Guillain-Barré syndrome: SARS-CoV-2 can trigger rare autoimmune diseases
Many people who contract the SARS-CoV-2 coronavirus experience mild or no symptoms. In some cases, however, the disease takes a severe course. In addition, researchers have also frequently identified neurological complaints in COVID-19. And as is now reported, the novel pathogen can also trigger the dreaded Guillain-Barré syndrome.
As explained on the public health portal of Austria “Gesundheit.gv.at”, Guillain-Barré syndrome (GBS) is a very rare autoimmune disease. The immune system attacks the body’s peripheral nerve cells, i.e. outside the brain and spine, and destroys their insulating myelin layer. The disease, also known as “acute idiopathic polyneuritis”, can also be triggered by the new coronavirus.
SARS-CoV-2 infection causes severe neurological complications more quickly
According to a current announcement by the German Society for Neurology (DGN), the possibility of SARS-CoV-2-associated Guillain-Barré syndrome (GBS) was discussed for the first time in the specialist magazine “Lancet Neurology” at the beginning of April.
Shortly thereafter, two further publications from Europe followed in the specialist journals “New England Journal of Medicine” and “Neurology”, which describe a GBS and a GBS variant in COVID-19 patients.
The GBS often arises as a result of infections, for example after bacterial intestinal infection or infection with the cytomegalovirus.
The SARS-CoV-2 coronavirus is now also one of the GBS-causing pathogens. A special feature: While it often takes two to four weeks for an infection-associated GBS to appear, SARS-CoV-2 infection developed this serious neurological complication after only five to ten days.
Respiratory muscles can be affected
As the DGN explains, Guillain-Barré syndrome (GBS) is a severe neurological disease. The myelin layer of the peripheral nerves is damaged by an excessive autoimmune reaction, often as a result of infections, so that the nerve fibers can no longer transmit stimuli.
Autoantibodies against building components of the nerve membranes (gangliosides) in the blood are often detectable in GBS. The consequences are paralysis (paresis), which usually begins on both sides in the legs and then also affects the arms and face.
In some patients, the respiratory muscles can even be affected, so that they have to be ventilated.
According to the DGN, those affected either receive high-dose intravenous immunoglobulins or undergo plasmapheresis, an extracorporeal blood purification procedure in which the autoantibodies that trigger the disease are filtered out.
It often takes many weeks for the symptoms to resolve, and some patients have permanent neurological complaints.
Patient with no respiratory symptoms, fever or diarrhea
It is known that around three quarters of all GBS cases occur as a result of infections, be it due to bacterial inflammation of the intestine with Campylobacter jejuni or an infection of the upper respiratory tract with the cytomegalovirus or other viruses. SARS-CoV-2-associated GBS cases have now been reported for the first time in the magazines mentioned:
The first case report of what is believed to be a SARS-CoV-2 GBS relates to a 61-year-old woman from China who was admitted to the clinic with paralysis (paralysis) of the lower extremities, but showed no respiratory symptoms, fever or diarrhea. The pareses spread over the next three days.
According to the information, therapy was carried out with IV immunoglobulins. On day eight, the patient developed cough, fever and showed signs of viral pneumonia on chest CT. The SARS-CoV-19 throat swab was positive.
The authors discuss SARS-CoV-2-associated GBS, but because the classic COVID-19 respiratory symptoms only came on a week after the onset of GBS, the possibility of a coincidental occurrence of both diseases must also be considered.
Patients had SARS-CoV-2 positive throat swabs
However, just two weeks later, a case series with GBS was published in five Italian SARS CoV-2 patients. Of 1,000 to 1,200 people affected by Covid-19, five developed GBS within five to ten days after the onset of symptoms of COVID-19, three of whom had to be ventilated mechanically.
However, the study could not determine whether ventilation was necessary due to the GBS or the respiratory infection.
A third work from Madrid presents two cases of Covid 19 patients with the GBS variant of Miller Fisher syndrome (MFS). MFS-inducing ganglioside antibodies were detectable in the serum and both men had SARS-CoV-2-positive throat swabs.
The classic GBS or MFS typically occurs ten days to four weeks after the underlying infection, usually after the person has recovered from the infectious disease.
In contrast, the interval is significantly shorter for SARS-CoV-2 infections. All previously reported patients became ill five to ten days after the onset of symptoms of COVID-19 disease.
Cause of the need for ventilation
“In ventilated patients in the intensive care unit, the GBS represents an important differential diagnosis for so-called critical illness neuropathy, a peripheral nerve damage that usually occurs later in the course of the disease in patients in the intensive care unit,” explains Prof. Dr. Helmar Lehmann from the Neurological University Clinic in Cologne.
“The distinction is relevant, however, so as not to miss treatment with immunoglobulins,” adds Prof. Dr. Peter Berlit, General Secretary of the German Society for Neurology.
It is therefore important that patients with Guillain-Barré syndrome (or Miller Fisher syndrome) are clarified whether they have SARS-CoV-2 infection. Conversely, in those with severe COVID-19 courses who need ventilation, it must be clarified whether a GBS / MFS could not actually be the cause of the ventilation requirement.
According to the DGN, this applies in particular if the imaging findings in the lungs do not point to organ damage that requires mechanical ventilation. (ad)
- German Society for Neurology (DGN): SARS-CoV-2 can trigger the dreaded Guillain-Barré syndrome, (accessed: April 25, 2020), German Society for Neurology (DGN)
- Zhao H, Shen D, Zhou H et al .: Guillain-Barré syndrome associated with SARS-CoV-2 infection: causality or coincidence ?; in: Lancet Neurology, (published: April 1, 2020), Lancet Neurology
- Toscano G, Palmerini F, Ravaglia S et al .: Guillain-Barré Syndrome Associated with SARS-CoV-2; in: New England Journal of Medicine, (published: April 17, 2020), New England Journal of Medicine
- Gutiérrez-Ortiz C, Méndez A, Rodrigo-Rey S et al .: Miller Fisher Syndrome and polyneuritis cranialis in COVID-19; in: Neurology, (published: April 17, 2020), Neurology
- Austria’s public health portal: www.gesundheit.gv.at: Guillain-Barré syndrome (accessed: April 25, 2020), gesundheit.gv.at
This article contains general information only and should not be used for self-diagnosis or treatment. He can not substitute a visit at the doctor.