Update on neurological symptoms in patients infected with severe acute respiratory syndrome coronavirus‐2

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Abstract

Novel coronavirus 19 (COVID‐19) is the latest and most intense epidemic, which is caused by the severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2). In addition to causing respiratory symptoms, SARS‐CoV‐2 can have severe effects on the nervous system. Clinically, COVID‐19 patients have been reported ranging from mild hypogeusia and hyposmia to severe neurological disorders, such as encephalopathy, encephalitis, strokes, and seizures syndrome. However, the pathological mechanisms of this SARS‐CoV‐2 neuro aggressiveness remain unclear, so it is of great significance to explore the neurological effects of SARS‐CoV‐2 infection. To facilitate clinicians to timely recognize the manifestations of COVID‐19 patients with neurological injury and timely treatment, the author hereby reviews the latest research progress in the possible pathways, clinical manifestations, and pathogenesis of COVID‐19 patients with nerve injury.

Abstract

Severe acute respiratory syndrome coronavirus‐2 can cause nervous system injury in the human body by direct, hypoxia, and immune injury, which affects a part of novel coronavirus 19 patients with strokes, seizures, myelitis, as well as other neurological complications.

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Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Chaolin Huang, Yeming Wang, Xingwang Li … (2020)

Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.

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Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

Dawei Wang, Bo Hu, Fangfang Zhu … (2020)

In December 2019, novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited.

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COVID-19: consider cytokine storm syndromes and immunosuppression

Puja Mehta, Daniel McAuley, Michael Brown … (2020)

As of March 12, 2020, coronavirus disease 2019 (COVID-19) has been confirmed in 125 048 people worldwide, carrying a mortality of approximately 3·7%, 1 compared with a mortality rate of less than 1% from influenza. There is an urgent need for effective treatment. Current focus has been on the development of novel therapeutics, including antivirals and vaccines. Accumulating evidence suggests that a subgroup of patients with severe COVID-19 might have a cytokine storm syndrome. We recommend identification and treatment of hyperinflammation using existing, approved therapies with proven safety profiles to address the immediate need to reduce the rising mortality. Current management of COVID-19 is supportive, and respiratory failure from acute respiratory distress syndrome (ARDS) is the leading cause of mortality. 2 Secondary haemophagocytic lymphohistiocytosis (sHLH) is an under-recognised, hyperinflammatory syndrome characterised by a fulminant and fatal hypercytokinaemia with multiorgan failure. In adults, sHLH is most commonly triggered by viral infections 3 and occurs in 3·7–4·3% of sepsis cases. 4 Cardinal features of sHLH include unremitting fever, cytopenias, and hyperferritinaemia; pulmonary involvement (including ARDS) occurs in approximately 50% of patients. 5 A cytokine profile resembling sHLH is associated with COVID-19 disease severity, characterised by increased interleukin (IL)-2, IL-7, granulocyte-colony stimulating factor, interferon-γ inducible protein 10, monocyte chemoattractant protein 1, macrophage inflammatory protein 1-α, and tumour necrosis factor-α. 6 Predictors of fatality from a recent retrospective, multicentre study of 150 confirmed COVID-19 cases in Wuhan, China, included elevated ferritin (mean 1297·6 ng/ml in non-survivors vs 614·0 ng/ml in survivors; p 39·4°C 49 Organomegaly None 0 Hepatomegaly or splenomegaly 23 Hepatomegaly and splenomegaly 38 Number of cytopenias * One lineage 0 Two lineages 24 Three lineages 34 Triglycerides (mmol/L) 4·0 mmol/L 64 Fibrinogen (g/L) >2·5 g/L 0 ≤2·5 g/L 30 Ferritin ng/ml 6000 ng/ml 50 Serum aspartate aminotransferase <30 IU/L 0 ≥30 IU/L 19 Haemophagocytosis on bone marrow aspirate No 0 Yes 35 Known immunosuppression † No 0 Yes 18 The Hscore 11 generates a probability for the presence of secondary HLH. HScores greater than 169 are 93% sensitive and 86% specific for HLH. Note that bone marrow haemophagocytosis is not mandatory for a diagnosis of HLH. HScores can be calculated using an online HScore calculator. 11 HLH=haemophagocytic lymphohistiocytosis. * Defined as either haemoglobin concentration of 9·2 g/dL or less (≤5·71 mmol/L), a white blood cell count of 5000 white blood cells per mm3 or less, or platelet count of 110 000 platelets per mm3 or less, or all of these criteria combined. † HIV positive or receiving longterm immunosuppressive therapy (ie, glucocorticoids, cyclosporine, azathioprine).

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Author and article information

Contributors

Liang Dong: donglqqsx2008@163.com

Journal

Journal ID (nlm-ta): Ibrain

Journal ID (iso-abbrev): Ibrain

Journal ID (doi): 10.1002/(ISSN)2769-2795

Journal ID (publisher-id): IBRA

Title: Ibrain

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Print): 2313-1934

ISSN (Electronic): 2769-2795

Publication date (Electronic): 20 December 2021

Publication date Collection: Winter 2021

Volume: 7

Issue: 4 ( doiID: 10.1002/ibra.v7.4 )

Pages: 351-361

Affiliations

[ ¹ ] Health Management Center, Xiangya Hospital Central South University Changsha Hunan China

[ ² ] National Clinical Research Center for Geriatric Disorders, Xiangya Hospital Central South University Changsha China

[ ³ ] Department of Anesthesiology Liuzhou People's Hospital Affiliated to Guangxi Medical University Liuzhou Guangxi China

[ ⁴ ] Department of Infectious Diseases, Xiangya Hospital Central South University Changsha Hunan China

[ ⁵ ] Key Laboratory of Viral Hepatitis Changsha Hunan China

Author notes

[*] [* ] Correspondence Liang Dong, Department of Anesthesiology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, Guangxi 545006, China.

Email: donglqqsx2008@ 123456163.com

Article

Publisher ID: IBRA12008

DOI: 10.1002/ibra.12008

PMC ID: 10528815

PubMed ID: 37786557

SO-VID: 572e87da-011c-4012-b1e6-dcc2cfc107f4

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

History

Date received : 10 November 2021

Date accepted : 10 November 2021

Page count

Figures: 2, Tables: 0, Pages: 11, Words: 7493

Funding

Funded by: High Level Introduction of Talent Research Start‐up Fund

Award ID: LRYGCC202111

Funded by: National Natural Science Foundation of China , doi 10.13039/501100001809;

Award ID: 81760019

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source-schema-version-number 2.0

cover-date Winter 2021

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.3.4 mode:remove_FC converted:26.09.2023

Keywords: ace‐2 receptors,covid‐19,neurological symptoms,pathological mechanisms

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Keywords: ace‐2 receptors, covid‐19, neurological symptoms, pathological mechanisms

Update on neurological symptoms in patients infected with severe acute respiratory syndrome coronavirus‐2

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Novel Coronavirus Disease COVID-19

Most cited references 94

Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

COVID-19: consider cytokine storm syndromes and immunosuppression

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