Coronavirus Informative Videos
The Neurology and Neuropsychiatry of COVID-19
Evidence on the neurological and neuropsychiatric manifestations and complications of COVID-19 infections is emerging and this is likely to accelerate as the pandemic develops and clinical syndromes are detected, characterized and their mechanisms investigated. This published research database is listed by topic in order of date of publication.
To date and of interest to the AE community, conditions COVID-19 has triggered are Guillain-Barré Syndrome (GBS), Encephalopathy, Encephalitis, Meningoencephalitis, Psychiatric, Epilepsy, ADEM, anti-NMDAr encephalitis, Limbic encephalitis, and acute myelitis.
COVID-19 NEUROLOGY RESOURCE CENTER
Neurology Colleagues: You can count on the American Acadamy of Neurology (AAN) to provide you with expert guidance on the care of neurology patients affected by COVID-19, as well as timely news on how this pandemic is affecting the field of neurology overall. Please visit this page often for continuous updates.
LATEST COVID-19 ARTICLES, VIDEOS, AND PODCASTS
The Lancet COVID-19 RESOURCE CENTER
To assist health workers and researchers working under challenging conditions to bring this outbreak to a close, The Lancet has created a Coronavirus Resource Centre. This resource brings together new 2019 novel coronavirus disease (COVID-19) content from across The Lancet journals as it is published. All of our COVID-19 content is free to access.
FACT SHEET FOR HEALTHCARE PROVIDERS ADMINISTERING VACCINE (VACCINATION PROVIDERS) EMERGENCY USE AUTHORIZATION (EUA) OF THE PFIZER-BIONTECH COVID-19 VACCINE TO PREVENT CORONAVIRUS DISEASE 2019 (COVID-19)
Do not administer Pfizer-BioNTech COVID-19 Vaccine to individuals with known
history of a severe allergic reaction (e.g., anaphylaxis) to any component of the
Pfizer-BioNTech COVID-19 Vaccine (see Full EUA Prescribing Information).
Warnings
Appropriate medical treatment used to manage immediate allergic reactions must
be immediately available in the event an acute anaphylactic reaction occurs
following administration of Pfizer-BioNTech COVID-19 Vaccine.
Immunocompromised persons, including individuals receiving immunosuppressant
therapy, may have a diminished immune response to the Pfizer-BioNTech
COVID-19 Vaccine.
Pfizer-BioNTech COVID-19 Vaccine may not protect all vaccine recipients.
Emergence of a Highly Fit SARS-CoV-2 Variant
Patients infected with D614G-associated SARS-CoV-2 are more likely to have higher viral loads in the upper respiratory tract than patients infected with virus strains without the mutation, but disease severity is not affected.
Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine
FDA Takes Key Action in Fight Against COVID-19 By Issuing Emergency Use Authorization for First COVID-19 Vaccine
December-11-202, the U.S. Food and Drug Administration issued the first emergency use authorization (EUA) for a vaccine for the prevention of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in individuals 16 years of age and older. The emergency use authorization allows the Pfizer-BioNTech COVID-19 Vaccine to be distributed in the U.S.
See: fact sheet for healthcare providers at bottom of page.
NMDA-receptor encephalitis associated with COVID-19 infection in a toddler
There have been two cases of anti-NMDAR encephalitis associated with SARS-CoV-2 in adults reported.
Both patients showed significant recovery following immunotherapy with steroids and IVIG. At the time of publication, the authors are unaware of other cases of anti-NMDAR encephalitis with recent SARS-CoV-2 infection in pediatric populations. As the understanding of both the neurological and non-neurological manifestations of SARS-CoV-2 in children are evolving, we report a child with SARS-CoV-2-associated anti-NMDAR encephalitis.
Tocilizumab is recommended for the treatment of severe COVID-19
The use of tocilizumab to block interleukin 6 (IL-6) signaling in COVID-19 patients may be safer than expected. IL-6 is produced to stimulate the acute-phase response to deal with various infections and tissue injuries. Upon infection with SARS-CoV-2, pathogenic T cells are activated rapidly to produce proinflammatory cytokines. Tocilizumab is a monoclonal antibody that blocks IL-6 receptors
effectively.
IL-6 plays an important part in antibody production, and antibodies are the body’s most direct and effective immune weapon against viruses. Therefore, whether IL-6 blockade by tocilizumab will affect the antiviral immune response of COVID-19 patients (especially the formation of antiviral antibodies) has become an important concern for targeted IL-6 immunotherapy in COVID-19 patients. The increase in the level of antiviral antibodies may have been related to blockade of the excessive IL-6 signal, alleviation of the IS.
What is ‘Long COVID’ and what parts of the body does it affect?
This easy read review highlights the detrimental physical and psychological impact that ongoing COVID is having on many people’s lives.
- So-called ‘long COVID’ might actually be four different syndromes, doctors say.
- While the illness starts in the respiratory system, symptoms can fluctuate around the brain, cardiovascular system and heart, the kidneys, the gut, the liver and the skin.
- It’s vital both doctors and patients continue to report these symptoms, so medical researchers can better understand COVID-19.
Ongoing illness after infection with COVID-19, sometimes called “long COVID”, may not be one syndrome but possibly up to four causing a rollercoaster of symptoms affecting all parts of the body and mind.
Facial Masking for Covid-19 — Potential for “Variolation” as We Await a Vaccine
As SARS-CoV-2 continues its global spread, it’s possible that one of the pillars of Covid-19 pandemic control — universal facial masking — might help reduce the severity of disease and ensure that a greater proportion of new infections are asymptomatic. If this hypothesis is borne out, universal masking could become a form of “variolation” that would generate immunity and thereby slow the spread of the virus in the United States and elsewhere, as we await a vaccine.
Facial Masking for Covid-19 — Potential for “Variolation” as We Await a Vaccine. Ultimately, combating the pandemic will involve driving down both transmission rates and severity of disease. Increasing evidence suggests that population-wide facial masking might benefit both components of the response.
Postpartum consciousness disturbance: can covid-19 cause posterior reversible encephalopathy syndrome?
Genomic evidence for reinfection with SARS-CoV-2: a case study
Remdesivir Effective, Well-Tolerated in Final Trial Report
WHO reveals corticosteroids are effective in reducing the fatality rate of COVID-19
Easy read:
- When severely ill COVID-19 patients are treated with corticosteroids such as dexamethasone, their survival rates increase, according to the WHO.
- Mimicking the action of cortisol in the body, these drugs can help avoid ‘cytokine storms’ which cause deadly levels of inflammation.
- Those treated with corticosteroids had a risk of death after 28 days of 32%. For those receiving usual care or a placebo, the risk was 40%.
Persistence and decay of human antibody responses to the receptor binding domain of SARS-CoV-2 spike protein in COVID-19 patients
These data suggest that RBD-targeted antibodies are excellent markers of previous and recent infection, that differential isotype measurements can help distinguish between recent and older infections, and that IgG responses persist over the first few months after infection and are highly correlated with neutralizing antibodies.
Stroke May Be First Symptom of COVID-19 in Younger Patients
Investigators carried out a meta-analysis of data, including 160 patients with COVID-19 and stroke, and found that nearly half of patients under the age of 50 were asymptomatic at the time of stroke onset.
Stroke May Be First Symptom of COVID-19 in Younger Patients
Investigators carried out a meta-analysis of data, including 160 patients with COVID-19 and stroke, and found that nearly half of patients under the age of 50 were asymptomatic at the time of stroke onset.
Inborn errors of type I IFN immunity in patients with life-threatening COVID-19
Clinical outcome upon infection with SARS-CoV-2 ranges from silent infection to lethal COVID-19. We have found an enrichment in rare variants predicted to be loss-of-function (LOF) at the 13 human loci known to govern TLR3- and IRF7-dependent type I interferon (IFN) immunity to influenza virus, in 659 patients with life-threatening COVID-19 pneumonia, relative to 534 subjects with asymptomatic or benign infection.
We show that human fibroblasts with mutations affecting this pathway are vulnerable to SARS-CoV-2. Inborn errors of TLR3- and IRF7-dependent type I IFN immunity can underlie life-threatening COVID-19 pneumonia in patients with no prior severe infection.
Age groups that sustain resurging COVID-19 epidemics in the United States
Novel use of home pulse oximetry monitoring in COVID-19 patients discharged from the emergency department identifies need for hospitalization
Cytokine Storm
Infectious COVID-19 Can Persist in Gut for Weeks
How the Coronavirus Attacks the Brain
The coronavirus targets the lungs foremost, but also the kidneys, liver, and blood vessels. Still, about half of patients report neurological symptoms, including headaches, confusion, and delirium, suggesting the virus may also attack the brain.
A new study offers the first clear evidence that, in some people, the coronavirus invades brain cells, hijacking them to make copies of itself. The virus also seems to suck up all of the oxygen nearby, starving neighboring cells to death.
It’s unclear how the virus gets to the brain or how often it sets off this trail of destruction. Infection of the brain is likely to be rare, but some people may be susceptible because of their genetic backgrounds, a high viral load or other reasons.
“If the brain does become infected, it could have a lethal consequence,” said Akiko Iwasaki, an immunologist at Yale University who led the work.
The coronavirus seems to rapidly decrease the number of synapses, the connections between neurons. “Days after infection, and we already see a dramatic reduction in the amount of synapses,” Dr. Muotri said. “We don’t know yet if that is reversible or not.”
ACE2 and TMPRSS2 are expressed on the human ocular surface, suggesting susceptibility to SARS-CoV-2 infection
May-2020 Not certified by peer review
Risk Score Predicts COVID-19 Mortality, Outperforms Others
Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19
Findings In this prospective meta-analysis of 7 randomized trials that included 1703 patients of whom 647 died, 28-day all-cause mortality was lower among patients who received corticosteroids compared with those who received usual care or placebo (summary odds ratio, 0.66).
Meaning Administration of systemic corticosteroids, compared with usual care or placebo, was associated with lower 28-day all-cause mortality in critically ill patients with COVID-19.
AI Can Pinpoint COVID-19 From Chest X-Rays
Unexpected Results in New COVID-19 'Cytokine Storm' Data
Temporal profile and determinants of viral shedding and of viral clearance confirmation on nasopharyngeal swabs from SARS-CoV-2-positive subjects: a population-based prospective cohort study in Reggio Emilia, Italy
Conclusions Postponing follow-up testing of clinically recovered COVID-19 patients could increase the efficiency and performance of testing protocols. Understanding viral shedding duration also has implications for containment measures of paucisymptomatic subjects.
SARS-CoV-2 infects human neural progenitor cells and brain organoids
The finding that SARS-CoV-2 can productively infect human brain organoids highlights the potential of direct viral involvement in neurological symptoms in COVID-19 patients. These results provided insight on the pathognomonic symptoms of anosmia (loss of smell) and ageusia (loss of taste) as well as other neurological manifestations of COVID-19 including seizure, encephalopathy, encephalitis, Guillain-Barre syndrome, and Miller Fisher syndrome.
Neurologic complications of COVID-19
Highly Recommended
August 14-2020
Common neurologic complications in patients with coronavirus disease 2019 (COVID-19), resulting from SARS-CoV-2 infection, are presented. ACUTE ENCEPHALOPATHY, ACUTE CEREBROVASCULAR DISEASES, Acute ischemic stroke, Encephalitis, meningitis, Acute necrotizing hemorrhagic encephalopathy, Acute disseminated encephalomyelitis, Acute disseminated encephalomyelitis (ADEM), SEIZURES, Critical illness polyneuropathy, and myopathy, Acute inflammatory demyelinating polyneuropathy, and Olfactory neuropathy
CONCLUSIONS
Human coronaviruses, including SARS-CoV-2, have the ability for neurotropism. Commonly reported neurologic complications in patients infected with
SARS-CoV-2 include encephalopathy, neuromuscular disorders, and acute cerebrovascular disorders.
Other complications, such as postinfectious demyelination, encephalitis, and seizures are likely underreported given the inability to obtain further diagnostic information, such as CSF sampling and EEG
monitoring. Clinicians should have a high clinical suspicion for associated neurologic complications in a COVID-19–infected patient.
Guillain-Barré syndrome: The first documented COVID-19–triggered autoimmune neurologic disease More to come with myositis in the offing
Objective To present the COVID-19–associated GBS, the prototypic viral-triggered autoimmune disease, in the context of other emerging COVID-19–triggered autoimmunities, and discuss potential concerns with ongoing neuroimmunotherapies.
Conclusions Emerging data indicate that COVID-19 can trigger not only GBS but other autoimmune neurological diseases necessitating vigilance for early diagnosis and therapy initiation. Although COVID-19 infection, like most other viruses, can potentially worsen patients with pre-existing autoimmunity, there is no evidence that patients with autoimmune neurological diseases stable on common immunotherapies are facing increased risks of infection.
Obesity Boosts Risks in COVID-19 From Diagnosis to Death
Easy Read:
A new analysis of existing research confirms a stark link between excess weight and COVID-19: People with obesity are much more likely to be diagnosed with the novel coronavirus, undergo hospitalization and ICU admission, and die.
On the biological front, it appears that the immune system is much weaker if you’re obese, and excess weight may worsen the course of a respiratory disease such as COVID-19 because of lung disorders such as sleep apnea.
In addition to highlighting inflammation and a weakened immune system, the review offers multiple explanations for why patients with obesity face worse outcomes in COVID-19. It may be more difficult for medical professionals to care for them in the hospital because of their weight, the authors wrote, and “obesity may also impair therapeutic treatments during COVID-19 infections.” The authors noted that ACE inhibitors may worsen COVID-19 in patients with type 2 diabetes.
The researchers noted that “potentially the vaccines developed to address COVID-19 will be less effective for individuals with obesity due to a weakened immune response.” They pointed to research that suggests T-cell responses are weaker and antibody titers wane at a faster rate in people with obesity who are vaccinated against influenza.
International experience of mechanical thrombectomy during the COVID-19 pandemic: insights from STAR and ENRG
Conclusion We observed a low rate of COVID-19 infection among stroke patients undergoing mechanical thrombectomy (MT) in low-COVID burden counties (LCC). Overall, more than half of the patients underwent intubation prior to MT, leading to prolonged door to reperfusion time, higher in-hospital mortality, and a lower likelihood of functional independence at discharge.
This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the COVID-19 pandemic or until otherwise determined by BMJ. You may use, download, and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trademarks are retained.
Clinical Characteristics and Viral RNA Detection in Children With Coronavirus Disease 2019 in the Republic of Korea
Question How long is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA detected in children, and are children with coronavirus disease 2019 (COVID-19) identifiable by symptoms?
Findings In this case series of 91 children with COVID-19 in Korea, 22.0% were asymptomatic. Only 8.5% of symptomatic cases were diagnosed at the time of symptom onset, while 66.2% had unrecognized symptoms before diagnosis and 25.4% developed symptoms after diagnosis; SARS-CoV-2 RNA was detected for a mean of 17.6 days overall and 14.1 days in asymptomatic cases.
Meaning Symptom screening fails to identify most COVID-19 cases in children, and SARS-CoV-2 RNA in children is detected for an unexpectedly long time.
Convalescent Plasma Therapy for COVID-19: State of the Art
Evaluating the evidence for direct central nervous system invasion in patients infected with the nCOVID-19 virus
We performed a PubMed review of the literature to specifically assess the evidence for the direct CNS invasion by the nCOVID-19 virus. This phenomenon would explain the cerebral oedema and encephalitis, that does occur, and bring Neurosurgeons into the management of these patients by for example directed intra-cranial pressure management post insertion of an intra-cranial pressure monitor. Unfortunately, the answers to these questions were not definitively answered by the research reviewed.
Immunology of COVID-19: Current State of the Science
55% of coronavirus patients still have neurological problems three months later: study
While lung scarring, heart, and kidney damage may result from COVID-19, doctors and researchers are starting to clock the potential long-term impact of the virus on the brain also.
Younger COVID-19 patients who were otherwise healthy are suffering blood clots and strokes.
And many “long-haulers,” or COVID-19 patients who have continued showing symptoms for months after the initial infection passed, report neurological problems such as confusion and difficulty concentrating (or brain fog), as well as headaches, extreme fatigue, mood changes, insomnia and loss of taste and/or smell.
Now a study of 60 COVID-19 patients published in Lancet this week finds that 55% of them were still displaying such neurological symptoms during follow-up visits three months later. And when doctors compared brain scans of these 60 COVID patients with those of a control group who had not been infected, they found that the brains of the COVID patients showed structural changes that correlated with memory loss and smell loss.
And that’s not exclusive to adults. A U.K. study of 4 cases showed children developed neurological manifestations such as headaches, muscle weakness, confusion, and disorientation. While two of the kids recovered, the other two continued to show symptoms, including muscle weakness so severe that they needed a wheelchair. The University College of London warned about a potential brain damage “epidemic” caused by COVID-19 in the journal Brain last month.
While it’s too soon to say whether such post-COVID conditions will be chronic, there is worry about recovered patients being able to return to work and school. “Patients are going to be somewhat debilitated, so their ability to work, their contribution to the workforce, to the domestic product, is going to be reduced,” he said. “It will affect society on many levels if the rates [of infection and long-term illness] persist to be this great.”
Research shows the most and least effective materials for face masks
When the researchers compared wearing masks to wearing no protection during 20-minute and 30-second exposures to the virus, they found that infection risks were reduced by 24-94% or by 44-99% depending on the mask and exposure duration. Risk reduction decreased as exposure duration increased, they found.
This article lists masks from best to worse.
Surprisingly, vacuum cleaner filters, which can be inserted into filter pockets in cloth masks are highly effective. The vacuum filters reduced infection risk by 83% for a 30-second exposure and 58% for a 20-minute exposure. Of the other nontraditional materials evaluated by the researchers, tea towels, cotton-blend fabrics, and antimicrobial pillowcases were the next best for protection.
Scarves, which reduced infection risk by 44% after 30 seconds and 24% after 20 minutes, and similarly effective cotton t-shirts are only slightly better than wearing no mask at all, they found.
“We knew that masks work, but we wanted to know how well and compare different materials’
Cleaner Data Confirm COVID-19 Link to Diabetes, Hypertension
Patients with diabetes also need to be current on vaccinations to reduce their risk for pneumonia. And recognition of the heightened COVID-19 risk for people with these comorbidities is important among people who work in relevant government agencies, health care workers, and patient advocacy groups
“This is the first opportunity for the neuroscience community to understand the virus”
“When it became apparent the virus had taken hold in Italy, I said to the guys, ‘We’ve got to get something up and running’,” Michael wanted to find out: what is Covid-19 doing to the brain, how is it doing it, what makes a person more at risk of these complications, and how do these patients recover?
Michael and his team developed a way for doctors to record the symptoms of patients experiencing neurological and psychiatric complications. Michael’s work is ongoing. Alongside his team, he plans to focus on looking at patients’ immune response and carrying out geometric testing to try to understand genetic differences in patients who experience more severe symptoms.
Hyperglycemia Predicts COVID-19 Death Even Without Diabetes
Conjunctivitis Can Be Sole Covid-19 Symptom
“Conjunctivitis per se is not a very common finding among positive subjects, but when it occurs, it generally presents with or anticipates other symptoms, such as fever, general malaise, cough,” said Dr. Edoardo Trovato Battagliola.
“We don’t know in what percentage of patients, conjunctivitis will be the sole or the starting symptom of SARS-COV-2,” said Dr. Saeed Shoar,”But as (these case reports) revealed, it can start days before the typical symptoms of COVID-19 begin,”
Spectrum of Neurological Manifestations in Covid-19: A Review
Postinfectious brainstem encephalitis associated with SARS-CoV-2
We report a postinfectious brainstem syndrome in a patient with COVID-19 who presented with generalized myoclonus, ocular flutter with convergence spasm, and acquired hyperekplexia. Clinical improvement was seen following corticosteroids, highlighting this as a possible treatment in patients where a post-COVID-19 autoimmune encephalitis is suspected.
Continuous EEG Monitoring Reveals Seizures, Other Abnormalities in COVID-19 Patients
Easy Read. Acute symptomatic seizures detected in five of 22 patients monitored. Patients with severe COVID-19 disease are at increased risk for acute symptomatic seizures and a variety of electroencephalographic (EEG) abnormalities. The largest study to date of continuous EEG (cEEG) monitoring of patients with COVID-19 concludes.
“Knowing that COVID-19 may increase the risk of seizures is important, especially since signs often cannot be detected while patients are heavily sedated on a ventilator,” says neurologist Christopher Newey, DO, MS. “For COVID-19 patients with neurologic changes, continuous EEG monitoring may inform evaluation and management. Seizures could indicate that COVID-19 is neurotropic or may possibly lead to microthrombi in the brain secondary to hypoxia or inflammation,” he conjectures. “It’s also possible that excessive cytokine activity disrupts the blood-brain barrier.”
Scientists warn of potential wave of COVID-linked brain damage
“My worry is that we have millions of people with COVID-19 now. And if in a year’s time we have 10 million recovered people, and those people have cognitive deficits … then that’s going to affect their ability to work and their ability to go about activities of daily living,” Adrian Owen, a neuroscientist at Western University in Canada, told Reuters in an interview.
In the UCL study, published in the journal Brain, nine patients who had brain inflammation were diagnosed with a rare condition called acute disseminated encephalomyelitis (ADEM) which is more usually seen in children and can be triggered by viral infections.
The team said it would normally see about one adult patient with ADEM per month at their specialist London clinic, but this had risen to at least one a week during the study period, something they described as “a concerning increase”.
Identifying airborne transmission as the dominant route for the spread of COVID-19
Other mitigation measures, such as social distancing implemented in the United States, are insufficient by themselves in protecting the public.
We conclude that wearing of face masks in public corresponds to the most effective means to prevent interhuman transmission, and this inexpensive practice, in conjunction with simultaneous social distancing, quarantine, and contact tracing, represents the most likely fighting opportunity to stop the COVID-19 pandemic. Our work also highlights the fact that sound science is essential in decision-making for the current and future public health pandemics.
Headache May Predict Clinical Evolution of COVID-19
An observational study of more than 100 patients showed that headache onset could occur during the presymptomatic or symptomatic phase of COVID-19 and could resemble tension-type or migraine headache.
In a subgroup of participants, headache persisted even after the symptoms of COVID-19 had been resolved.
Comorbidities Increase COVID-19 Deaths by Factor of 12
The pandemic “is an ongoing public health crisis in the United States that continues to affect all populations and result in severe outcomes including death,” they said, emphasizing “the continued need for community mitigation strategies, especially for vulnerable populations, to slow COVID-19 transmission.”
WHO Halts Trial of Hydroxychloroquine in COVID-19 Patients
Data from those studies “showed that hydroxychloroquine does not result in the reduction of mortality of hospitalized COVID-19 patients,” the WHO statement said.
The U.S. Food and Drug Administration on Monday, June 15th, revoked its emergency use authorization for hydroxychloroquine to treat COVID-19, saying it was no longer reasonable to believe that hydroxychloroquine and the related drug chloroquine would be effective in treating the disease.
Dexamethasone Hailed as 'Breakthrough' in COVID-19 Trial, Reduced Deaths
Trial results announced on Tuesday showed dexamethasone, which is used to reduce inflammation in other diseases such as arthritis, reduced death rates by around a third among the most severely ill of COVID-19 patients admitted to hospital.
The preliminary results suggest the drug should immediately become standard care in patients with severe cases of the pandemic disease, said the researchers who led the trials.
“This is a (trial) result that shows that if patients who have COVID-19 and are on ventilators or are on oxygen are given dexamethasone, it will save lives, and it will do so at a remarkably low cost,” said Martin Landray, an Oxford University professor co-leading the trial, known as the RECOVERY trial.
Save Lives Around the World
England’s chief medical officer, Chris Whitty, said Tuesday’s announcement was “the most important trial result for COVID-19 so far”, adding: “It will save lives around the world
New Study Reveals COVID-19 Causes Serious Neurological Symptoms Shockingly Often
The findings illustrate that COVID-19, the disease the coronavirus causes, is far more than a respiratory infection and rather one that poses “a global threat” to the whole nervous system, including the brain, spinal cord, and nerves, the study authors say.
“It’s important for the general public and physicians to be aware of this, because a SARS-CoV-2 infection may present with neurological symptoms initially, before any fever, cough or respiratory problems occur,” lead study author Igor Koralnik, professor of neurology at Northwestern University Feinberg School of Medicine, said in a press release.
Some of the other neurological symptoms patients experienced included headache, decreased alertness, and muscle pain.
COVID-19-associated acute necrotizing myelitis
Mutation of Coronavirus Is Significantly Increasing Its Ability To Infect
“Viruses with this mutation were much more infectious than those without the mutation in the cell culture system we used,” says Scripps Research virologist Hyeryun Choe, PhD, senior author of the study.
It is still unknown whether the new D614G variant affects the severity of symptoms of infected people, or increases mortality, the scientists say.
COVID-19 gone bad: A new character in the spectrum of the hyperferritinemic syndrome?
SARS-CoV-2 Infection Rate 16% in Asymptomatic Pregnant Women at Delivery
Test results were substantially concordant among patient and support person pairs. “Among patients who tested positive for COVID-19 infection and had a support person present, 11 of 19 (58%) support persons also tested positive for COVID-19 infection,” the authors reported. “Among patients who tested negative for COVID-19 infection and had a support person present, only 3 of 127 (2.4%) support persons tested positive for COVID-19 infection.”
Anti-NMDA receptor encephalitis in a psychiatric Covid-19 patient: A case report
COVID-19 patients having known psychiatric disorders should be monitored closely for neurologic manifestations including headache, dizziness, and symptoms, changes in mental status, meningeal signs, dyskinesias. Patients with severe infection may be at greater risk for developing neurological sequelae and increased mortality. Furthermore, SARS-CoV-2 infection should be considered as a differential diagnosis in psychiatric patients with presentation of sudden onset symptoms including respiratory distress and other Covid-19 related symptoms to avoid wrong or delayed diagnosis
Psychosis spike linked to effect of coronavirus
Dozens of patients across Scotland have been treated for psychosis in recent weeks, as evidence mounts that the coronavirus pandemic can trigger mental illness.
A UK-wide surveillance programme suggests that some patients infected with Covid-19 suffer “altered mental states” such as psychosis and encephalitis, an inflammation of the brain that can cause seizures and hallucinations.
About 400 cases have been flagged to the project, known as CoroNerve, in the past month. Behind a stroke, psychosis has emerged as the second most common condition linked to the virus, affecting about one in three patients.
COVID-19 Data Dives: Airborne Transmission Increases With Crowding
Even if the airborne transmission can happen, it doesn’t mean that it is the dominant mode of transmission or the major contributor to dynamics. The evidence we have now is still that close contacts are the most important. I will revisit this as the evidence evolves.
Respiratory virus shedding in exhaled breath and efficacy of face masks
Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis
Neurological Manifestations of COVID-19 and Other Coronavirus Infections: A Systematic Review
Highlights
Neurological manifestations has been reported in SARS-CoV2 infection recently.
SARS-CoV2 could spread to the brain hematogenously or through the cribriform plate.
Neurological symptoms can be due to systemic illness or viral invasion of the CNS.
UK-wide surveillance of neurological and neuropsychiatric complications of COVID-19: The first 153 patients
These data provide valuable and timely information urgently needed by clinicians, researchers, and funders to inform immediate steps in COVID-19 neuroscience research and health policy throughout the areas of neurology and neuropsychiatry
Convalescent plasma in Covid-19: Possible mechanisms of action
There is not specific treatment for COVID-19.
Convalescent plasma (CP) emerges as the first option of management for hospitalized patients with COVID-19.
Transference of neutralizing antibodies helps to control COVID-19 infection and modulates inflammatory response.
Other plasma components may enhance the antiviral and anti-inflammatory properties of CP.
Children are falling sick with a rare mystery inflammatory syndrome linked to Coronavirus
Children and teens with the rare but potentially dangerous complication have been identified in at least seven states and the Washington, D.C., area as well as some parts of Europe. The condition can resemble features of other inflammatory illnesses like the Kawasaki Disease and toxic shock-like syndrome.
Physicians and scientists are working hard to understanding the mechanisms at play, and why only some children are so severely affected,” she said. Dr. John revealed that “the feature that’s been most concerning is that they have problems with their heart function.”
Dr. John added: “In general, families do not need to worry about this. I doubt that this is really new. I think it’s just really newly recognized. I hope what comes of this is that, because we’re seeing more cases, it will not take long before we will be better at recognizing this and treating it.”
Immunomodulation in COVID-19
As insight is gained into the clinical phenotypes associated with COVID-19, we propose JAK and IL-1 inhibitors as therapeutic targets warranting rapid investigation. Multidisciplinary collaboration with experts in haematology, inflammation, tissue damage, and repair and resolution is paramount.
Coronavirus Infections in Children Including COVID-19: An Overview of the Epidemiology, Clinical Features, Diagnosis, Treatment and Prevention Options in Children.
Rapid development of an inactivated vaccine candidate for SARS-CoV-2
FDA Authorizes Emergency Use of Remdesivir for COVID-19
Neurons promote encephalitogenic CD4 + lymphocyte infiltration in experimental autoimmune encephalomyelitis
'Hypercoagulation,' Antiphospholipid Antibodies Seen in COVID-19
“Antiphospholipid antibodies abnormally target phospholipid proteins, and the presence of these antibodies is central to the diagnosis of the antiphospholipid syndrome.”
Why Some People Get Sicker Than Others
Sudden Loss of Taste and Smell Should Be Part of COVID-19 Screen
“Based on our study, if you have smell and taste loss, you are more than 10 times more likely to have COVID-19 infection than other causes of infection. The most common first sign of a COVID-19 infection remains fever, but fatigue and loss of smell and taste follow as other very common initial symptoms,” said Yan.
Hydroxychloroquine for COVID-19: What's the Evidence?
Remdesivir Prevents Disease Progression in Monkeys With COVID-19
Twelve hours after the initial treatment, the scientists examined all animals and found the six treated animals in significantly better health than the untreated group, a trend that continued during the seven-day study.
The investigators note that the data supports initiating remdesivir treatment in COVID-19 patients as early as possible to achieve maximum treatment effect. “This finding is of great significance for patient management, where a clinical improvement should not be interpreted as a lack of infectiousness,” they write.
Imaging Recommendations Issued for COVID-19 Patients
- Recommendations: Imaging is indicated for patients with features of moderate to severe COVID-19 regardless of COVID-19 test results.
- Imaging is indicated for patients with COVID-19 and evidence of worsening respiratory status.
- When access to CT is limited, chest radiography may be preferred for COVID-19 patients unless features of respiratory worsening warrant using CT.
- Additional recommendations: Daily chest radiographs are not indicated in stable, intubated patients with COVID-19.
- CT is indicated in patients with functional impairment, hypoxemia, or both, after COVID-19 recovery.
- COVID-19 testing is warranted in patients incidentally found to have findings suggestive of COVID-19 on a CT scan.
COVID-19: First Data Confirm Neurologic Symptoms Common
Nervous system manifestations of COVID-19 were “significantly more common” in severe versus nonsevere infection.
The public and medical personnel alike need to be aware that there may be neurological manifestations of COVID-19 and such symptoms indicate a need for prompt medical attention.
COVID-19: Exercise may protect against deadly complication
Hydroxychloroquine for COVID-19 Study Did Not Meet 'Expected Standard'
Elisabeth Bik took a close look at the IJAA article and detailed a long list of serious problems with the study, including questions about its ethical underpinnings, messy confounding variables, missing patients, rushed and conflicted peer review, and confusing data.
COVID-19:Attacks the 1-Beta Chain of Hemoglobin and Captures the Porphyrin to Inhibit Human Heme Metabolism
A first Case of Meningitis/Encephalitis associated with SARS-Coronavirus-2
Highlights
Responding to stress experienced by hospital staff working with Covid-19
Download Graphic here https://www.kingsfund.org.uk/sites/default/files/2020-04/rapid-guidance-stress-diagram.pdf
The Spectrum of Neurologic Disease in the Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic Infection
Coronavirus disease 2019 has now reached pandemic status and is common all over the world; thus, with so many affected patients, we can expect as neurologists to be confronted with these patients commonly in coming months and years.
Many Children With COVID-19 Don't Have Cough or Fever
Among pediatric patients younger than 18 years in the United States, 73% had at least one of the trio of symptoms, compared with 93% of adults aged 18-64, noted Lucy A. McNamara, PhD, and the CDC’s COVID-19 response team, based on a preliminary analysis of the 149,082 cases reported as of April 2.
Neurologic Symptoms and COVID-19: What's Known, What Isn't
However, US neurologists are now reporting that COVID-19 symptoms may also could include encephalopathy, ataxia, and other neurologic signs.
Use of Hydroxychloroquine and Chloroquine During the COVID-19 Pandemic: What Every Clinician Should Know
Risk Factors for Death From COVID-19 Identified in Wuhan Patients
The average age of survivors was 52 years compared to 69 for those who died. Liu cited weakening of the immune system and increased inflammation, which damages organs and also promotes viral replication, as explanations for the age effect.
From the time of initial symptoms, median time to discharge from the hospital was 22 days. Average time to death was 18.5 days.
The FDA-approved Drug Ivermectin inhibits the replication of SARS-CoV-2 in vitro
Highlights:
Ivermectin is an inhibitor of the COVID-19 causative virus (SARS-CoV-2) in vitro.
A single treatment able to effect ∼5000-fold reduction in virus at 48h in cell culture.
Ivermectin is FDA-approved for parasitic infections, and therefore has a potential for repurposing.
Ivermectin is widely available, due to its inclusion on the WHO model list of essential medicines.
Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study
Coronavirus survivors' plasma could save lives
This paper: The feasibility of convalescent plasma therapy in severe COVID-19 patients: a pilot study
Two independent research studies have shown the benefit of receiving infusions of blood from COVID-19 survivors.
The teams – both based in China – extracted blood plasma from patients who had recovered from COVID-19, which contained antibodies against the disease. The first study from the National Engineering Technology Research Center for Combined Vaccines in Wuhan gave plasma to 10 patients who were severely ill with COVID-19. Six days after receiving the infusion, the COVID-19 virus was undetectable in seven of the 10 patients.
Hydroxychloroquine: Possible COVID Drug Can Be Toxic to Retinas
Comorbidities Increase Likelihood of Retinal Toxicity
While a detailed patient history may be impossible to obtain if HCQ is used in the treatment of COVID-19, certain comorbidities do place patients at an increased risk for retinal toxicity. HCQ is excreted through renal clearance, so the dosage should be reduced in those with compromised kidney function to minimize the risk for toxicity. The presence of macular disease, such as age-related macular degeneration, has also been demonstrated to be a risk factor for the development of toxic maculopathy. The concurrent use of tamoxifen also increases the risk for retinal toxicity. Tamoxifen itself may deposit in the retina and make the macula more susceptible to the potentially toxic effects of HCQ.
'No Complacency' on COVID-19 After Death of 13-Year-Old-Boy
“It is essential that we undertake research to determine why a proportion of deaths occur outside of the groups expected to succumb to infection as it may indicate an underlying genetic susceptibility of how the immune system interacts with the virus.
“Determining if this is the case could help us to learn more about the interaction of the virus with the immune system and subsequently what further treatments may be suitable in patients with severe infection.”
Evidence of the COVID-19 Virus Targeting the CNS: Tissue Distribution, Host–Virus Interaction, and Proposed Neurotropic Mechanisms
A dominant cerebral involvement alone with the potential of causing cerebral edema in COVID-19 can take a lead in causing death long before systemic homeostatic dysregulation sets in.
Also, a staging system based on the severity and organ involvement is needed in COVID-19 in order to rank the patients for aggressive or conventional treatment modalities.
COVID-19: Neurologists in Italy to Colleagues in US: Look for Poorly-Defined Neurologic Conditions in Patients with the Coronavirus
Australia's Trialing a TB Vaccine Against COVID-19, And Health Workers Get It First
Similar trials are being conducted in several other countries including the Netherlands, Germany and the United Kingdom.
“This trial will allow the vaccine’s effectiveness against COVID-19 symptoms to be properly tested, and may help save the lives of our heroic frontline healthcare workers,”
Antibodies, Immunity, and COVID-19
In summary, a robust and well-designed seroprevalence study using residual serum samples from across the US has found that herd immunity to SARS-Cov-2 is nowhere in sight, even as the COVID-19 pandemic has raged on for a year. The good news is that the limited number of reinfections of SARS-CoV-2 to date, and the experience with natural infections with other viruses, suggests that protective immunity to COVID-19 should result, a harbinger for the success of vaccines. The bad news is that, like the 1918 influenza pandemic, achieving herd immunity through natural infections will take years of painful sacrifice that are tallied in numerous deaths, severe long-term health sequelae, and widespread economic disruption and hardship. Let us hope that safe and effective vaccines help avoid the consequences of naturally developing herd immunity to COVID-19, as they have reliably done for so many other respiratory viruses.
Supplementation with vitamin D in the COVID-19 pandemic?
Supplementation with daily (preferred) or weekly doses of vitamin D, aimed at increasing the concentration of serum 25(OH)D to the optimal level of 30–50 ng/mL could be considered a global strategy, being more important in countries with a high prevalence of vitamin D deficiency and particularly in those patients with COVID-19 who are a high risk of ICU admission.
Human recombinant soluble ACE2 (hrsACE2) shows promise for treating severe COVID19
Easy to Read Article
A recent study by Zoufaly et al. published in The Lancet Respiratory Medicine describes encouraging data from the first severe COVID-19 patient successfully treated with human recombinant soluble angiotensin-converting enzyme-2 (hrsACE2).
While promising, we must be mindful that this represents a single observation. Nonetheless, the results, in this instance, clearly demonstrate that SARS-CoV-2 disappeared rapidly from the serum and gradually from the nasal cavity and lungs following hrsACE2 treatment. As with any emerging drug, further research is required to reveal the full potential of hrsACE2 as a sound therapeutic tool, but initial clinical observations are promising.
Largest COVID-19 contact tracing study to date finds children key to spread, evidence of superspreaders
Easy to Read article:
A study of more than a half-million people in India who were exposed to the novel coronavirus SARS-CoV-2 suggests that the virus’ continued spread is driven by only a small percentage of those who become infected. Furthermore, children and young adults were found to be potentially much more important to transmitting the virus — especially within households — than previous studies have identified.
“Our study presents the largest empirical demonstration of superspreading that we are aware of in any infectious disease,” Laxminarayan said. “Superspreading events are the rule rather than the exception when one is looking at the spread of COVID-19, both in India and likely in all affected places.”
The findings provide extensive insight into the spread and deadliness of COVID-19 in countries such as India. The researchers also reported, however, the first large-scale evidence that the implementation of a countrywide shutdown in India led to substantial reductions in coronavirus transmission.
Anti–SARS-CoV-2 antibodies in the CSF, blood-brain barrier dysfunction, and neurological outcome
High-titer anti-SARS-CoV-2 antibodies were detected in the CSF of comatose or encephalopathic patients demonstrating intrathecal IgG synthesis or BBB disruption. A disrupted BBB may facilitate the entry of cytokines and inflammatory mediators into the CNS enhancing neuroinflammation and neurodegeneration. The observations highlight the need for prospective CSF studies to determine the pathogenic role of anti–SARS-CoV-2 antibodies and identify early therapeutic interventions.
Meningitis as an Initial Presentation of COVID-19: A Case Report
This case indicates that in addition to common presenting symptoms of fever, fatigue, and mild respiratory symptoms like dry cough and shortness of breath, patients with COVID-19 can also develop neurological manifestations like headache, anosmia, hyposmia, dysgeusia, meningitis, encephalitis, and acute cerebrovascular accidents during the course of the disease, which highlights the neurotropic potential of SARS-CoV-2. To date, the underlying pathophysiological mechanisms through which SARS-CoV-2 implicates the central nervous system (CNS) are not fully understood.
Time to get ill: the intersection of viral infections, sex, and the X chromosome
Females have more robust immune responses than males, and viral infections are more severe for males.
Risk of COVID-19 During Air Travel
The risk of contracting coronavirus disease 2019 (COVID-19) during air travel is lower than from an office building, classroom, supermarket, or commuter train.
Steps Passengers Can Take
Wear a mask, don’t travel if you feel unwell, and limit carry-on baggage. Keep distance from others wherever possible; report to staff if someone is clearly unwell. If there is an overhead air nozzle, adjust it to point straight at your head and keep it on full. Stay seated if possible, and follow crew instructions. Wash or sanitize hands frequently and avoid touching your face.
Coronavirus Can Survive on Surfaces for Weeks, Study Says
The study also found that the virus survived longer at lower temperatures and tended to last longer on non-porous or smooth surfaces such as glass and stainless steel rather than porous or rough surfaces such as cotton.
Efficacy of masks and face coverings in controlling outward aerosol particle emission from expiratory activities
These observations directly demonstrate that wearing of surgical masks or KN95 respirators, even without fit-testing, substantially reduce the number of particles emitted from breathing, talking, and coughing. While the efficacy of cloth and paper masks is not as clear and confounded by shedding of mask fibers, the observations indicate it is likely that they provide some reductions in emitted expiratory particles, in particular the larger particles (> 0.5 μm). We have not directly measured virus emission; nonetheless, our results strongly imply that mask wearing will reduce emission of virus-laden aerosols and droplets associated with expiratory activities, unless appreciable shedding of viable viruses on mask fibers occurs. The majority of the particles emitted were in the aerosol range (< 5 μm). As inertial impaction should increase as particle size increases, it seems likely that the emission reductions observed here provide a lower bound for the reduction of particles in the droplet range (> 5 μm). Our observations are consistent with suggestions that mask wearing can help in mitigating pandemics associated with respiratory disease. Our results highlight the importance of regular changing of disposable masks and washing of homemade masks, and suggests that special care must be taken when removing and cleaning the masks.
Plasmapheresis treatment in COVID-19–related autoimmune meningoencephalitis: Case series
Convalescent Blood Plasma Safe, Effective for COVID-19
Convalescent blood plasma is a useful and relatively safe therapy for COVID-19, and perhaps should be used more widely, according to Prof Arturo Casadevall, Chair of Molecular Microbiology and Immunology at the Johns Hopkins Bloomberg School of Public Health.
Blood plasma is currently the only therapy against COVID-19 associated with a major reduction in mortality if given before ICU admission.
COVID is harming sperm, Israeli researchers say, raising infertility worries
COVID-19 is harming the sperm of patients, even weeks after recovery, Israeli doctors have concluded, raising concerns that the disease could reduce fertility.
Literature suggests that the virus is found in the sperm of 13% of male patients who have the disease, and 8.6% of those who are recovering a week or two after the active disease. A month later, there are no traces of coronavirus ribonucleic acid (RNA) in the sperm.
80 Percent of Hospitalized Covid Patients Had Neurological Symptoms, Study Finds
This article is an easy read that references the research paper:
Frequent neurologic manifestations and encephalopathy‐associated morbidity in Covid‐19 patients
Frequent neurologic manifestations and encephalopathy‐associated morbidity in Covid‐19 patients
Neurologic manifestations were present at Covid‐19 onset in 215 (42.2%), at hospitalization in 319 (62.7%), and at any time during the disease course in 419 patients (82.3%). The most frequent neurologic manifestations were myalgias (44.8%), headaches (37.7%), encephalopathy (31.8%), dizziness (29.7%), dysgeusia (15.9%), and anosmia (11.4%). Strokes, movement disorders, motor and sensory deficits, ataxia, and seizures were uncommon (0.2 to 1.4% of patients each). Severe respiratory disease requiring mechanical ventilation occurred in 134 patients (26.3%). Independent risk factors for developing any neurologic manifestation were severe Covid‐19 (OR 4.02; 95% CI 2.04–8.89; P < 0.001) and younger age (OR 0.982; 95% CI 0.968–0.996; P = 0.014). Of all patients, 362 (71.1%) had a favorable functional outcome at discharge (modified Rankin Scale 0–2). However, encephalopathy was independently associated with worse functional outcome (OR 0.22; 95% CI 0.11–0.42; P < 0.001) and higher mortality within 30 days of hospitalization (35 [21.7%] vs. 11 [3.2%] patients; P < 0.001).
Interpretation
Neurologic manifestations occur in most hospitalized Covid‐19 patients. Encephalopathy was associated with increased morbidity and mortality, independent of respiratory disease severity.
SARS-CoV2 Pandemic: An International Experience
We describe the first international cohort of 55 pediatric patients with multi-system inflammatory syndrome (MIS-C) during the SARS-CoV2 pandemic with a range of cardiac manifestations. This paper brings awareness and alertness to the global medical community to recognize these children during the pandemic and understand the need for early cardiology evaluation and follow-up.
Possible autoimmune encephalitis with claustrum sign in case of acute SARS CoV-2 infection
Case Study: An 18-year-old woman presented to the hospital after a one-week history of fever, fatigue,malaise, and loss of appetite that progressed to include drowsiness and confusion. There was history of exposure to COVID-19 in a sick family member six days prior to symptom onset. Autoimmune encephalitis has rarely been reported as a presentation of COVID-, and the possibility of a coincidental association in this and other described cases cannot be excluded.
The finding of the claustrum sign on brain MRI, not previously reported in a COVID-patient,provides further support for the idea that acute SARS-CoV-2 infection may present as an autoimmune encephalitis.
Autoimmune Encephalitis Presenting with Acute Excited Catatonia in a 40-Year-Old Male Patient with Covid-19
Acute malignant catatonia with autonomic instability developed in a previously healthy man. CT and MRI were normal, EEG showed slowing and cerebrospinal fluid showed a subtle indication of inflammation. 18F-FDG-PET conveyed high bilateral uptake in the striatum. Antibody testing revealed antibodies attacking healthy brain cells in the hippocampus, thalamus, striatum and cortex. Early treatment with plasmapheresis and corticosteroid reversed disease progression and may have prevented large-scale neurological damage.
(Note: This article is a preprint and has not been peer-reviewed [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.)
Surgical, N95 masks block most particles, homemade cloth masks release their own
The results confirm that masks and face coverings are effective in reducing the spread of airborne particles, Ristenpart said, and also the importance of regularly washing cloth masks.
Video: Testing a surgical mask is included in article.
The airborne lifetime of small speech droplets and their potential importance in SARS-CoV-2 transmission
Covid-19: Do many people have pre-existing immunity?
Inflammation: the key factor that explains vulnerability to severe COVID
- While access to healthcare, occupational exposure, and environmental risks such as pollution all affect survival rate, for many at-risk groups, the key factor is inflammation.
- Cytokines, a key player in the immune response, can help stop viruses reproducing.
- Yet when too many are produced at once, this causes inflammation which can severely damage the lungs.
- Studies like these highlight how different people are. The more we understand about these differences and vulnerabilities, the more we can consider how best to treat each patient. Data like these also highlight the need to consider variation in immune function and include people of varied demographics in drug and vaccine trials.
Safety and immunogenicity of an rAd26 and rAd5 vector-based heterologous prime-boost COVID-19 vaccine in two formulations: two open, non-randomised phase 1/2 studies from Russia
Interpretation
Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19)
Mysterious Post-COVID Syndrome Affecting Kids Appears to Be Even Worse Than We Thought
After contracting and beating a coronavirus infection, a body needs time to rest, to recover its health and strength. Sadly, for some children, that isn’t what happens next.
A mysterious, new disease called multisystem inflammatory syndrome in children (MIS-C, and also known as a paediatric multisystem inflammatory syndrome or PIMS) has affected hundreds of children around the world since it was first discovered earlier this year.
The condition, thought to be somehow linked to COVID-19, can emerge in kids even after very mild coronavirus infections. But a light case of coronavirus is no guarantee that a subsequent case of MIS-C won’t be very serious, and sometimes even fatal.
“Children did not need to exhibit the classic upper respiratory symptoms of COVID-19 to develop MIS-C, which is frightening,” says neonatologist Alvaro Moreira from the University of Texas Health Science Centre at San Antonio.
“Children might have no symptoms, no one knew they had the disease, and a few weeks later, they may develop this exaggerated inflammation in the body.”
Covid-19: UK studies find gastrointestinal symptoms are common in children
Gastrointestinal symptoms are common in children infected with SARS-CoV-2 and should trigger tests for the virus, researchers have said.
A prospective study of 992 healthy children (median age 10.1 years) of healthcare workers from across the UK found that 68 (6.9%) tested positive for SARS-CoV-2 antibodies.1 Half of the children testing positive reported no symptoms, but for those that did the commonest were fever (21 of 68, 31%); gastrointestinal symptoms, including diarrhoea, vomiting, and abdominal cramps (13 of 68, 19%); and headache (12 of 68, 18%).
Neuropathological Features of Covid-19 - to the editor
In conclusion, histopathological examination of brain specimens obtained from 18 patients who died 0 to 32 days after the onset of symptoms of Covid-19 showed only hypoxic changes and did not show encephalitis or other specific brain changes referable to the virus. There was no cytoplasmic viral staining on immunohistochemical analysis. The virus was detected at low levels in 6 brain sections obtained from 5 patients; these levels were not consistently related to the interval from the onset of symptoms to death. Positive tests may have been due to in situ virions or viral RNA from blood.
A Supercomputer Analyzed Covid-19 — and an Interesting New Theory Has Emerged
Covid-19 is like a burglar who slips in your unlocked second-floor window and starts to ransack your house. Once inside, though, they don’t just take your stuff — they also throw open all your doors and windows so their accomplices can rush in and help pillage more efficiently.
Oxford vaccine trial on hold because of potential safety issue
The decision to pause the trials comes after a study participant in the U.K. reportedly developed a spinal cord injury.
“Our standard review process was triggered and we voluntarily paused vaccination to allow review of safety data by an independent committee,” AstraZeneca, which is developing the vaccine in partnership with the U.K.’s University of Oxford, said in a statement. “This is a routine action which has to happen whenever there is a potentially unexplained illness in one of the trials, while it is investigated, ensuring we maintain the integrity of the trials.”
Postinfectious brainstem encephalitis associated with SARS-CoV-2
Five common skin manifestations of COVID‐19 identified
An initial 120 images were reviewed by four dermatologists, without knowing any other clinical information, and they identified patterns of symptoms associated with COVID‐19. These patterns were then applied to the rest of the images and further refined. Five common skin symptoms were identified in this way.
These symptoms are chilblain‐like lesions, outbreaks of small blisters, wheals, rashes comprised of small flat and raised red bumps, and livedo and necrosis. Livedo is a skin condition where circulation is impaired within the blood vessels of the skin, necrosis refers to the premature death of skin tissue.
These symptoms are associated with different severity of COVID‐19 infection, from less severe disease in the chilblain‐like lesions, to most severe in patients with livedo.
The researchers noted that some of the skin symptoms associated with COVID‐19 are common and can have many causes, particularly wheals and rashes. As such, they may not be particularly helpful as an aid to diagnosis
High frequency of cerebrospinal fluid autoantibodies in COVID-19 patients with neurological symptoms
Antigens for the autoantibodies included proteins that are well-known in clinical practice, such as the glutamate receptor NMDA, as well as various undetermined antigens in several parts of the brain.
The team says that although some autoantibodies still need to be identified, they may at least partly explain the multiple organ disease that can occur in COVID-19 patients and help to inform immunotherapy decisions in certain cases.
In most patients, increased CSF protein, lactate or white blood cells with negative SARSCoV-2 PCR indicated inflammatory changes compatible with autoimmune encephalitis.
Recent findings suggest that several viral infections can lead to secondary autoimmune encephalitis, including EBV, HHV-6, enterovirus, adenovirus, hepatitis C or HIV infections. Thus, the present findings suggest that SARS-CoV-2 is no exception to this general principle. The following months will show whether such autoreactivity can cause persisting neurological morbidity even after
clearance of SARS-CoV-2 and remission of COVID-19, in a way reminiscent of the
unexplained severe ‘encephalitis lethargica’ – commonly with postencephalitic parkinsonism – in more than a million patients of the influenza pandemic in 1918. Together, the high frequency of autoantibodies targeting the brain in the absence of other explanations suggests a
causal association with clinical symptoms, in particular with hyperexcitability (myoclonus, seizures). While several underlying autoantigens still await identification in future studies,
the presence of autoantibodies may explain some aspects of multi-organ disease in COVID-19 and guide immunotherapy in selected cases.
COVID-19: dealing with a potential risk factor for chronic neurological disorders
Neurological manifestations of coronavirus infections – a systematic review Conclusions
Our systematic review provides high level evidence that HCoVs, particularly SARS‐CoV‐1 and SARS‐CoV‐2, have a common ground on neurological symptomatology and complications. Particularly, clinicians treating these patients should be vigilant for at least five classes of neurological complications: (1) Cerebrovascular disorders including ischemic stroke and macro/micro‐hemorrhages, (2) encephalopathies, likely caused by combinatorial effects of sepsis, hypoxia, and immune hyperstimulation, (3) para‐/postinfectious immune‐mediated complications such as GBS and ADEM, (4) (meningo‐)encephalitis, potentially with concomitant seizures, and (5) neuropsychiatric complications such as mood disorders or psychosis. Thus, the clinical neuroimaging protocol, as herein recommended, should include appropriate MRI sequences for early diagnosis and monitoring of patients. Our results also underscore the need to further research and optimize treatment regarding modulation of the coagulation and immune systems in order to reduce the risk of neurological complications.
Coronavirus Disease 2019 (COVID‐19) in autoimmune hepatitis: a lesson from immunosuppressed patients
Ten patients from six different hospitals in Italy were diagnosed with COVID‐19 during the outbreak of SARS‐CoV‐2 in March 2020. All patients were taking immunosuppressive therapy.
Conclusion:
Patients under immunosuppressive therapy for AIH developing COVID‐19 show a disease course presumptively similar to that reported in non‐immunosuppressed population. These data might help medical decision when dealing with SARS‐CoV‐2 infection in immunocompromised .
A case of limbic encephalitis associated with asymptomatic COVID-19 infection
Our case suggests that neurological manifestations can be the initial symptom of COVID-19 and that COVID-19 infection should be considered in patients presenting with limbic encephalitis.
COVID-19 Linked to Development of Myasthenia Gravis
We note that symptoms of myasthenia gravis appeared within 5 to 7 days after fever onset in all 3 patients, and the time from presumed infection with SARS-CoV-2 to the beginning of myasthenia gravis symptoms is consistent with the time from infection to symptoms in other neurologic disorders triggered by infections.
Hydroxychloroquine with or without Azithromycin in Mild-to-Moderate Covid-19
Conclusions: Among patients hospitalized with mild-to-moderate Covid-19, the use of hydroxychloroquine, alone or with azithromycin, did not improve clinical status at 15 days as compared with standard care.
Tocilizumab for treatment of mechanically ventilated patients with COVID-19
CONCLUSIONS:
In this cohort of mechanically ventilated COVID-19 patients, tocilizumab was associated with lower mortality despite higher superinfection occurrence.
Dexamethasone in Hospitalized Patients with Covid-19 — Preliminary Report
CONCLUSIONS:
In patients hospitalized with Covid-19, the use of dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization but not among those receiving no respiratory support.
Remdesivir Reduces Time to Recovery in Adults Hospitalized With COVID-19: A Meaningful Step in Therapeutic Discovery
COVID-19 Update: New Symptom, Test to Guide Steroid Treatment
Combination Therapy Quells COVID-19 Cytokine Storm
While these data are not randomized and have a relatively small sample size, we had recently seen the results of the RECOVERY trial, a UK-based randomized trial demonstrating the benefit of steroids in COVID-19,”.
“Taken together, these studies seem to suggest that there is a benefit with steroid therapy.” Further validation of these results is warranted
The COVID-19 Cytokine Storm; What We Know So Far
Researchers: COVID-19 spreads ten meters or more by breathing
The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings
delirium/psychosis and no distinct MRI or CSF abnormalities, and with 9/10 making a full or
partial recovery with supportive care only; (ii) inflammatory CNS syndromes
including encephalitis (n = 2, para- or post-infectious), acute disseminated encephalomyelitis, with haemorrhage in five, necrosis in one, and myelitis in two, and isolated myelitis.
SARS-CoV-2 infection is
associated with a wide spectrum of neurological syndromes affecting the whole neuraxis,
including the cerebral vasculature and, in some cases, responding to immunotherapies. The
high incidence of acute disseminated encephalomyelitis, particularly with haemorrhagic
change, is striking.
COVID-19 Antibodies Can Disappear After 2-3 Months, Study Shows
The decrease in detectable antibodies was sharp after 8 weeks, with a 71% median drop for IgG levels in the asymptomatic group and a 76% median drop in the symptomatic group, the study said.
The findings call into question the idea of “immunity passports,” which some countries want to issue to people who test positive for antibodies. These people would be allowed to go back to work and travel because they’re supposedly immune to the virus.
“Together, these data might indicate the risks of using COVID-19 ‘immunity passports’ and support the prolongation of public health interventions, including social distancing, hygiene, isolation of high-risk groups and widespread testing,” the authors wrote.
Neuroinvasive potential of SARS-CoV-2 revealed in a human brain organoid model
Neurological associations of COVID-19
Highly Recommended
17 page review. The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is
of a scale not seen since the 1918 influenza pandemic. Encephalopathy
has been reported for 93 patients in total, including 16 (7%) of 214 hospitalised patients with COVID-19 in Wuhan,
China, and 40 (69%) of 58 patients in intensive care with COVID-19 in France. Encephalitis has been described
in eight patients to date, and Guillain-Barré syndrome in 19 patients
Overall, the proportion of patients with neurological
manifestations is small compared with that with respiratory disease. However, the continuing pandemic, and the
expectation that 50–80% of the world’s population might
be infected before herd immunity develops, suggest that
the overall number of patients with neurological disease could become large. Neurological complications,
particularly encephalitis and stroke, can cause lifelong
disability, with associated long-term care needs and potentially large health, social, and economic costs. Health-care
planners and policy makers need to be aware of the
growing burden.
Three Stages to COVID-19 Brain Damage, New Review Suggests
“Our major take-home points are that patients with COVID-19 symptoms, such as shortness of breath, headache, or dizziness, may have neurological symptoms that, at the time of hospitalization, might not be noticed or prioritized, or whose neurological symptoms may become apparent only after they leave the hospital,”
Hospitalized patients with COVID-19 should have a neurological evaluation and ideally a brain MRI before leaving the hospital; and, if there are abnormalities, they should follow up with a neurologist in 3 to 4 months.
Prevalence of Asymptomatic SARS-CoV-2 Infection A Narrative Review
Key Summary Points
The likelihood that approximately 40% to 45% of those infected with SARS-CoV-2 will remain asymptomatic suggests that the virus might have greater potential than previously estimated to spread silently and deeply through human populations.
Asymptomatic persons can transmit SARS-CoV-2 to others for an extended period, perhaps longer than 14 days.
The absence of COVID-19 symptoms in persons infected with SARS-CoV-2 might not necessarily imply an absence of harm. More research is needed to determine the significance of subclinical lung changes visible on computed tomography scans.
The focus of testing programs for SARS-CoV-2 should be substantially broadened to include persons who do not have symptoms of COVID-19.
COVID-19 May Be Triggering Diabetes in Healthy People, Experts Warn
Clinical observations so far show a bi-directional relationship between COVID-19 and diabetes. On the one hand, diabetes is associated with increased risk of COVID-19 severity and mortality. Between 20 and 30% of patients who died with COVID-19 have been reported to have diabetes. On the other hand, new-onset diabetes and atypical metabolic complications of pre-existing diabetes, including life-threatening ones, have been observed in people with COVID-19.
Guillain-Barr´e syndrome: The first documented COVID-19–triggered autoimmune neurologic disease
COVID-19 infection, like most other viruses, can potentially worsen patients with pre-existing
autoimmunity, there is no evidence that patients with autoimmune neurological diseases stable on
common immunotherapies are facing increased risks of infection
COVID Testing FAQ, From Reinfection to Persistent Positives
“Has my patient been reinfected, or is this just delayed recovery?”
Medscape spoke with Paul Auwaerter, MD, to get the answers to our readers’ frequently asked questions about coronavirus testing. This interview has been edited for length and clarity.
Acute disseminated encephalomyelitis after SARS-CoV-2 infection
Neuropathogenesis and Neurologic Manifestations of the Coronaviruses in the Age of Coronavirus Disease 2019 A Review
This review serves to summarize available information regarding coronaviruses in the nervous system, identify the potential tissue targets and routes of entry of SARS-CoV-2 into the central nervous system, and describe the range of clinical neurological complications that have been reported thus far in COVID-19 and their potential pathogenesis.
The most common neurologic complaints in COVID-19 are anosmia, ageusia, and headache, but other diseases, such as stroke, impairment of consciousness, seizure, and encephalopathy, have also been reported.
The understanding of neurologic disease in patients with COVID-19 is evolving, and clinicians should continue to monitor patients closely for neurological disease. Early detection of neurological deficits may lead to improved clinical outcomes and better treatment algorithms
COVID-19—White matter and globus pallidum lesions Demyelination or small-vessel vasculitis?
Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area
Question: What are the characteristics, clinical presentation, and outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19) in the US?
Findings In this case series that included 5700 patients hospitalized with COVID-19 in the New York City area, the most common comorbidities were hypertension, obesity, and diabetes. Among patients who were discharged or died (n = 2634), 14.2% were treated in the intensive care unit, 12.2% received invasive mechanical ventilation, 3.2% were treated with kidney replacement therapy, and 21% died.
Meaning This study provides characteristics and early outcomes of patients hospitalized with COVID-19 in the New York City area.
Conjunctivitis Can Be Sole Covid-19 Symptom
Because these patients were treated during the current SARS-CoV-2 pandemic, they also inquired about recent travels and discovered that all five of the patients had recently traveled to Lombardy, a Covid-19 hotspot. None had fever, respiratory symptoms, or other symptoms of Covid-19.
Still, tests performed using naso-pharyngeal swabs were done for all five patients, and all five came back positive for SARS-CoV-2.
MedTech FDA names 28 antibody tests to be taken off the market
The FDA changed its policy May 4, giving test makers with active products 10 days to submit applications for review. The agency said it expects its list of removed products to be updated in the future.
“Our action today is an important step the agency has taken to ensure that Americans have access to trustworthy tests,” FDA Commissioner Stephen Hahn, M.D.
To date, 12 antibody tests have passed the FDA’s emergency authorization process, while the agency works with the National Institutes of Health and the Centers for Disease Control and Prevention to independently validate certain serology tests.
Safety, tolerability, and immunogenicity of a recombinant adenovirus type-5 vectored COVID-19 vaccine: a dose-escalation, open-label, non-randomised, first-in-human trial
The trial demonstrates that a single dose of the new vaccine produces virus-specific antibodies and T cells in 14 days, making it a potential candidate for further investigation.
Steroid-responsive Encephalitis in Covid-19 Disease
Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic
If infection with SARS-CoV-2 follows a similar course to that with SARS-CoV or MERS-CoV, most patients should recover without experiencing mental illness. SARS-CoV-2 might cause delirium in a significant proportion of patients in the acute stage. Clinicians should be aware of the possibility of depression, anxiety, fatigue, post-traumatic stress disorder, and rarer neuropsychiatric syndromes in the longer term.
Trending Clinical Topic: Kawasaki Disease and COVID-19
New Focus on Renin-Angiotensin System Role in COVID-19
On the influenza study, Oudit said: “The influenza virus may well also activate the renin–angiotensin system. That study suggests that ACE inhibitors and ARBs may be protective here as well.”
Early Safety Indicators of COVID-19 Convalescent Plasma in 5,000 Patients
available for COVID-19 patients. It has robust historical precedence and sound
biological plausibility. Although promising, convalescent plasma has not yet been shown
to be safe as a treatment for COVID-19.
Conclusion: Given the deadly nature of COVID-19 and the large population of critically ill patients included in these analyses, the mortality rate does not appear excessive.
These early indicators suggest that transfusion of convalescent plasma is safe in
hospitalized patients with COVID-19.
Coronavirus Disease 2019 (COVID-19) in Children
- Shortness of breath
- Pharyngeal erythema/sore throat
- Diarrhea
- Myalgia
- Fatigue
- Rhinorrhea
- Vomiting
- Nasal congestion
- Abdominal pain
- Conjunctivitis
- Rash
Researchers Have Discovered a Strong Correlation Between Severe Vitamin D Deficiency and COVID-19 Mortality Rates
Backman is careful to note that people should not take excessive doses of vitamin D, which might come with negative side effects. He said the subject needs much more research to know how vitamin D could be used most effectively to protect against COVID-19 complications.
Neurological Implications of COVID 19 Infections
Therapeutic strategies for critically ill patients with COVID-19
COVID-19 Panel: Helmet CPAP, Pronation Key Tools for Some Patients
Compassionate Use of Remdesivir for Patients with Severe Covid-19
'Silent Hypoxemia' and Other Curious Clinical Observations in COVID-19
A Rush to Judgment? Rapid Reporting and Dissemination of Results and Its Consequences Regarding the Use of Hydroxychloroquine for COVID-19
Despite the study’s substantial limitations, a simplification and probable overinterpretation of these findings was rapidly disseminated by the lay press and amplified on social media, ultimately endorsed by many government and institutional leaders.
A major consequence has been an inadequate supply of HCQ for patients in whom efficacy is established. Hydroxychloroquine is an essential treatment of rheumatoid arthritis and of systemic lupus erythematosus, reducing flares and preventing organ damage in the latter disease. HCQ shortages could place these patients at risk for severe and even life-threatening flares; some may require hospitalization when hospitals are already at capacity. There currently are no data to recommend the use of HCQ as prophylaxis for COVID-19.
Neurologic Features in Severe SARS-CoV-2 Infection
In this consecutive series of patients, ARDS due to SARS-CoV-2 infection was associated with encephalopathy, prominent agitation and confusion, and corticospinal tract signs. Two of 13 patients who underwent brain MRI had single acute ischemic strokes. Data are lacking to determine which of these features were due to critical illness–related encephalopathy, cytokines, or the effect or withdrawal of medication, and which features were specific to SARS-CoV-2 infection.
IDSA: No Recommendations for COVID-19 Treatment for Now, 'Knowledge Gaps' Cited
Many pharmacologic therapies are being used or considered for the treatment of patients with COVID-19. Given the rapidly emerging literature on treatment, the IDSA convened the panel to develop interim evidence-based guidelines to support clinicians in making decisions about treatment and management of patients with COVID-19.
This is a “living document” that represents the best understanding to date on the treatment of patients with COVID-19, and it will be updated frequently as new information becomes available
Warning of Higher COVID-19 Problems From Glucocorticoid Use
If any doctor or healthcare professional is coming across people who received steroid therapy for the previous 3 months, they need to be regarded as an ‘at risk’ individual in terms of the progression of their illness, with a fairly low threshold for giving them supplemental steroid therapy, which might be life-saving. That’s the plea here.
Cardiology Groups Push Back on Hydroxychloroquine, Azithromycin for COVID-19
“Hydroxychloroquine and azithromycin have been touted for potential prophylaxis or treatment for COVID-19; both drugs are listed as definite causes of torsade de pointes” and increase in the risk of other arrhythmias and sudden death, the American Heart Association, the American College of Cardiology, and the Heart Rhythm Society said in a joint statement April 8 in Circulation.
The statement came amid ongoing promotion by the Trump administration of hydroxychloroquine, in particular, for COVID-19 despite lack of strong data.
Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China
Question What are neurologic manifestations of patients with coronavirus disease 2019?
Findings In a case series of 214 patients with coronavirus disease 2019, neurologic symptoms were seen in 36.4% of patients and were more common in patients with severe infection (45.5%) according to their respiratory status, which included acute cerebrovascular events, impaired consciousness, and muscle injury.
Meaning Neurologic symptoms manifest in a notable proportion of patients with coronavirus disease 2019.
Nephrologists on Lessons Learned With Kidney Disease in COVID-19
“The mortality we’re seeing with these [dialysis and transplant] patients is because COVID-19 pneumonia/disease can be very aggressive with a severe distress syndrome,” Soler told Medscape Medical News. Discusses Dialysis/Transplant COVID-19 Experience in Spain
COVID-19: Facing Hard Truths on the Front Line
The article includes: Ethical guidance published for frontline staff dealing with the pandemic
Spectrum of neurological manifestations associated with SARS-CoV-2 infection
Acute Hemorrhagic Necrotizing Encephalopathy :
Ischemic Stroke / Intra Cerebral Hemorrhage / Cerebral venous sinus thrombosis :
- Neurological Manifestations of Hospitalized Patients with COVID-19 in Wuhan, China: a retrospective case series study
- Acute Cerebrovascular Disease Following COVID-19: A Single Center, Retrospective, Observational Study
- Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19
Encephalitis
COVID-19 Linked to Multiple Cardiovascular Presentations
COVID-19 Daily: More Will Die, First Antibody Test Authorized
COVID-19.
COVID-19: More Hydroxychloroquine Data From France, More Questions
Personally, I really believe in hydroxychloroquine. It would nevertheless be a shame to think we had found the fountain of youth and realize, in 4 weeks, that we have the same number of deaths. That is the problem. I hope that we will soon have solid data so we do not waste time focusing solely on hydroxychloroquine.
Treatment of Coronavirus Disease 2019 (COVID-19): Investigational Drugs and Other Therapies
No drugs or biologics have been proven to be effective for the prevention or treatment of COVID-19. Numerous antiviral agents, immunotherapies, and vaccines are being investigated and developed as potential therapies. Searching for effective therapies for COVID-19 infection is a complex process.
Coronavirus on Fabric: What You Should Know
If you suspect you got too close for too long, or someone coughed on you, there’s no harm in changing your clothing and washing it right away, especially if there are hard surfaces like buttons and zippers where the virus might linger. Wash your hands again after you put everything into the machine. Dry everything on high, since the virus dies at temperatures above 133°F. File these steps under “abundance of caution”: They’re not necessary, but if it gives you peace of mind, it may be worth it.
Michigan woman with coronavirus develops rare complication affecting brain
It is believed to be the first published case linking COVID-19 and acute necrotizing encephalitis. The rare and serious brain disease can develop in people who have a viral infection, and causes lesions to form in the brain, tissue death and symptoms such as seizures, drowsiness, confusion and coma.
Should We All Be Wearing Masks In Public? Health Experts Revisit The Question
At least 8 strains of the coronavirus are spreading across the globe
Scientists have identified at least eight strains of coronavirus as the bug wreaks havoc spreading across the globe.
More than 2,000 genetic sequences of the virus have been submitted from labs to the open database NextStrain, which shows it mutating on maps in real-time, according to the site.
Treatment of Coronavirus Disease 2019 (COVID-19): Investigational Drugs and Other Therapies
How long coronavirus survives on surfaces - and what it means for handling money, food and more
What Neurologists Can Expect From COVID-19
The data are still limited on whether coronaviruses have a significant neurologic component. There are reports of other coronaviruses entering the brain of patients and experimental animals. Does that mean anything? Right now, we simply don’t know.
You could be spreading the coronavirus without realising you’ve got it
Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma
Limbic encephalitis and Post-Acute neuropsychology rehabilitation: A review and case examples
Relapse involving need for re-admission to an acute setting occurred in four cases and medication side effects (sedation) in three. As a whole, these cases highlight the complex and potentially unusual course of recovery in individuals with LE.
Stop testing for autoantibodies to the VGKC-complex: only request LGI1 and CASPR2
Double-negative VGKC antibodies usually target intracellular epitopes and lack pathogenic potential. The VGKC antibody titre is not a clinically reliable measure. The concept of a ‘clinically relevant’ VGKC antibody titre has created many misdiagnoses, often where finding the antibody has overruled the clinical diagnosis. The evidence from multiple international groups suggests there are no longer clinical reasons to test for VGKC antibodies. Stopping this test will reduce clinically irrelevant results, improve diagnostic accuracy and limit the use of unnecessary, potentially toxic, immunotherapies in patients.
The Clinical Value of 18 F-FDG-PET in Autoimmune Encephalitis Associated With LGI1 Antibody
Regarding the abnormal metabolic pattern in LGI1 AE subjects exhibiting hypermetabolism was specifically located in the basal ganglia (BG) and medial temporal lobe (MTL). BG hypermetabolism was observed in 28 subjects (82%), and 68% of patients showed MTL hypermetabolism. A total of 17 patients (50%) exhibited faciobrachial dystonic seizures (FBDS), and the remaining subjects showed non-FBDS symptoms (50 and 50%). BG-only hypermetabolism was detected in seven subjects in the FBDS subgroup (7/16) but in only one subject in the non-FBDS subgroup
Psychiatric Manifestation of Anti-LGI1 Encephalitis
Distinctive binding properties of human monoclonal LGI1 autoantibodies determine pathogenic mechanisms
IVIG Shows Efficacy for Autoimmune Encephalitis and Epilepsy
Limbic encephalitis in a neuroscientist: CASPR 2 antibody-associated disease after antigen exposure
Autoimmune limbic encephalitis is part of CASPR 2 antibody-associated disease. A man with this rare disorder and a very high antibody titre had a unique history of laboratory exposure to the antigen. Together with earlier observations this case calls for caution in laboratory handling of nerve tissue.
Pilomotor Seizures in a Patient With LGI1 Encephalitis
Intrathecal B-cell activation in LGI1 antibody encephalitis
Psychosis associated to CASPR2 autoantibodies and ovarian teratoma: A case report
First report of CASPR2 associated psychosis related to an ovarian teratoma. Prompt reduction of psychotic symptoms after excision of teratoma. The diagnosis of autoimmune psychosis can be made in the presence of autoantibodies in the serum while CSF is unremarkable.
Patients with depressive and psychotic symptoms non-responding to antidepressant and antipsychotic treatment should be screened for neuronal autoantibodies including CASPR2.
Daratumumab treatment for therapy-refractory anti-CASPR2 encephalitis
Predictors of neural-specific autoantibodies and immunotherapy response in patients with cognitive dysfunction.
Factors underlying the development of chronic temporal lobe epilepsy in autoimmune encephalitis
LGI1 expression and human brain asymmetry
Distinction between anti-VGKC-complex seropositive patients with and without anti-LGI1/CASPR2 antibodies
Non-inheritable predisposition to LGI1 and Caspr2 antibody diseases
Neuroimmunology 2017: making progress over 20 years
Psychiatric symptoms delay the diagnosis of anti-LGI1 encephalitis
Mechanisms of Caspr2 antibodies in autoimmune encephalitis and neuromyotonia
The importance of early immunotherapy in patients with faciobrachial dystonic seizures (LGI1 Limbic encephalitis)
LGI1, CASPR2 and related antibodies: a molecular evolution of the phenotypes
IVIG treatment for repeated hypothermic attacks associated with LGI1 antibody encephalitis
Focal CA3 hippocampal subfield atrophy following LGI1 VGKC-complex antibody limbic encephalitis
Autoimmune episodic ataxia in patients with anti-CASPR2 antibody-associated encephalitis
The value of LGI1, Caspr2 and voltage-gated potassium channel antibodies in encephalitis
Anti-LGI1 encephalitis is strongly associated with HLA-DR7 and HLA-DRB4
From VGKC to LGI1 and Caspr2 encephalitis: The evolution of a disease entity over time
Unexplicated neuropsychiatric disorders a case report LGI1
Clinical spectrum and diagnostic value of antibodies against the potassium channel-related protein complex
Long-Term Memory Dysfunction in Limbic Encephalitis
LE involves frontal lobe structures also, but the main underlying brain pathology involving infiltrating lymphocytes affects the amygdalohippocampal complex indicating that dysfunctional LTM is more probable than impaired working-memory pathways. In particular, some LE forms are susceptible to LTM dysfunction as their disease-mediating antibodies against membrane receptors are critically involved in hippocampal synaptic long-term plasticity and LTM formation. It is thus not surprising that some AMPAR-antibodies associated LE patients present with an amnestic syndrome, such as the unique clinical manifestation of autoimmunity. Antibody-mediated immunopathology involving distinct memory phenotypes fluctuates.
Anti-CASPR2 clinical phenotypes correlate with HLA and immunological features
Interpretation Symptoms’ distribution supports specific clinical phenotypes without overlap between LE and MoS. The distinct immunogenetic characteristics shared by all patients with LE and the particular oncological and autoimmune associations of MoS suggest two very different aetiopathogenesis.
Synaptic autoimmunity: new insights into LGI1 antibody-mediated neuronal dysfunction
The neuropsychological spectrum of anti-LGI1 antibody mediated autoimmune encephalitis
Novel Findings of HLA Association With anti-LGI1 Encephalitis: HLA-DRB1*03:01 and HLA-DQB1*02:01
Clinical and Electroencephalographic Features of the Seizures in Neuronal Surface Antibody-Associated Autoimmune Encephalitis
Leucine-rich glioma-inactivated protein 1 (LGI-1) mediated limbic encephalitis associated with syndrome of inappropriate antidiuretic hormone secretion: a case report
Pathologic tearfulness after limbic encephalitis A novel disorder and its neural basis
Beyond the limbic system: disruption and functional compensation of large-scale brain networks in patients with anti-LGI1 encephalitis
Hippocampal Functional Dynamics Are Clinically Implicated in Autoimmune Encephalitis With Faciobrachial Dystonic Seizures
Distinct HLA associations of LGI1 and CASPR2-antibody diseases
Genetic predisposition in anti-LGI1 and anti-NMDA receptor encephalitis
Immune or Genetic-Mediated Disruption of CASPR2 Causes Pain Hypersensitivity Due to Enhanced Primary Afferent Excitability
Intracellular and non-neuronal targets of voltage-gated potassium channel complex antibodies
A Genetic Disposition for Autoimmune Encephalitis: Searching for Human Leukocyte Antigen (HLA) Complex Subtype
AE with LGI1 or CASPR2 (formerly called voltage-gated potassium channel-complex antibodies)
Clinical features of limbic encephalitis with LGI1 antibody
Delayed LGI1 seropositivity in voltage-gated potassium channel (VGKC)-complex antibody limbic encephalitis
Emergence of new-onset psychotic disorder following recovery from LGI1 antibody-associated limbic encephalitis
What are the emerging features of anti-VGKC autoimmune encephalitis?
VGKC-Complex Antibodies in the Absence of LGI1 and Caspr2 Antibodies
Creutzfeldt-Jakob Disease-Like Periodic Sharp Wave Complexes in VGKC Antibodies Encephalitis: A Case Report
What we know about the new Covid-19-linked illness in children
Doctors in 17 US states are reporting that at least 164 children have fallen sick with a rare inflammatory illness similar to a condition known as Kawasaki disease. Symptoms include fever and inflammation and can affect organs, including the heart. Some of the children have tested positive for Covid-19 or antibodies to the virus, and three have died.
“As in any infection, it is important for parents to seek care with their pediatrician if their child has high fevers, new rash, significant abdominal pain, persistent vomiting, persistent diarrhea, or any other concerning symptom.”
But she and other doctors underscore that despite the increased incidence of the pediatric syndrome, it is still quite rare, “probably affecting no more than one in 1,000 children exposed to SARS-CoV-2.”
Convalescent plasma in Covid-19: Possible mechanisms of action
There is not specific treatment for COVID-19.
Convalescent plasma (CP) emerges as the first option of management for hospitalized patients with COVID-19.
Transference of neutralizing antibodies helps to control COVID-19 infection and modulates inflammatory response.
Other plasma components may enhance the antiviral and anti-inflammatory properties of CP.
Children are falling sick with a rare mystery inflammatory syndrome linked to Coronavirus
Children and teens with the rare but potentially dangerous complication have been identified in at least seven states and the Washington, D.C., area as well as some parts of Europe. The condition can resemble features of other inflammatory illnesses like the Kawasaki Disease and toxic shock-like syndrome.
Physicians and scientists are working hard to understanding the mechanisms at play, and why only some children are so severely affected,” she said. Dr. John revealed that “the feature that’s been most concerning is that they have problems with their heart function.”
Dr. John added: “In general, families do not need to worry about this. I doubt that this is really new. I think it’s just really newly recognized. I hope what comes of this is that, because we’re seeing more cases, it will not take long before we will be better at recognizing this and treating it.”
Immunomodulation in COVID-19
As insight is gained into the clinical phenotypes associated with COVID-19, we propose JAK and IL-1 inhibitors as therapeutic targets warranting rapid investigation. Multidisciplinary collaboration with experts in haematology, inflammation, tissue damage, and repair and resolution is paramount.
Coronavirus Infections in Children Including COVID-19: An Overview of the Epidemiology, Clinical Features, Diagnosis, Treatment and Prevention Options in Children.
Rapid development of an inactivated vaccine candidate for SARS-CoV-2
FDA Authorizes Emergency Use of Remdesivir for COVID-19
Neurons promote encephalitogenic CD4 + lymphocyte infiltration in experimental autoimmune encephalomyelitis
'Hypercoagulation,' Antiphospholipid Antibodies Seen in COVID-19
“Antiphospholipid antibodies abnormally target phospholipid proteins, and the presence of these antibodies is central to the diagnosis of the antiphospholipid syndrome.”
Why Some People Get Sicker Than Others
Sudden Loss of Taste and Smell Should Be Part of COVID-19 Screen
“Based on our study, if you have smell and taste loss, you are more than 10 times more likely to have COVID-19 infection than other causes of infection. The most common first sign of a COVID-19 infection remains fever, but fatigue and loss of smell and taste follow as other very common initial symptoms,” said Yan.
More Evidence Supports COVID-19/Guillain-Barré Link
Three of the patients developed a demyelinating form of GBS; the other two had findings generally consistent with an axonal variant. All five patients received intravenous immune globulin treatment.
Hydroxychloroquine for COVID-19: What's the Evidence?
Remdesivir Prevents Disease Progression in Monkeys With COVID-19
Twelve hours after the initial treatment, the scientists examined all animals and found the six treated animals in significantly better health than the untreated group, a trend that continued during the seven-day study.
The investigators note that the data supports initiating remdesivir treatment in COVID-19 patients as early as possible to achieve maximum treatment effect. “This finding is of great significance for patient management, where a clinical improvement should not be interpreted as a lack of infectiousness,” they write.
Imaging Recommendations Issued for COVID-19 Patients
- Recommendations: Imaging is indicated for patients with features of moderate to severe COVID-19 regardless of COVID-19 test results.
- Imaging is indicated for patients with COVID-19 and evidence of worsening respiratory status.
- When access to CT is limited, chest radiography may be preferred for COVID-19 patients unless features of respiratory worsening warrant using CT.
- Additional recommendations: Daily chest radiographs are not indicated in stable, intubated patients with COVID-19.
- CT is indicated in patients with functional impairment, hypoxemia, or both, after COVID-19 recovery.
- COVID-19 testing is warranted in patients incidentally found to have findings suggestive of COVID-19 on a CT scan.
COVID-19: First Data Confirm Neurologic Symptoms Common
Nervous system manifestations of COVID-19 were “significantly more common” in severe versus nonsevere infection.
The public and medical personnel alike need to be aware that there may be neurological manifestations of COVID-19 and such symptoms indicate a need for prompt medical attention.
COVID-19: Exercise may protect against deadly complication
Hydroxychloroquine for COVID-19 Study Did Not Meet 'Expected Standard'
Elisabeth Bik took a close look at the IJAA article and detailed a long list of serious problems with the study, including questions about its ethical underpinnings, messy confounding variables, missing patients, rushed and conflicted peer review, and confusing data.
COVID-19:Attacks the 1-Beta Chain of Hemoglobin and Captures the Porphyrin to Inhibit Human Heme Metabolism
A first Case of Meningitis/Encephalitis associated with SARS-Coronavirus-2
Highlights
Responding to stress experienced by hospital staff working with Covid-19
Download Graphic here https://www.kingsfund.org.uk/sites/default/files/2020-04/rapid-guidance-stress-diagram.pdf
The Spectrum of Neurologic Disease in the Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic Infection
Coronavirus disease 2019 has now reached pandemic status and is common all over the world; thus, with so many affected patients, we can expect as neurologists to be confronted with these patients commonly in coming months and years.
Many Children With COVID-19 Don't Have Cough or Fever
Among pediatric patients younger than 18 years in the United States, 73% had at least one of the trio of symptoms, compared with 93% of adults aged 18-64, noted Lucy A. McNamara, PhD, and the CDC’s COVID-19 response team, based on a preliminary analysis of the 149,082 cases reported as of April 2.
Neurologic Symptoms and COVID-19: What's Known, What Isn't
However, US neurologists are now reporting that COVID-19 symptoms may also could include encephalopathy, ataxia, and other neurologic signs.
Use of Hydroxychloroquine and Chloroquine During the COVID-19 Pandemic: What Every Clinician Should Know
Risk Factors for Death From COVID-19 Identified in Wuhan Patients
The average age of survivors was 52 years compared to 69 for those who died. Liu cited weakening of the immune system and increased inflammation, which damages organs and also promotes viral replication, as explanations for the age effect.
From the time of initial symptoms, median time to discharge from the hospital was 22 days. Average time to death was 18.5 days.
The FDA-approved Drug Ivermectin inhibits the replication of SARS-CoV-2 in vitro
Highlights:
Ivermectin is an inhibitor of the COVID-19 causative virus (SARS-CoV-2) in vitro.
A single treatment able to effect ∼5000-fold reduction in virus at 48h in cell culture.
Ivermectin is FDA-approved for parasitic infections, and therefore has a potential for repurposing.
Ivermectin is widely available, due to its inclusion on the WHO model list of essential medicines.
Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study
Coronavirus survivors' plasma could save lives
This paper: The feasibility of convalescent plasma therapy in severe COVID-19 patients: a pilot study
Two independent research studies have shown the benefit of receiving infusions of blood from COVID-19 survivors.
The teams – both based in China – extracted blood plasma from patients who had recovered from COVID-19, which contained antibodies against the disease. The first study from the National Engineering Technology Research Center for Combined Vaccines in Wuhan gave plasma to 10 patients who were severely ill with COVID-19. Six days after receiving the infusion, the COVID-19 virus was undetectable in seven of the 10 patients.
Hydroxychloroquine: Possible COVID Drug Can Be Toxic to Retinas
Comorbidities Increase Likelihood of Retinal Toxicity
While a detailed patient history may be impossible to obtain if HCQ is used in the treatment of COVID-19, certain comorbidities do place patients at an increased risk for retinal toxicity. HCQ is excreted through renal clearance, so the dosage should be reduced in those with compromised kidney function to minimize the risk for toxicity. The presence of macular disease, such as age-related macular degeneration, has also been demonstrated to be a risk factor for the development of toxic maculopathy. The concurrent use of tamoxifen also increases the risk for retinal toxicity. Tamoxifen itself may deposit in the retina and make the macula more susceptible to the potentially toxic effects of HCQ.
'No Complacency' on COVID-19 After Death of 13-Year-Old-Boy
“It is essential that we undertake research to determine why a proportion of deaths occur outside of the groups expected to succumb to infection as it may indicate an underlying genetic susceptibility of how the immune system interacts with the virus.
“Determining if this is the case could help us to learn more about the interaction of the virus with the immune system and subsequently what further treatments may be suitable in patients with severe infection.”
Evidence of the COVID-19 Virus Targeting the CNS: Tissue Distribution, Host–Virus Interaction, and Proposed Neurotropic Mechanisms
A dominant cerebral involvement alone with the potential of causing cerebral edema in COVID-19 can take a lead in causing death long before systemic homeostatic dysregulation sets in.
Also, a staging system based on the severity and organ involvement is needed in COVID-19 in order to rank the patients for aggressive or conventional treatment modalities.
COVID-19: Neurologists in Italy to Colleagues in US: Look for Poorly-Defined Neurologic Conditions in Patients with the Coronavirus
Australia's Trialing a TB Vaccine Against COVID-19, And Health Workers Get It First
Similar trials are being conducted in several other countries including the Netherlands, Germany and the United Kingdom.
“This trial will allow the vaccine’s effectiveness against COVID-19 symptoms to be properly tested, and may help save the lives of our heroic frontline healthcare workers,”
Trending Clinical Topic: Kawasaki Disease and COVID-19
New Focus on Renin-Angiotensin System Role in COVID-19
On the influenza study, Oudit said: “The influenza virus may well also activate the renin–angiotensin system. That study suggests that ACE inhibitors and ARBs may be protective here as well.”
Early Safety Indicators of COVID-19 Convalescent Plasma in 5,000 Patients
available for COVID-19 patients. It has robust historical precedence and sound
biological plausibility. Although promising, convalescent plasma has not yet been shown
to be safe as a treatment for COVID-19.
Conclusion: Given the deadly nature of COVID-19 and the large population of critically ill patients included in these analyses, the mortality rate does not appear excessive.
These early indicators suggest that transfusion of convalescent plasma is safe in
hospitalized patients with COVID-19.
Coronavirus Disease 2019 (COVID-19) in Children
- Shortness of breath
- Pharyngeal erythema/sore throat
- Diarrhea
- Myalgia
- Fatigue
- Rhinorrhea
- Vomiting
- Nasal congestion
- Abdominal pain
- Conjunctivitis
- Rash
Researchers Have Discovered a Strong Correlation Between Severe Vitamin D Deficiency and COVID-19 Mortality Rates
Backman is careful to note that people should not take excessive doses of vitamin D, which might come with negative side effects. He said the subject needs much more research to know how vitamin D could be used most effectively to protect against COVID-19 complications.
Neurological Implications of COVID 19 Infections
Therapeutic strategies for critically ill patients with COVID-19
COVID-19 Panel: Helmet CPAP, Pronation Key Tools for Some Patients
Compassionate Use of Remdesivir for Patients with Severe Covid-19
'Silent Hypoxemia' and Other Curious Clinical Observations in COVID-19
A Rush to Judgment? Rapid Reporting and Dissemination of Results and Its Consequences Regarding the Use of Hydroxychloroquine for COVID-19
Despite the study’s substantial limitations, a simplification and probable overinterpretation of these findings was rapidly disseminated by the lay press and amplified on social media, ultimately endorsed by many government and institutional leaders.
A major consequence has been an inadequate supply of HCQ for patients in whom efficacy is established. Hydroxychloroquine is an essential treatment of rheumatoid arthritis and of systemic lupus erythematosus, reducing flares and preventing organ damage in the latter disease. HCQ shortages could place these patients at risk for severe and even life-threatening flares; some may require hospitalization when hospitals are already at capacity. There currently are no data to recommend the use of HCQ as prophylaxis for COVID-19.
Neurologic Features in Severe SARS-CoV-2 Infection
In this consecutive series of patients, ARDS due to SARS-CoV-2 infection was associated with encephalopathy, prominent agitation and confusion, and corticospinal tract signs. Two of 13 patients who underwent brain MRI had single acute ischemic strokes. Data are lacking to determine which of these features were due to critical illness–related encephalopathy, cytokines, or the effect or withdrawal of medication, and which features were specific to SARS-CoV-2 infection.
IDSA: No Recommendations for COVID-19 Treatment for Now, 'Knowledge Gaps' Cited
Many pharmacologic therapies are being used or considered for the treatment of patients with COVID-19. Given the rapidly emerging literature on treatment, the IDSA convened the panel to develop interim evidence-based guidelines to support clinicians in making decisions about treatment and management of patients with COVID-19.
This is a “living document” that represents the best understanding to date on the treatment of patients with COVID-19, and it will be updated frequently as new information becomes available
Warning of Higher COVID-19 Problems From Glucocorticoid Use
If any doctor or healthcare professional is coming across people who received steroid therapy for the previous 3 months, they need to be regarded as an ‘at risk’ individual in terms of the progression of their illness, with a fairly low threshold for giving them supplemental steroid therapy, which might be life-saving. That’s the plea here.
Cardiology Groups Push Back on Hydroxychloroquine, Azithromycin for COVID-19
“Hydroxychloroquine and azithromycin have been touted for potential prophylaxis or treatment for COVID-19; both drugs are listed as definite causes of torsade de pointes” and increase in the risk of other arrhythmias and sudden death, the American Heart Association, the American College of Cardiology, and the Heart Rhythm Society said in a joint statement April 8 in Circulation.
The statement came amid ongoing promotion by the Trump administration of hydroxychloroquine, in particular, for COVID-19 despite lack of strong data.
Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China
Question What are neurologic manifestations of patients with coronavirus disease 2019?
Findings In a case series of 214 patients with coronavirus disease 2019, neurologic symptoms were seen in 36.4% of patients and were more common in patients with severe infection (45.5%) according to their respiratory status, which included acute cerebrovascular events, impaired consciousness, and muscle injury.
Meaning Neurologic symptoms manifest in a notable proportion of patients with coronavirus disease 2019.
Nephrologists on Lessons Learned With Kidney Disease in COVID-19
“The mortality we’re seeing with these [dialysis and transplant] patients is because COVID-19 pneumonia/disease can be very aggressive with a severe distress syndrome,” Soler told Medscape Medical News. Discusses Dialysis/Transplant COVID-19 Experience in Spain
COVID-19: Facing Hard Truths on the Front Line
The article includes: Ethical guidance published for frontline staff dealing with the pandemic
Spectrum of neurological manifestations associated with SARS-CoV-2 infection
Acute Hemorrhagic Necrotizing Encephalopathy :
Ischemic Stroke / Intra Cerebral Hemorrhage / Cerebral venous sinus thrombosis :
- Neurological Manifestations of Hospitalized Patients with COVID-19 in Wuhan, China: a retrospective case series study
- Acute Cerebrovascular Disease Following COVID-19: A Single Center, Retrospective, Observational Study
- Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19
Encephalitis
COVID-19 Linked to Multiple Cardiovascular Presentations
COVID-19 Daily: More Will Die, First Antibody Test Authorized
COVID-19.
COVID-19: More Hydroxychloroquine Data From France, More Questions
Personally, I really believe in hydroxychloroquine. It would nevertheless be a shame to think we had found the fountain of youth and realize, in 4 weeks, that we have the same number of deaths. That is the problem. I hope that we will soon have solid data so we do not waste time focusing solely on hydroxychloroquine.
Treatment of Coronavirus Disease 2019 (COVID-19): Investigational Drugs and Other Therapies
No drugs or biologics have been proven to be effective for the prevention or treatment of COVID-19. Numerous antiviral agents, immunotherapies, and vaccines are being investigated and developed as potential therapies. Searching for effective therapies for COVID-19 infection is a complex process.
Coronavirus on Fabric: What You Should Know
If you suspect you got too close for too long, or someone coughed on you, there’s no harm in changing your clothing and washing it right away, especially if there are hard surfaces like buttons and zippers where the virus might linger. Wash your hands again after you put everything into the machine. Dry everything on high, since the virus dies at temperatures above 133°F. File these steps under “abundance of caution”: They’re not necessary, but if it gives you peace of mind, it may be worth it.
Michigan woman with coronavirus develops rare complication affecting brain
It is believed to be the first published case linking COVID-19 and acute necrotizing encephalitis. The rare and serious brain disease can develop in people who have a viral infection, and causes lesions to form in the brain, tissue death and symptoms such as seizures, drowsiness, confusion and coma.
Should We All Be Wearing Masks In Public? Health Experts Revisit The Question
At least 8 strains of the coronavirus are spreading across the globe
Scientists have identified at least eight strains of coronavirus as the bug wreaks havoc spreading across the globe.
More than 2,000 genetic sequences of the virus have been submitted from labs to the open database NextStrain, which shows it mutating on maps in real-time, according to the site.
Treatment of Coronavirus Disease 2019 (COVID-19): Investigational Drugs and Other Therapies
How long coronavirus survives on surfaces - and what it means for handling money, food and more
What Neurologists Can Expect From COVID-19
The data are still limited on whether coronaviruses have a significant neurologic component. There are reports of other coronaviruses entering the brain of patients and experimental animals. Does that mean anything? Right now, we simply don’t know.
