ABSTRACT
SARS-CoV-2 is a new virus causing an infection and illness referred to as COVID-19. As of July 7th of 2020, this virus has been associated worldwide with over 12 million of infections and more than 550,000 deaths. Transmission rate of SARS-CoV-2 in the population is high, and the origin of this coronavirus appears to be related to some species of the bat. However, scientific information related to the pathogenesis, and immune response to COVID-19 changes rapidly, which is why the aim of this work is to provide recent information related to an exacerbated inflammatory immune response which causes multiorgan failure and patient death. The timely identification of infected individuals will be key to stop the spread of infection and in severe cases to establish optimal strategies to reduce the risk of death in critically ill patients. In this review, we have considered the latest findings collected from the clinical studies, diagnostic tests, and treatment for COVID-19. Information presented here will help to the better understanding of this disease.
El SARS-CoV-2 es un nuevo virus que causa la enfermedad denominada COVID-19. Este virus ha generado hasta el 7 de julio de 2020 12 millones de contagios y más de 550 000 muertes en todo el mundo. Se sabe que la tasa de transmisión es muy alta y su origen está relacionado con una especie del murciélago. Sin embargo, la información científica relacionada con la COVID-19 cambia rápidamente, por lo que este trabajo tiene como objetivo aportar información reciente y relacionada con el desarrollo de la respuesta inflamatoria exacerbada, que con frecuencia causa falla orgánica múltiple y muerte del paciente. La rápida identificación de los individuos infectados es clave para detener la propagación de esta enfermedad y en los casos más graves establecer estrategias que permitan la reducción de la infección y del riesgo de muerte. En esta revisión, hemos considerado los últimos hallazgos recopilados de los estudios clínicos, pruebas diagnósticas y de tratamiento para COVID-19. La información presentada en este trabajo contribuirá al entendimiento de esta enfermedad.
ABSTRACT
We investigated the incidence, clinical characteristics, risk factors, and outcome of meningoencephalitis (ME) in patients with COVID-19 attending emergency departments (ED), before hospitalization. We retrospectively reviewed all COVID patients diagnosed with ME in 61 Spanish EDs (20% of Spanish EDs, COVID-ME) during the COVID pandemic. We formed two control groups: non-COVID patients with ME (non-COVID-ME) and COVID patients without ME (COVID-non-ME). Unadjusted comparisons between cases and controls were performed regarding 57 baseline and clinical characteristics and 4 outcomes. Cerebrospinal fluid (CSF) biochemical and serologic findings of COVID-ME and non-COVID-ME were also investigated. We identified 29 ME in 71,904 patients with COVID-19 attending EDs (0.40, 95%CI=0.27-0.58). This incidence was higher than that observed in non-COVID patients (150/1,358,134, 0.11, 95%CI=0.09-0.13; OR=3.65, 95%CI=2.45-5.44). With respect to non-COVID-ME, COVID-ME more frequently had dyspnea and chest X-ray abnormalities, and neck stiffness was less frequent (OR=0.3, 95%CI=0.1-0.9). In 69.0% of COVID-ME, CSF cells were predominantly lymphocytes, and SARS-CoV-2 antigen was detected by RT-PCR in 1 patient. The clinical characteristics associated with a higher risk of presenting ME in COVID patients were vomiting (OR=3.7, 95%CI=1.4-10.2), headache (OR=24.7, 95%CI=10.2-60.1), and altered mental status (OR=12.9, 95%CI=6.6-25.0). COVID-ME patients had a higher in-hospital mortality than non-COVID-ME patients (OR=2.26; 95%CI=1.04-4.48), and a higher need for hospitalization (OR=8.02; 95%CI=1.19-66.7) and intensive care admission (OR=5.89; 95%CI=3.12-11.14) than COVID-non-ME patients. ME is an unusual form of COVID presentation (<0.5 cases), but is more than 4-fold more frequent than in non-COVID patients attending the ED. As the majority of these MEs had lymphocytic predominance and in one patient SARS-CoV-2 antigen was detected in CSF, SARS-CoV-2 could be the cause of most of the cases observed. COVID-ME patients had a higher unadjusted in-hospital mortality than non-COVID-ME patients.
Subject(s)
COVID-19/complications , Meningoencephalitis/virology , Adult , Aged , Critical Care , Emergency Service, Hospital , Female , Hospital Mortality , Hospitalization , Humans , Incidence , Male , Middle Aged , Retrospective Studies , Risk Factors , SpainABSTRACT
We diagnosed 11 Guillain-Barré syndrome (GBS) cases among 71,904 COVID patients attended at 61 Spanish emergency departments (EDs) during the 2-month pandemic peak. The relative frequency of GBS among ED patients was higher in COVID (0.15) than non-COVID (0.02) patients (odds ratio [OR] = 6.30, 95% confidence interval [CI] = 3.18-12.5), as was the standardized incidence (9.44 and 0.69 cases/100,000 inhabitant-years, respectively, OR = 13.5, 95% CI = 9.87-18.4). Regarding clinical characteristics, olfactory-gustatory disorders were more frequent in COVID-GBS than non-COVID-GBS (OR = 27.59, 95% CI = 1.296-587) and COVID-non-GBS (OR = 7.875, 95% CI = 1.587-39.09) patients. Although COVID-GBS patients were more frequently admitted to intensive care, mortality was not increased versus control groups. Our results suggest SARS-CoV-2 could be another viral infection causing GBS. ANN NEUROL 2021;89:598-603.