Guillain-Barré Syndrome in the COVID-19 Pandemic

There have been several reported cases of severe acute respiratory syndrome (SARS-CoV-2) infection that were associated with an increased incidence of neurological manifestations, including Guillain–Barré syndrome (GBS). This review aims to present information on the reports of GBS associated with coronavirus disease 2019 (COVID-19) infection. Our review is retrospective work examining articles published from the 1 April 2020 to the 8 May 2021 in the English language. We used the diagnostic criteria and classification published by the National Institute of Neurological Disorders and Stroke and Brighton Collaboration. GBS is usually a postinfectious syndrome, but GBS in the COVID-19 pandemic also takes on a para-infectious profile. In the reports, the genetic factor has a role in developing GBS in some patients. In conclusion, the association between COVID-19 and GBS is not very clear. Still, one mechanism is strongly associated with COVID-19 and immune-mediated neurological complications, which is molecular mimicry between SARS-CoV-2 and human autoantigens.

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Intracerebral haemorrhage and Guillain-Barré syndrome: an exploration of potential pathophysiology

BMJ Case Reports ◽

10.1136/bcr-2021-243245 ◽

2021 ◽

Vol 14 (8) ◽

pp. e243245

Author(s):

Sophia Connor ◽

Omar Azzam ◽

David Prentice

Keyword(s):

Differential Diagnosis ◽

Intracerebral Haemorrhage ◽

Molecular Mimicry ◽

Guillain Barre Syndrome ◽

Important Differential Diagnosis ◽

Immune Mediated ◽

Guillain Barré Syndrome ◽

Guillain Barré

Guillain-Barré syndrome (GBS) is an immune-mediated polyneuropathy classically thought to be caused by infections through the process of molecular mimicry. We report a case of GBS caused by intracerebral haemorrhage and postulate potential theories for the development of GBS following intracerebral haemorrhage and other non-infectious aetiologies by association. We highlight that GBS is an important differential diagnosis in patients developing generalised paresis following intracerebral haemorrhage.

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Guillain-Barré Syndrome Variant presenting as Acute Descending Paralysis in Diabetes

Recent Research in Endocrinology and Metabolic Disorder ◽

10.33702/rremd.2020.2.1.1 ◽

2020 ◽

Vol 2 (1) ◽

pp. 1-2

Author(s):

Sumesh Raj ◽

Manoj Parameswaran

Keyword(s):

Molecular Mimicry ◽

Radicular Pain ◽

Guillain Barre Syndrome ◽

Gastrointestinal Dysfunction ◽

Common Features ◽

High Clinical Suspicion ◽

Immune Mediated ◽

Guillain Barré Syndrome ◽

Diagnostic Modalities ◽

Guillain Barré

Guillain-Barré Syndrome (GBS) is an acute monophasic immune-mediated polyradiculopathy. Neuropathic or radicular pain and dysautonomia are common features in all forms of GBS. Phenotypic variants are hypothesized to be mediated by molecular mimicry targeting peripheral nerve motor axons, with resulting weakness deviating from the classic symmetric “ascending” pattern. Weakness can range from mild to severe flaccid quadriplegia and respiratory failure within days of onset. Urinary retention and gastrointestinal dysfunction are seen in approximately 5% of variant cases. A spectrum of clinical features necessitates the use of laboratory testing and diagnostic modalities to exclude mimics and confirm a diagnosis of GBS. A high clinical suspicion must exist as GBS responds to treatment with plasmapheresis or IVIG. Our patient embodied both a diagnostically challenging presentation and clinical response consistent with variant GBS.

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The role of molecular mimicry in the etiology of Guillain Barré Syndrome

Macedonian Pharmaceutical Bulletin ◽

10.33320/maced.pharm.bull.2010.56.001 ◽

2011 ◽

Vol 56 ◽

pp. 3-12

Author(s):

Aleksandra Grozdanova ◽

Slobodan Apostolski ◽

Ljubica Suturkova

Keyword(s):

Molecular Mimicry ◽

Epidemiological Studies ◽

Guillain Barre Syndrome ◽

Contributory Factor ◽

Animal Disease Models ◽

Immune Mediated ◽

Guillain Barré Syndrome ◽

Bacterial Lipopolysaccharides ◽

Guillain Barré

Molecular mimicry between host tissue structures and microbial components has been proposed as the pathogenic mechanism for triggering of autoimmune diseases by preceding infection. Recent studies stated that molecular mimicry as the causative mechanism remains unproven for most of the human diseases. Still, in the case of the peripheral neuropathy Guillain-Barré syndrome (GBS) this hypothesis is supported by abundant experimental evidence. GBS is the most frequent cause of acute neuromuscular paralysis and in some cases occurs after infection with Campylobacter jejuni (C. jejuni). Epidemiological studies, showed that more than one third of GBS patients had antecedent C. jejuni infection and that only specific C. jejuni serotypes are associated with development of GBS. The molecular mimicry between the human gangliosides and the core oligosaccharides of bacterial lipopolysaccharides (LPSs) presumably results in production of antiganglioside cross-reactive antibodies which are likely to be a contributory factor in the induction and pathogenesis of GBS. Antiganglioside antibodies were found in the sera from patients with GBS and by sensitization of rabbits with gangliosides and C. jejuni LPSs animal disease models of GBS were established. GBS as prototype of post-infection immune-mediated disease probably will provide the first verification that an autoimmune disease can be triggered by molecular mimicry.

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The importance of thinking about Guillain-Barré syndrome during the COVID-19 pandemic: a case with pure dysautonomic presentation

Journal of NeuroVirology ◽

10.1007/s13365-021-00997-7 ◽

2021 ◽

Author(s):

Erica Biassoni ◽

Andrea Assini ◽

Ilaria Gandoglia ◽

Luana Benedetti ◽

Silvia Boni ◽

...

Keyword(s):

Nervous System ◽

Electrophysiological Study ◽

Clinical Manifestations ◽

Neurological Complications ◽

Guillain Barre Syndrome ◽

System Disease ◽

Immune Mediated ◽

Inflammatory Mechanism ◽

Guillain Barré Syndrome ◽

Guillain Barré

AbstractGuillain-Barré syndrome (GBS) is a peripheral nervous system disease caused by an immune-mediated inflammatory mechanism, usually triggered by a previous infectious process or vaccine; its typical presentation is a rapid and progressive bilateral limb hyposthenia, associated with sensory deficits and reduction or absence of osteotendinous reflexes. However, also autonomic nervous system can be involved with heart rate fluctuations, blood pressure instability, pupillary dysfunction, and urinary retention. Since the beginning of COVID-19 pandemic, GBS has been reported among neurological complications of SARS-CoV-2 infection, although etiopathological mechanisms still have to be clearly defined. We report the case of a 79-year-old man with multiple comorbidities, including diabetes, who was affected by SARS-CoV-2 interstitial pneumonia and developed dysautonomic symptoms after 10 days of hospitalization. A neurological evaluation was performed, and GBS was considered as a possible cause of the clinical manifestations. This hypothesis was confirmed by electrophysiological study and further supported, ex-juvantibus, by the satisfactory response to immunoglobulin treatment. In our opinion, this case of pure dysautonomic presentation of GBS in a SARS-CoV-2 positive patient is relevant because it suggests to consider GBS upon SARS-CoV-2 infection even if the symptoms have uncommon characteristics (e.g., pure vegetative manifestations) and if there are confounding factors which could lead to a misdiagnosis (e.g., old age, SARS-CoV-2 infection consequences and diabetes).

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SARS-CoV-2 and Guillain-Barré syndrome: molecular mimicry with human heat shock proteins as potential pathogenic mechanism

Cell Stress and Chaperones ◽

10.1007/s12192-020-01145-6 ◽

2020 ◽

Vol 25 (5) ◽

pp. 731-735 ◽

Cited By ~ 8

Author(s):

Guglielmo Lucchese ◽

Agnes Flöel

Keyword(s):

Amino Acid ◽

Heat Shock ◽

Heat Shock Proteins ◽

Molecular Mimicry ◽

Guillain Barre Syndrome ◽

Potential Mechanism ◽

Immune Mediated ◽

Guillain Barré Syndrome ◽

Guillain Barré ◽

Shock Proteins

Abstract Severe acute respiratory syndrome-related coronavirus 2 infection has been associated with Guillain-Barré syndrome. We investigated here the potential mechanism underlying the virus-induced damage of the peripheral nervous systems by searching the viral amino acid sequence for peptides common to human autoantigens associated with immune-mediated polyneuropathies. Our results show molecular mimicry between the virus and human heat shock proteins 90 and 60, which are associated with Guillain-Barré syndrome and other autoimmune diseases. Crucially, the shared peptides are embedded in immunoreactive epitopes that have been experimentally validated in the human host.

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Reworsening of Recurrent Guillain-Barré Syndrome Triggered by COVID-19 Infection

The Open Neurology Journal ◽

10.2174/1874205x02115010048 ◽

2021 ◽

Vol 15 (1) ◽

pp. 48-51

Author(s):

Gian Luca Vita ◽

Carmen Terranova ◽

Maria Sframeli ◽

Antonio Toscano ◽

Giuseppe Vita

Keyword(s):

Viral Infection ◽

Neurological Diseases ◽

Intravenous Immunoglobulins ◽

Guillain Barre Syndrome ◽

Case Presentation ◽

Appropriate Treatment ◽

Immune Mediated ◽

Guillain Barré Syndrome ◽

Guillain Barré

Introduction: Guillain-Barré Syndrome (GBS) is an acute, immune-mediated, generalized polyradiculoneuropathy often triggered by a bacterial or viral infection, vaccination, or surgery. During the SARS-CoV-2 pandemic, some patients were reported with GBS associated COVID-19 infection. Case Presentation: We report, herein, a patient who had a recurrent GBS after forty years. Intravenous immunoglobulins (IVIg) induced improvement, but her condition worsened suddenly after twenty days, coinciding with a COVID-19 infection. A second IVIg cycle was administered, and she improved again. Conclusion: The take-home message is that in the current pandemic, any re-worsening or lack of improvement after appropriate treatment of GBS or possibly other autoimmune neurological diseases must be checked to determine if it is related to COVID-19 infection.

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Colistin neurotoxicity mimicking Guillain-Barré syndrome in a patient with cystic fibrosis: case report and review

Oxford Medical Case Reports ◽

10.1093/omcr/omab080 ◽

2021 ◽

Vol 2021 (9) ◽

Author(s):

Celeste Camargo ◽

Tathagat Narula ◽

Daniel A Jackson ◽

Teresa Padro ◽

W David Freeman

Keyword(s):

Cystic Fibrosis ◽

Drug Toxicity ◽

Clinical Presentation ◽

Guillain Barre Syndrome ◽

Drug Induced ◽

Common Presentation ◽

Intravenous Treatment ◽

Immune Mediated ◽

Guillain Barré Syndrome ◽

Guillain Barré

ABSTRACT Guillain-Barré syndrome (GBS) is an immune-mediated polyneuropathy, which is characterized by areflexia and ascending paresthesia which can progress to a respiratory failure. Certain conditions, such as vasculitis and heavy metal and drug toxicity, may have misleadingly similar clinical presentation to GBS. We describe a case of a patient with cystic fibrosis and intravenous colistin-induced neurotoxicity mimicking GBS. The patient had used inhaled colistin on five occasions with no adverse effects, however, developed symptoms on the second day of intravenous treatment. Overlapping findings between immune-mediated polyneuropathy and drug-induced neurotoxicity include limb paresthesia and decreased reflexes. Perioral tingling, however, is a common presentation of colistin-induced neurotoxicity, and therefore, is an important differentiating factor. Early diagnosis prevents further neurologic decline, extensive unnecessary workup and potentially harmful incorrect management.

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Patients’ experiences and perceptions of Guillain-Barré syndrome: A systematic review and meta-synthesis of qualitative research

PLoS ONE ◽

10.1371/journal.pone.0245826 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0245826

Author(s):

Despina Laparidou ◽

Ffion Curtis ◽

Joseph Akanuwe ◽

Jennifer Jackson ◽

Timothy L. Hodgson ◽

...

Keyword(s):

Systematic Review ◽

Guillain Barre Syndrome ◽

Link Type ◽

Immune Mediated ◽

Acceptable Quality ◽

Guillain Barré Syndrome ◽

Internet Searches ◽

Guillain Barré ◽

Full Text Screening

Background Guillain-Barré syndrome (GBS) is an immune-mediated polyradiculoneuropathy, with an incidence of 1-2/100,000 per year. Its severity is variable, ranging from very mild cases with brief weakness to severe paralysis, leading to inability to breathe independently, or even death. Currently there is limited evidence exploring the experiences of GBS patients. The aim of this study was to review patients’ experiences and perceptions of GBS and its variants at diagnosis, discharge and during recovery, by conducting a systematic review and thematic meta-synthesis of qualitative studies of patients’ experiences of GBS (and its variants). Methods We searched twelve electronic databases, supplemented with internet searches and forward and backward citation tracking from the included studies and review articles. Data were synthesised thematically following the Thomas and Harden approach. The CASP Qualitative Checklist was used to assess the quality of the included studies of this review. Results Our search strategy identified a total of 5,282 citations and after removing duplicates and excluding citations based on title and abstract, and full-text screening, five studies were included in the review and meta-synthesis; all included studies were considered of acceptable quality. Through constant discussions and an iterative approach, we developed six analytical themes following a patient’s journey from suspecting that they had a health problem, through to being hospitalised, experiencing ongoing difficulties, slowly recovering from GBS, adjusting to their new circumstances, and re-evaluating their lives. Conclusions Despite the variety of experiences, it was evident from all included studies that being diagnosed with and surviving GBS was a life-changing experience for all participants. Trial registration Protocol was registered (CRD42019122199) on the International Prospective Register of Systematic Reviews (http://www.crd.york.ac.uk/PROSPERO).

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