephalopathy syndrome, venous sinus thrombosis, vasculitis and infarction, Guillain-Barré syndrome, transverse myelitis, and myositis. This review describes the characteristic magnetic resonance neuroimaging features of these diseases and their differentiations from other imaging mimics. In addition, we review the possible pathophysiology underlying the association between these diseases and COVID-19-infection. As new SARS-CoV-2 variants emerge and COVID-19 infection continues to spread worldwide, pediatricians, radiologists, and first-line care givers should be aware of possible neurological diseases associated with COVID-19 infection when these reported neuroimaging patterns are observed in children during this pandemic.
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Affiliation(s)
- Alex Mun-Ching Wong
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Cheng Hong Toh
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
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25
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Aschman T, Schneider J, Greuel S, Meinhardt J, Streit S, Goebel HH, Büttnerova I, Elezkurtaj S, Scheibe F, Radke J, Meisel C, Drosten C, Radbruch H, Heppner FL, Corman VM, Stenzel W. Association Between SARS-CoV-2 Infection and Immune-Mediated Myopathy in Patients Who Have Died. JAMA Neurol 2021; 78:948-960. [PMID: 34115106 DOI: 10.1001/jamaneurol.2021.2004] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Myalgia, increased levels of creatine kinase, and persistent muscle weakness have been reported in patients with COVID-19. Objective To study skeletal muscle and myocardial inflammation in patients with COVID-19 who had died. Design, Setting, and Participants This case-control autopsy series was conducted in a university hospital as a multidisciplinary postmortem investigation. Patients with COVID-19 or other critical illnesses who had died between March 2020 and February 2021 and on whom an autopsy was performed were included. Individuals for whom informed consent to autopsy was available and the postmortem interval was less than 6 days were randomly selected. Individuals who were infected with SARS-CoV-2 per polymerase chain reaction test results and had clinical features suggestive of COVID-19 were compared with individuals with negative SARS-CoV-2 polymerase chain reaction test results and an absence of clinical features suggestive of COVID-19. Main Outcomes and Measures Inflammation of skeletal muscle tissue was assessed by quantification of immune cell infiltrates, expression of major histocompatibility complex (MHC) class I and class II antigens on the sarcolemma, and a blinded evaluation on a visual analog scale ranging from absence of pathology to the most pronounced pathology. Inflammation of cardiac muscles was assessed by quantification of immune cell infiltrates. Results Forty-three patients with COVID-19 (median [interquartile range] age, 72 [16] years; 31 men [72%]) and 11 patients with diseases other than COVID-19 (median [interquartile range] age, 71 [5] years; 7 men [64%]) were included. Skeletal muscle samples from the patients who died with COVID-19 showed a higher overall pathology score (mean [SD], 3.4 [1.8] vs 1.5 [1.0]; 95% CI, 0-3; P < .001) and a higher inflammation score (mean [SD], 3.5 [2.1] vs 1.0 [0.6]; 95% CI, 0-4; P < .001). Relevant expression of MHC class I antigens on the sarcolemma was present in 23 of 42 specimens from patients with COVID-19 (55%) and upregulation of MHC class II antigens in 7 of 42 specimens from patients with COVID-19 (17%), but neither were found in any of the controls. Increased numbers of natural killer cells (median [interquartile range], 8 [8] vs 3 [4] cells per 10 high-power fields; 95% CI, 1-10 cells per 10 high-power fields; P < .001) were found. Skeletal muscles showed more inflammatory features than cardiac muscles, and inflammation was most pronounced in patients with COVID-19 with chronic courses. In some muscle specimens, SARS-CoV-2 RNA was detected by reverse transcription-polymerase chain reaction, but no evidence for a direct viral infection of myofibers was found by immunohistochemistry and electron microscopy. Conclusions and Relevance In this case-control study of patients who had died with and without COVID-19, most individuals with severe COVID-19 showed signs of myositis ranging from mild to severe. Inflammation of skeletal muscles was associated with the duration of illness and was more pronounced than cardiac inflammation. Detection of viral load was low or negative in most skeletal and cardiac muscles and probably attributable to circulating viral RNA rather than genuine infection of myocytes. This suggests that SARS-CoV-2 may be associated with a postinfectious, immune-mediated myopathy.
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Affiliation(s)
- Tom Aschman
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Julia Schneider
- Department of Virology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Selina Greuel
- Department of Pathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jenny Meinhardt
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Simon Streit
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hans-Hilmar Goebel
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ivana Büttnerova
- Department of Autoimmune Diagnostics, Labor Berlin-Charité Vivantes GmbH, Berlin, Germany
| | - Sefer Elezkurtaj
- Department of Pathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Franziska Scheibe
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Josefine Radke
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christian Meisel
- Institute for Medical Immunology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christian Drosten
- Department of Virology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Helena Radbruch
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Frank L Heppner
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,Cluster of Excellence, NeuroCure, Berlin, Germany.,German Center for Neurodegenerative Diseases Berlin, Berlin, Germany
| | - Victor Max Corman
- Department of Virology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Werner Stenzel
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Leibniz ScienceCampus Chronic Inflammation, Berlin, Germany
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26
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Review of COVID-19, part 2: Musculoskeletal and neuroimaging manifestations including vascular involvement of the aorta and extremities. Clin Imaging 2021; 79:300-313. [PMID: 34388683 PMCID: PMC8349444 DOI: 10.1016/j.clinimag.2021.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/30/2021] [Accepted: 08/05/2021] [Indexed: 12/12/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) has affected almost every country in the world resulting in severe morbidity, mortality and economic hardship, altering the landscape of healthcare forever. Its devastating and most frequent thoracic and cardiac manifestations have been well reported since the start of the pandemic. Its extra-thoracic manifestations are myriad and understanding them is critical in diagnosis and disease management. The role of radiology is growing in the second wave and second year of the pandemic as the multiorgan manifestations of COVID-19 continue to unfold. Musculoskeletal, neurologic and vascular disease processes account for a significant number of COVID-19 complications and understanding their frequency, clinical sequelae and imaging manifestations is vital in guiding management and improving overall survival. The authors aim to provide a comprehensive overview of the pathophysiology of the virus along with a detailed and systematic imaging review of the extra-thoracic manifestation of COVID-19. In Part I, abdominal manifestations of COVID-19 in adults and multisystem inflammatory syndrome in children will be reviewed. In Part II, manifestations of COVID-19 in the musculoskeletal, central nervous and vascular systems will be reviewed.
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27
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Nath A. Neurologic Manifestations of Severe Acute Respiratory Syndrome Coronavirus 2 Infection. Continuum (Minneap Minn) 2021; 27:1051-1065. [PMID: 34623104 PMCID: PMC9527260 DOI: 10.1212/con.0000000000000992] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW This article describes the spectrum of neurologic complications associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, their underlying pathology and pathogenic mechanisms, gaps in knowledge, and current therapeutic strategies. RECENT FINDINGS COVID-19 is the clinical syndrome caused by the novel coronavirus SARS-CoV-2. It can affect the entire neuraxis, and presentations in the acute phase are variable, although anosmia is a common manifestation. Encephalopathy is common in patients who are hospitalized and is often associated with multiorgan involvement. Immune-mediated encephalitis is probably underrecognized; however, viral encephalitis is rare. Other manifestations include stroke, seizures, myelitis, and peripheral neuropathies, including Guillain-Barré syndrome, which sometimes has atypical manifestations. Treatment is symptomatic, and immunotherapies have been used successfully in some patients. Long-term complications include dysautonomia, exercise intolerance, malaise, sleep disturbances, cognitive impairment, and mood disorders. SUMMARY Neurologic manifestations of COVID-19 may occur in the acute setting and may be independent of respiratory manifestations. Immune-mediated syndromes and cerebrovascular complications are common. Large populations of patients are expected to have long-term neurologic complications of COVID-19, many of which may emerge only after recovery from the acute illness.
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Abstract
The article highlights the pathogenesis, clinical manifestations of lesions of the central and peripheral nervous system that have arisen or persist in patients in the postcoid period (Long-COVID-19). Their correct assessment, the use of effective methods of complex treatment, targeted neurorehabilitation contribute to the reversibility of functional disorders, prevention, reduction of disability, improvement of quality of life indicators, prevention of the progression of cognitive, emotional, behavioral disorders initiated by SARS-CoV-2.
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Abstract
Introduction COVID-19 has caused unprecedented hardships in the 21st century with more than 150 million infections. Various immunological phenomena have been described during the course of the infection, and this infection has also triggered autoimmunity. Rheumatological illnesses have been described following resolution of the acute infection; hence we sought to conduct a review of the rheumatological complications of COVID-19. Methods We conducted a literature search for articles relating to sequelae of COVID-19 from Jan 2020 to 30th April 2021. Results We found a number of reports of inflammatory arthritis after SARS-CoV-2 infection. SLE and renal disease have been described, and vasculitis also appears to be a common complication. Rhabdomyolysis and myositis has also been reported in a number of patients. We also found some evidence of large vessel vasculitis in ‘long COVID’ patients. Conclusions This review highlights a number of important complications such as inflammatory arthritis, lupus-like disease, myostis and vasculitis following SARS-CoV-2 infection.
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Abstract
PURPOSE Myositis as a rare manifestation of COVID-19 is only recently being reported. This review examines the current literature on COVID-19-induced myositis focusing on etiopathogenesis, clinical presentations, diagnostic practices, and therapeutic challenges with immunosuppression, and the difficulties experienced by rheumatologists in established myositis in the COVID-19 era. RECENT FINDINGS COVID-19 is associated with a viral myositis attributable to direct myocyte invasion or induction of autoimmunity. COVID-19-induced myositis may be varied in presentation, from typical dermatomyositis to rhabdomyolysis, and a paraspinal affliction with back pain. It may or may not present with acute exponential elevations of enzyme markers such as creatine kinase (CK). Virus-mediated muscle inflammation is attributed to ACE2 (angiotensin-converting enzyme) receptor-mediated direct entry and affliction of muscle fibers, leading on to innate and adaptive immune activation. A greater recognition of the stark similarity between anti-MDA5-positive myositis with COVID-19 has thrown researchers into the alley of exploration - finding common etiopathogenic basis as well as therapeutic strategies. For patients with established myositis, chronic care was disrupted during the pandemic with several logistic challenges and treatment dilemmas leading to high flare rates. Teleconsultation bridged the gap while ushering in an era of patient-led care with the digital transition to tools of remote disease assessment. COVID-19 has brought along greater insight into unique manifestations of COVID-19-related myositis, ranging from direct virus-induced muscle disease to triggered autoimmunity and other etiopathogenic links to explore. A remarkable shift in the means of delivering chronic care has led patients and caregivers worldwide to embrace a virtual shift with teleconsultation and opened doorways to a new era of patient-led care.
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Affiliation(s)
- Ahmad Saud
- Department of Medicine, Royal College of Surgeons Ireland, Dublin, Ireland
| | - R Naveen
- Department of Clinical Immunology and Rheumatology, C Block, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareilley Road, Lucknow, 226014, India
| | - Rohit Aggarwal
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Latika Gupta
- Department of Clinical Immunology and Rheumatology, C Block, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareilley Road, Lucknow, 226014, India.
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31
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Hookey G, Ahmad Q, McCune T, Kowalewska J, Amaker B, Inayat N. Diagnostic role of technitium-99m bone scan in severe COVID-19-associated myositis. Radiol Case Rep 2021; 16:2123-2128. [PMID: 34007372 PMCID: PMC8118662 DOI: 10.1016/j.radcr.2021.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), initially appreciated as a respiratory illness, is now known to affect many organs in the human body. Significant data has become available on muscle involvement, with creatinine kinase elevations present in a significant percentage of patients. For those with suspected COVID-19-associated myositis, the imaging modality of choice has been gadolinium-enhanced magnetic resonance imaging; however, the use of technitium-99 m bone scan has not been previously reported. Here, we report two cases of COVID-19 patients with severe elevation in creatinine kinase who underwent technitium-99 m bone scan. The resulting images showed diffuse symmetrical muscle involvement. Both patients developed acute renal injury due to rhabdomyolysis. To our knowledge, this is the first report of bone scan as a diagnostic imaging modality for COVID-19-associated myositis.
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32
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Mangan MS, Yildiz E. New Onset of Unilateral Orbital Myositis following Mild COVID-19 Infection. Ocul Immunol Inflamm 2021; 29:669-670. [PMID: 33797304 DOI: 10.1080/09273948.2021.1887282] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: The authors present a case of unilateral orbital myositis of new onset following COVID-19 without a severe course.Methods: The patient had been received topical treatment with a preliminary diagnosis of conjunctivitis but no recovery had been noticed. The history revealed that the ocular signs had started 1 week after the COVID-19.Results: The examination revealed sectoral hyperemia of the temporal region in the bulbar conjunctiva together with marked limitation of right inward gaze. MRI of the orbits demonstrated diffuse fusiform enhancing enlargement of the right lateral rectus and superior rectus. The results of the laboratory tests and examination findings were normal. Systemic corticosteroids were started for the orbital myositis.Conclusions: Although conjunctivitis is the more common ocular disease following COVID-19, the possibility of orbital myositis should be considered in cases with resistance to topical treatment and/or gaze limitation. The possible role of orbital myositis as a trigger for COVID-19 could be explained with an immune-mediated mechanism.
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Affiliation(s)
- Mehmet Serhat Mangan
- Division of Ophthalmic Plastic and Reconstructive Surgery, University of Health Sciences, Haydarpasa Numune Education and Research Hospital, Sadik Eratik Eye Institute, Istanbul, Turkey
| | - Elvin Yildiz
- Division of Cornea and Ocular Surface, University of Health Sciences, Haydarpasa Numune Education and Research Hospital, Sadik Eratik Eye Institute, Istanbul, Turkey
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33
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Lehmann HC, Schoser B, Wunderlich G, Berlit P, Fink GR. [Neuromuscular complications of SARS-CoV-2 infection-Part 2: muscle disorders]. DER NERVENARZT 2021; 92:548-555. [PMID: 33779772 PMCID: PMC8005661 DOI: 10.1007/s00115-021-01093-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 01/08/2023]
Abstract
Neben Störungen und Erkrankungen peripherer Nerven sind in den letzten Monaten im Zusammenhang mit COVID-19 („coronavirus disease 2019“) auch Begleitsymptome und Störungen der Muskulatur bzw. der neuromuskulären Transmission beschrieben worden. Im zweiten Teil unserer Zusammenfassung geben wir eine Übersicht über häufig berichtete Symptome wie Myalgien und definierte Erkrankungen wie Rhabdomyolysen, Myositiden, Myasthenie und „intensive care unit acquired weakness“ (ICUAW), die im Rahmen eine SARS-CoV-2(„severe acute respiratory syndrome coronavirus 2“)-Infektion bzw. COVID-19 beschrieben wurden. Darüber hinaus werden Kriterien für eine Kausalität wie Effektstärke, Plausibilität, Zeitverlauf und experimentelle Evidenz für einen kausalen Zusammenhang der in beiden Teilen der Übersicht beschriebenen COVID-19 assoziierten neuromuskulären Erkrankungen diskutiert. Zum jetzigen Zeitpunkt sind – neben der auch in der Laienpresse bekannten Geruchssinnstörung – vor allem Myalgien als unspezifisches Symptom häufige Folge einer symptomatischen SARS-CoV‑2 Infektion. Andere neuromuskuläre Komplikationen erscheinen hinsichtlich ihrer Pathogenese prinzipiell plausibel, aber offenbar selten Folge einer SARS-CoV-2-Infektion zu sein. Prospektive bzw. Kohortenstudien sind notwendig, um eine Kausalität zu bestätigen und das Risiko abzuschätzen.
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Affiliation(s)
- Helmar C Lehmann
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln, Kerpener Straße 62, 50937, Köln, Deutschland.
| | - Benedikt Schoser
- LMU Klinikum, Friedrich-Baur-Institut, Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Gilbert Wunderlich
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln, Kerpener Straße 62, 50937, Köln, Deutschland.,Zentrum für Seltene Erkrankungen, Universitätsklinikum Köln, Köln, Deutschland
| | - Peter Berlit
- Deutsche Gesellschaft für Neurologie (DGN), Berlin, Deutschland
| | - Gereon R Fink
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln, Kerpener Straße 62, 50937, Köln, Deutschland.,Institut für Neurowissenschaften (INM-3), Forschungszentrum Jülich, Jülich, Deutschland
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Tang KT, Hsu BC, Chen DY. Autoimmune and Rheumatic Manifestations Associated With COVID-19 in Adults: An Updated Systematic Review. Front Immunol 2021; 12:645013. [PMID: 33777042 PMCID: PMC7994612 DOI: 10.3389/fimmu.2021.645013] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/17/2021] [Indexed: 12/18/2022] Open
Abstract
Background: Numerous cases of the coronavirus disease 2019 (COVID-19) with autoimmune and rheumatic manifestations have been reported. Despite the available reviews that summarized its autoimmune/rheumatic manifestations, a systematic approach is still lacking. Therefore, we conducted a comprehensive systematic review in order to give an overview upon these rare but clinically significant manifestations. Methods: We performed a literature search of PubMed and EMBASE as of October 9, 2020. All articles relevant to either systemic or organ-specific autoimmune and rheumatic manifestations potentially associated with COVID-19 were collected. The reviewed literature were limited to adults ≥18 years. Results: Although most of the existing evidence was based on case reports or case series without a long-term follow-up, a variety of autoimmune/rheumatic manifestations were associated with COVID-19. The manifestations that have a consistent association with COVID-19 include autoimmune cytopenia, cutaneous vasculitis, encephalitis, and Guillain-Barre syndrome. Such association is conflicting as regards to antiphospholipid syndrome, hemophagocytic lymphohistiocytosis, and myasthenia gravis. Conclusion: Our systematic review indicated the potential of the COVID-19 virus to trigger a myriad of autoimmune and rheumatic manifestations, which should be considered amid global efforts to combat COVID-19.
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Affiliation(s)
- Kuo-Tung Tang
- Division of Allergy, Immunology, and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Ph.D. Program in Translational Medicine and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Bo-Chueh Hsu
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital Puli Branch, Nantou, Taiwan
| | - Der-Yuan Chen
- Translational Medicine Laboratory, China Medical University Hospital, Taichung, Taiwan.,Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
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35
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Lindan CE, Mankad K, Ram D, Kociolek LK, Silvera VM, Boddaert N, Stivaros SM, Palasis S. Neuroimaging manifestations in children with SARS-CoV-2 infection: a multinational, multicentre collaborative study. THE LANCET. CHILD & ADOLESCENT HEALTH 2021; 5:167-177. [PMID: 33338439 PMCID: PMC7744016 DOI: 10.1016/s2352-4642(20)30362-x] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The CNS manifestations of COVID-19 in children have primarily been described in case reports, which limit the ability to appreciate the full spectrum of the disease in paediatric patients. We aimed to identify enough cases that could be evaluated in aggregate to better understand the neuroimaging manifestations of COVID-19 in the paediatric population. METHODS An international call for cases of children with encephalopathy related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and abnormal neuroimaging findings was made. Clinical history and associated plasma and cerebrospinal fluid data were requested. These data were reviewed by a central neuroradiology panel, a child neurologist, and a paediatric infectious diseases expert. The children were categorised on the basis of their time of probable exposure to SARS-CoV-2. In addition, cases were excluded when a direct link to SARS-CoV-2 infection could not be established or an established alternate diagnostic cause could be hypothesised. The accepted referral centre imaging data, from ten countries, were remotely reviewed by a central panel of five paediatric neuroradiologists and a consensus opinion obtained on the imaging findings. FINDINGS 38 children with neurological disease related to SARS-CoV-2 infection were identified from France (n=13), the UK (n=8), the USA (n=5), Brazil (n=4), Argentina (n=4), India (n=2), Peru (n=1), and Saudi Arabia (n=1). Recurring patterns of disease were identified, with neuroimaging abnormalities ranging from mild to severe. The most common imaging patterns were postinfectious immune-mediated acute disseminated encephalomyelitis-like changes of the brain (16 patients), myelitis (eight patients), and neural enhancement (13 patients). Cranial nerve enhancement could occur in the absence of corresponding neurological symptoms. Splenial lesions (seven patients) and myositis (four patients) were predominantly observed in children with multisystem inflammatory syndrome. Cerebrovascular complications in children were less common than in adults. Significant pre-existing conditions were absent and most children had favourable outcomes. However, fatal atypical CNS co-infections developed in four previously healthy children infected with SARS-CoV-2. INTERPRETATION Acute-phase and delayed-phase SARS-CoV-2-related CNS abnormalities are seen in children. Recurring patterns of disease and atypical neuroimaging manifestations can be found and should be recognised being as potentially due to SARS-CoV-2 infection as an underlying aetiological factor. Studies of paediatric specific cohorts are needed to better understand the effects of SARS-CoV-2 infection on the CNS at presentation and on long-term follow-up in children. FUNDING American Society of Pediatric Neuroradiology, University of Manchester (Manchester, UK). VIDEO ABSTRACT.
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Affiliation(s)
- Camilla E Lindan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK
| | - Dipak Ram
- Department of Paediatric Neurology, Royal Manchester Children's Hospital, Manchester, UK
| | - Larry K Kociolek
- Department of Pediatrics, Division of Infectious Diseases, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - V Michelle Silvera
- Department of Radiology, Pediatric Neuroradiology, Mayo Clinic, Rochester, MN, USA
| | - Nathalie Boddaert
- Service de Radiologie Pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Université de Paris, INSERM U1163, Institut Imagine, Paris, France
| | - Stavros Michael Stivaros
- Academic Unit of Paediatric Radiology, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK; Division of Informatics, Imaging, and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK; The Geoffrey Jefferson Brain Research Centre, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Susan Palasis
- Department of Medical Imaging, Division of Pediatric Neuroradiology, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL USA.
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Abstract
Purpose of Review The present review discusses the peripheral nervous system (PNS) manifestations associated with coronavirus disease 2019 (COVID-19). Recent Findings Nerve pain and skeletal muscle injury, Guillain-Barré syndrome, cranial polyneuritis, neuromuscular junction disorders, neuro-ophthalmological disorders, neurosensory hearing loss, and dysautonomia have been reported as PNS manifestations in patients with COVID-19. Summary Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19. COVID-19 has shown syndromic complexity. Not only does SARS-CoV-2 affect the central nervous system but also it involves the PNS. The PNS involvement may be due to dysregulation of the immune system attributable to COVID-19. Here we review the broad spectrum of PNS involvement of COVID-19.
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37
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Yu S, Yu M. Severe Acute Respiratory Syndrome Coronavirus 2-Induced Neurological Complications. Front Cell Dev Biol 2020; 8:605972. [PMID: 33363165 PMCID: PMC7758195 DOI: 10.3389/fcell.2020.605972] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/11/2020] [Indexed: 01/08/2023] Open
Abstract
Our review aims to highlight the neurological complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the available treatments according to the existing literature, discussing the underlying mechanisms. Since the end of 2019, SARS-CoV-2 has induced a worldwide pandemic that has threatened numerous lives. Fever, dry cough, and respiratory symptoms are typical manifestations of COVID-19. Recently, several neurological complications of the central and peripheral nervous systems following SARS-CoV-2 infection have gained clinicians' attention. Encephalopathy, stroke, encephalitis/meningitis, Guillain-Barré syndrome, and multiple sclerosis are considered probable neurological signs of COVID-19. The virus may invade the nervous system directly or induce a massive immune inflammatory response via a "cytokine storm." Specific antiviral drugs are still under study. To date, immunomodulatory therapies and supportive treatment are the predominant strategies. In order to improve the management of COVID-19 patients, it is crucial to monitor the onset of new neurological complications and to explore drugs/vaccines targeted against SARS-CoV-2 infection.
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Affiliation(s)
- Shijia Yu
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Mingjun Yu
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China
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