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LETTER TO EDITOR  
Year : 2022  |  Volume : 14  |  Issue : 2  |  Page : 90
Critical illness polyneuropathy as a sequelae of COVID-19


Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India

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Date of Submission13-Sep-2021
Date of Acceptance09-Apr-2022
Date of Web Publication25-May-2022
 

How to cite this article:
Bawiskar N, Talwar D, Kumar S, Acharya S. Critical illness polyneuropathy as a sequelae of COVID-19. J Global Infect Dis 2022;14:90

How to cite this URL:
Bawiskar N, Talwar D, Kumar S, Acharya S. Critical illness polyneuropathy as a sequelae of COVID-19. J Global Infect Dis [serial online] 2022 [cited 2022 Aug 17];14:90. Available from: https://www.jgid.org/text.asp?2022/14/2/90/346011




Sir,

Post-COVID-19 complications are predominantly those of the respiratory system and may rarely be neurological.[1] Neurological manifestations such as stroke, Guillain Barre Syndrome, encephalopathy, and neuropathy are some that have been observed and are likely to manifest in patients with comorbidities with a rare preponderance for those with mere risk factors but no established diagnosis.[2] In other viruses, neurological manifestations are as a result of direct effect of the virus, post infection immune mediated diseases or Para-infections. Although in COVID this requires further evaluation a similar conduct may be considered.[3]

We observed polyneuropathy in 2 patients with SARS-CoV2. A 48-year-old male with the complaints of shortness of breath, dry cough and fever since 10 days and a 17 year of male with the complaints of fever and running nose since 5 days. Both had no comorbidities such as diabetes mellitus, hypertension, or chronic kidney disease. There was previous history of admission. On examination fine sensations were lost in the dermatomal distribution of C6, C7, C8, L4, L5, S1, and S2. Nerve conduction study was indicative of signs of sensory motor axonal polyneuropathy.

SARS- CoV-2 is transmitted through close contact or distant spread through aerosol or contaminated surfaces. Retrograde transmission across infected neurons, white blood cell migration across Blood–Brain Barrier or entry through the olfactory nerve are postulated as modes of entry and infection into the central nervous system (CNS).[4] Direct transmission evidenced by the presence of SARS- CoV2 in cerebrospinal fluid has been observed in only 2 cases.[5] Angiotensin converting enzyme-2 (ACE-2) is present in lungs and also the neurons and glial cells. SARS CoV-2 attaches to this ACE-2 gaining access to the CNS. Inflammatory cytokine and immune mediated polyneuropathy and direct viral invasion explain the clinical presentation of neuropathy in these patients.

Only a small percentage of people develop neurological manifestations due to COVID with a relatively smaller percentage developing critical illness neuropathy. These cases provide an insight into this rare complication and highlight the need to study more cases for a better understanding.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Research quality and ethics statement

The authors followed applicable EQUATOR Network (“http:// www.equator-network.org/) guidelines, notably the CARE guideline, during the conduct of this report.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Gutiérrez-Ortiz C, Méndez-Guerrero A, Rodrigo-Rey S, San Pedro-Murillo E, Bermejo-Guerrero L, Gordo-Mañas R, et al. Miller Fisher syndrome and polyneuritis cranialis in COVID-19. Neurology 2020;95:e601-5.  Back to cited text no. 1
    
2.
Ellul MA, Benjamin L, Singh B, Lant S, Michael BD, Easton A, et al. Neurological associations of COVID-19. Lancet Neurol 2020;19:767-83.  Back to cited text no. 2
    
3.
Algahtani H, Subahi A, Shirah B. Neurological complications of middle east respiratory syndrome coronavirus: A report of two cases and review of the literature. Case Rep Neurol Med 2016;2016:3502683.  Back to cited text no. 3
    
4.
Zubair AS, McAlpine LS, Gardin T, Farhadian S, Kuruvilla DE, Spudich S. Neuropathogenesis and neurologic manifestations of the coronaviruses in the age of coronavirus disease 2019: A review. JAMA Neurol 2020;77:1018-27.  Back to cited text no. 4
    
5.
Chen X, Laurent S, Onur OA, Kleineberg NN, Fink GR, Schweitzer F, et al. A systematic review of neurological symptoms and complications of COVID-19. J Neurol 2021;268:392-402.  Back to cited text no. 5
    

Top
Correspondence Address:
Dr. Nipun Bawiskar
Department of Medicine, Jawahar Lal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jgid.jgid_254_21

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2008 Journal of Global Infectious Diseases | Published by Wolters Kluwer - Medknow
Online since 10th December, 2008