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Guillain-Barré syndrome after SARS-CoV-2 infection in an international prospective cohort study
Brain ( IF 14.5 ) Pub Date : 2021-09-23 , DOI: 10.1093/brain/awab279
Linda W G Luijten 1, 2 , Sonja E Leonhard 1 , Annemiek A van der Eijk 3 , Alex Y Doets 1 , Luise Appeltshauser 4 , Samuel Arends 1, 5 , Shahram Attarian 6 , Luana Benedetti 7 , Chiara Briani 8 , Carlos Casasnovas 9 , Francesca Castellani 8 , Efthimios Dardiotis 10 , Andoni Echaniz-Laguna 11 , Marcel P J Garssen 12 , Thomas Harbo 13 , Ruth Huizinga 14 , Andrea M Humm 15 , Korné Jellema 16 , Anneke J van der Kooi 17 , Krista Kuitwaard 1, 18 , Thierry Kuntzer 19 , Susumu Kusunoki 20 , Agustina M Lascano 21 , Eugenia Martinez-Hernandez 22 , Simon Rinaldi 23 , Johnny P A Samijn 24 , Olivier Scheidegger 25 , Pinelopi Tsouni 19, 26 , Alex Vicino 19 , Leo H Visser 2 , Christa Walgaard 1, 24 , Yuzhong Wang 27 , Paul W Wirtz 5 , Paolo Ripellino 28 , Bart C Jacobs 1, 14 ,
Affiliation  

In the wake of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, an increasing number of patients with neurological disorders, including Guillain-Barré syndrome (GBS), have been reported following this infection. It remains unclear, however, if these cases are coincidental or not, as most publications were case reports or small regional retrospective cohort studies. The International GBS Outcome Study is an ongoing prospective observational cohort study enrolling patients with GBS within 2 weeks from onset of weakness. Data from patients included in this study, between 30 January 2020 and 30 May 2020, were used to investigate clinical and laboratory signs of a preceding or concurrent SARS-CoV-2 infection and to describe the associated clinical phenotype and disease course. Patients were classified according to the SARS-CoV-2 case definitions of the European Centre for Disease Prevention and Control and laboratory recommendations of the World Health Organization. Forty-nine patients with GBS were included, of whom eight (16%) had a confirmed and three (6%) a probable SARS-CoV-2 infection. Nine of these 11 patients had no serological evidence of other recent preceding infections associated with GBS, whereas two had serological evidence of a recent Campylobacter jejuni infection. Patients with a confirmed or probable SARS-CoV-2 infection frequently had a sensorimotor variant 8/11 (73%) and facial palsy 7/11 (64%). The eight patients who underwent electrophysiological examination all had a demyelinating subtype, which was more prevalent than the other patients included in the same time window [14/30 (47%), P = 0.012] as well as historical region and age-matched control subjects included in the International GBS Outcome Study before the pandemic [23/44 (52%), P = 0.016]. The median time from the onset of infection to neurological symptoms was 16 days (interquartile range 12–22). Patients with SARS-CoV-2 infection shared uniform neurological features, similar to those previously described in other post-viral GBS patients. The frequency (22%) of a preceding SARS-CoV-2 infection in our study population was higher than estimates of the contemporaneous background prevalence of SARS-CoV-2, which may be a result of recruitment bias during the pandemic, but could also indicate that GBS may rarely follow a recent SARS-CoV-2 infection. Consistent with previous studies, we found no increase in patient recruitment during the pandemic for our ongoing International GBS Outcome Study compared to previous years, making a strong relationship of GBS with SARS-CoV-2 unlikely. A case-control study is required to determine if there is a causative link or not.

中文翻译:

国际前瞻性队列研究中 SARS-CoV-2 感染后的格林-巴利综合征

在严重急性呼吸系统综合症冠状病毒 2 (SARS-CoV-2) 大流行之后,据报道,越来越多的神经系统疾病患者,包括格林-巴利综合征 (GBS),在这种感染后出现。然而,尚不清楚这些病例是否是巧合,因为大多数出版物都是病例报告或小型区域回顾性队列研究。国际 GBS 结果研究是一项正在进行的前瞻性观察性队列研究,招募了在无力发作后 2 周内患有 GBS 的患者。本研究中纳入的患者在 2020 年 1 月 30 日至 2020 年 5 月 30 日期间的数据被用于调查之前或同时感染 SARS-CoV-2 的临床和实验室体征,并描述相关的临床表型和病程。根据欧洲疾病预防控制中心的 SARS-CoV-2 病例定义和世界卫生组织的实验室建议对患者进行分类。纳入了 49 名 GBS 患者,其中 8 名 (16%) 已确诊感染,3 名 (6%) 可能感染 SARS-CoV-2。这 11 名患者中有 9 名没有血清学证据证明其他近期与 GBS 相关的先前感染,而 2 名患者有近期感染的血清学证据空肠弯曲菌感染。确诊或可能感染 SARS-CoV-2 的患者经常有感觉运动变异 8/11 (73%) 和面瘫 7/11 (64%)。接受电生理检查的 8 名患者均有脱髓鞘亚型,这比同一时间窗内的其他患者 [14/30 (47%),P = 0.012] 以及历史地区和年龄匹配的对照更为普遍大流行前纳入国际 GBS 结果研究的受试者 [23/44 (52%),P= 0.016]。从感染开始到出现神经系统症状的中位时间为 16 天(四分位间距 12-22)。SARS-CoV-2 感染患者具有相同的神经学特征,类似于先前在其他病毒感染后 GBS 患者中描述的特征。在我们的研究人群中,先前感染 SARS-CoV-2 的频率 (22%) 高于同期 SARS-CoV-2 背景流行率的估计值,这可能是大流行期间招募偏倚的结果,但也可能是表明 GBS 可能很少发生在最近的 SARS-CoV-2 感染之后。与之前的研究一致,我们发现与往年相比,我们正在进行的国际 GBS 结果研究在大流行期间招募的患者人数没有增加,这使得 GBS 与 SARS-CoV-2 之间的密切关系不太可能。
更新日期:2021-09-24
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