Triggers of the dreaded Guillain-Barré syndrome? – Naturopathy portal and naturopathy specialist

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. Furthermore, researchers have also frequently identified neurological complaints in COVID-19. And as now reported, the new pathogen may also trigger the dreaded Guillain-Barré syndrome.

As explained in the Austrian public health portal “Gesundheit.gv.at”, Guillain-Barré syndrome (GBS) is a very rare autoimmune disease. The immune system attacks the body’s peripheral nerve cells, that is, outside the brain and spinal column, and destroys its myelin insulating layer. The disease, also known as “acute idiopathic polyneuritis,” can also be triggered by the new coronavirus.

SARS-CoV-2 infection causes serious neurological complications more quickly

According to a current announcement by the German Neurological Society (DGN), the possibility of Guillain-Barré syndrome (GBS) associated with SARS-CoV-2 was first discussed in the specialist journal “Lancet Neurology” in early April.

Shortly after, two more publications from Europe followed in the specialized journals “New England Journal of Medicine” and “Neurology”, which describe a GBS and a variant of GBS in patients with COVID-19.

GBS often arises as a result of infections, for example, after a bacterial intestinal infection or infection with cytomegalovirus.

The SARS-CoV-2 coronavirus is now also one of the pathogens causing GBS. 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 just five to ten days.

The respiratory muscles can be affected.

As the DGN explains, Guillain-Barré syndrome (GBS) is a serious neurological disease. The myelin layer of the peripheral nerves is damaged by an excessive autoimmune reaction, often as a result of infections, so the nerve fibers can no longer transmit stimuli.

Autoantibodies against the building blocks of nerve membranes (gangliosides) in the blood are often detectable in GBS. The consequences are paralysis (paresis), which usually begins on both sides of the legs and then also affects the arms and face.

In some patients, the respiratory muscles can be affected, so they must be ventilated.

According to the DGN, those affected receive intravenous immunoglobulins in high doses or undergo plasmapheresis, an extracorporeal blood purification procedure in which the autoantibodies that trigger the disease are filtered.

Symptoms often take many weeks to resolve, and some patients have permanent neurologic complaints.

Patient without respiratory symptoms, fever or diarrhea.

About three-quarters of all GBS cases are known to occur as a result of infections, either due to bacterial inflammation of the intestine with Campylobacter jejuni or an upper respiratory tract infection with cytomegalovirus or other viruses. GBS cases associated with SARS-CoV-2 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 Chinese woman who entered the clinic with paralysis (paralysis) of the lower extremities, but showed no respiratory symptoms, fever or diarrhea The pairs spread over the next three days.

According to the information, the therapy was performed with IV immunoglobulins. On day eight, the patient developed a cough, fever, and showed signs of viral pneumonia on chest CT. The throat swab with SARS-CoV-19 was positive.

The authors discuss GBS associated with SARS-CoV-2, but because the classic respiratory symptoms of COVID-19 only appeared one week after the onset of GBS, the possibility of a coincidence of both diseases should 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 patients with SARV CoV-2. Of 1,000 to 1,200 people affected by Covid-19, five developed GBS within five to ten days after the onset of COVID-19 symptoms, three of whom had to be mechanically ventilated.

However, the study was unable to determine if ventilation was necessary due to GBS or respiratory infection.

A third study from Madrid presents two cases of patients with Covid 19 with the GBS variant of Miller Fisher syndrome (MFS). MFS-inducing ganglioside antibodies were detectable in serum and both men had throat swabs with SARS-CoV-2 positive.

Classic GBS or MFS generally 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, GBS represents an important differential diagnosis for so-called critical illness neuropathy, peripheral nerve damage that generally occurs later in the course of the disease in patients in the intensive care unit.” explains Dr. Prof. Helmar Lehmann from the Clinic of the Neurological University in Cologne.

“However, the distinction is relevant so as not to miss immunoglobulin treatment,” adds Professor Dr. Peter Berlit, Secretary General of the German Society for Neurology.

Therefore, it is important to clarify whether patients with Guillain-Barré syndrome (or Miller Fisher syndrome) have SARS-CoV-2 infection. Conversely, in those with severe COVID-19 courses needing ventilation, it should be clarified whether a GBS / MFS could not 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 requiring mechanical ventilation. (ad)

Important note:
This article contains general information only and should not be used for self-diagnosis or treatment. It cannot replace a visit to the doctor.