ABSTRACT
Objective. Neuromuscular diseases (NMD) may represent a risk factor causing a more severe course and outcome of SARS-CoV-2 infection. Interestingly, we observed several cases of SARS-CoV-2 infection in Ligurian patients affected by Myasthenia Gravis from March 2020 to April 2021. Methods. We collected data from 13 patients affected by Myasthenia Gravis, followed in different Ligurian hospitals. While eight patients had a mild course of SARS-CoV-2 infection, 5 patients had an unfavorable course causing the death of 4 patients and a prolonged life threating hospitalization in one patient. We analyzed their MGFA class at the moment of the infection, the maximum MGFA class reached during their clinical history, and the previous number of myasthenic crisis. We also evaluated the age at the infection, the BMI and the number of comorbidities as independent risk factors for infection severity. Results. As expected, age and elevated BMI are independent risk factors for poor outcome of Covid-19 in myasthenic patients (mean age 68,3 range 47-87 years;comorbidity rate overall 53.8%). Also having 1 or more comorbidities predicts a higher hospitalization rate (7/8 patients, 85.7%). Interestingly, the five patients with an unfavorable SARS-CoV-2 infection course had a moderate MGFA class at the moment of the infection, but almost all (80%) had previous myasthenic crisis and the average maximum MGFA class reached during the clinical history was significantly higher (MGFA = 4), compared with the group with a prompt recover (MGFA = 2);p : 0.01. Conclusions. Among our neuromuscular patients, SARS-CoV-2 infection had a significant impact in particular in myasthenic patients causing the death of four of them and a long hospitalization in one. Despite Myasthenia was well compensated at the moment of the infection, patients with previous myasthenic crisis and a higher MGFA maximum tended to have an unfavorable course. This correlation, already described in a large French study (Solé G et al. Impact of Coronavirus Disease 2019 in a French Cohort of Myasthenia Gravis. Neurology 2021) supports the hypothesis that autoimmune neurological diseases may be a risk factor for a severe course of SARS-Cov-2 infection.
ABSTRACT
Background and aims: Several neurological complications related to SARS-CoV-2 infection have been reported. The involvement of peripheral nervous system (PNS) consists in the development of immune-mediated neuropathies such as Guillain-Barrè Syndrome. In this study we aim at assessing the presence of asymptomatic abnormalities in peripheral nerves conduction during the acute phase of COVID-19 and, their correlation with blood circulating inflammatory markers. Methods: Thirty-nine patients with COVID-19 were assessed by electroneurographic study of lower limbs and blood tests within one week of hospital admission (T0) and after 30 ± 10 days (T1). Results: Electroneurographic changes were found at least on one nerve at T0 in 12 patients, consisting of axonal or demyelinating changes. Two biological markers were found to be significantly correlated with the presence of neuropathic changes: Reactive Protein C and lymphocyte count. Patients with pathological electrophysiology at T0 showed significant improvement of electrophysiological parameters at T1. The improvements in electroneurographic data were significantly correlated with the trend of laboratory parameters, in particular with fibrinogen, D-Dimer, ferritin, C Reactive protein and lymphocytes. None of the patients with neuropathic changes developed clinical evidence of a full-blown peripheral neuropathy over time. Conclusions: Our study shows that asymptomatic alterations of the PNS can be found during the acute phase of COVID-19. These alterations significantly improve after 20–40 days from the acute phase of infection and that the improvement correlates significantly with the trend of laboratory parameters. Further studies are needed to evaluate possible long-term neurological complications and the predictive value of subclinical damage of PNS in the acute phase of infection.