Possible Autoimmune Encephalitis Associated with the Severe Acute Respiratory Syndrome Coronavirus 2 Omicron Variant Successfully Treated with Steroids: A Case Report.

We encountered a 55-year-old woman with possible autoimmune encephalitis associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant. She was not vaccinated against coronavirus disease 2019 (COVID-19). Consciousness disturbance, myoclonic-like movements and gait disturbance occurred 10 days after the COVID-19 symptom onset. Her neurological symptoms improved two days after methylprednisolone pulse therapy. Cerebrospinal fluid (CSF) was negative for SARS-CoV-2 reverse transcription-polymerase chain reaction, the CSF-to-serum albumin quotient was mildly elevated, and interleukin 6 and 8 levels were normal in serum but mildly elevated in CSF. Omicron variant infection may increase blood-brain barrier permeability and intrathecal inflammation, causing autoimmune encephalitis.

[Neuro COVID: Current Status and Issues to be Clarified].

Compared with the effects of direct viral infection, hypercytokinemia and autoantibodies have received significantly greater attention as etiopathogenetic contributors to neuromuscular injury and consequent symptoms caused by COVID-19. Neuromuscular complications observed during the acute phase are associated with a high mortality risk. Studies have reported brain fog and cognitive impairment as post-infection sequelae. The frequency of post-vaccination neurological adverse reactions was significantly higher in patients with COVID-19.

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What is important, I think, is to examine typical complications that are reported relatively frequently and to discuss the effects of COVID-19 infection on the brain, nerves, and muscles from their pathogenesis. If you read the article straightforwardly, you will easily understand that they refer to symptoms or complications found in the brain, nerves, and muscles associated with COVID-19. Even Guillain-Barré syndrome (GBS), the International GBS Outcome Study reported that there has been no significant increase in patient enrollment.3 In addition, the significance of discussing the subtypes of GBS in detail in this paper is not clear. [Extracted from the article] Copyright of Clinical & Experimental Neuroimmunology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Neuro-COVID-19.

Neuromuscular manifestations of new coronavirus disease 2019 (COVID-19) infection are frequent, and include dizziness, headache, myopathy, and olfactory and gustatory disturbances. Patients with acute central nervous system disorders, such as delirium, impaired consciousness, stroke and convulsive seizures, have a high mortality rate. The encephalitis/encephalopathy that causes consciousness disturbance and seizures can be classified into three conditions, including direct infection with the SARS-CoV-2 virus, encephalopathy caused by central nervous system damage secondary to systemic hypercytokinemia (cytokine storm) and autoimmune-mediated encephalitis that occurs after infection. The sequelae, called post-acute COVID-19 syndrome or long COVID, include neuromuscular manifestations, such as anxiety, depression, sleep disturbance, muscle weakness, brain fog and cognitive impairment. It is desirable to establish diagnostic criteria and treatment for these symptoms. Vaccine-induced thrombotic thrombocytopenia, Guillain-Barré syndrome, bilateral facial paralysis, encephalitis and opsoclonus-myoclonus syndrome have been reported as adverse reactions after the COVID-19 vaccine, although these are rare.

Estimation of the true infection rate and infection fatality rate of coronavirus disease 2019 in each country.

The True Infection Rate (TIR) in the whole population of each country and the Infection Fatality Rate (IFR) for coronavirus disease 2019 (COVID-19) are unknown although they are important parameters. We devised a simple method to infer TIR and IFR based on the open data. The prevalence rate of the Polymerase Chain Reaction (PCR) tests among the population (Examination Rate; ER) and the positive rate of PCR tests (Infection Rate; IR) for 66 countries were picked up at a website 5 times from April 10th to June 13th, 2020, and the trajectory of each country was drawn over the IR vs. ER plot. IR and ER showed a strong negative correlation for some countries, and TIR was estimated by extrapolating the regression line when the correlation coefficient was between -0.99 and -1. True/Identified Case Ratio (TICR) and IFR were also calculated using the estimated TIR. The estimated TIR well coincided with local antibody surveys. Estimated IFR took on a wide range of values up to 10%: generally high in the Western countries. The estimated IFR of Singapore was very low (0.018%), which may be related to the reported gene mutation causing the attenuation of the viral virulence.

Persistent intrathecal interleukin-8 production in a patient with SARS-CoV-2-related encephalopathy presenting aphasia: a case report.

BACKGROUND: Neurological manifestations of coronavirus disease 2019 (COVID-19) are increasingly recognized and include encephalopathy, although direct infection of the brain by SARS-CoV-2 remains controversial. We herein report the clinical course and cytokine profiles of a patient with severe SARS-CoV-2-related encephalopathy presenting aphasia. CASE PRESENTATION: An 81-year-old man developed acute consciousness disturbance and status epileptics several days after SARS-CoV-2 infection. Following treatment with remdesivir and dexamethasone, his consciousness and epileptic seizures improved; however, amnestic aphasia and agraphia remained. Two months after methylprednisolone pulse and intravenous immunoglobulin, his neurological deficits improved. We found increased levels of interleukin (IL)-6, IL-8, and monocyte chemoattractant protein-1 (MCP-1), but not IL-2 and IL-10 in the serum and cerebrospinal fluid (CSF), and the levels of serum IL-6 and MCP-1 were much higher than those in the CSF. The level of IL-8 in the CSF after immunotherapy was four times higher than that before immunotherapy. CONCLUSION: The cytokine profile of our patient was similar to that seen in severe SARS-CoV-2-related encephalopathy. We demonstrated (i) that the characteristic aphasia can occur as a focal neurological deficit associated with SARS-CoV-2-related encephalopathy, and (ii) that IL8-mediated central nervous system inflammation follows systemic inflammation in SARS-CoV-2-related encephalopathy and can persist and worsen even after immunotherapy. Monitoring IL-8 in CSF, and long-term corticosteroids may be required for treating SARS-CoV-2-related encephalopathy.

[COVID-19 in Japan: Insights from the Epidemiological Data].

The coronavirus disease 2019 (COVID-19) pandemic is a worldwide peril. The PCR tests are widely used to detect infections. However, multiple regression analysis revealed no correlation between the examination rate among population (ER) and the success of containment, which is achieved by social distancing. ER and fatality rate were even positively correlated. Japan has been criticized for its very low ER, but it achieved better containment than other major countries with much higher ER on 29 May. The estimation of the true infection rate (TIR) among population revealed that the low fatality rate in Japan and other Asian countries is partly due to low TIR. Fatality of COVID-19 is highly accentuated in aged persons. Despite having the highest aging rate in the world, the fatality rate in Japan is relatively low. The corrected fatality rate of Japan is the second-lowest among the G20 countries. Mimicking the attenuation of viral virulence due to natural selection would be a promising strategy to overcome pandemic. The prevention of in-hospital transmission, especially from severe cases, would be the key to achieve this. Attenuation of the viral virulence in the second wave is evident in many European countries, and also in Tokyo.

[Neuromuscular Manifestations and Pathogenesis of COVID-19].

A novel coronavirus infection, coronavirus disease 2019 (COVID-19), is frequently associated with neuromuscular symptoms. It is characterized by taste and smell disturbances, and nonspecific symptoms such as headache and dizziness. Neuromuscular complications such as cerebrovascular disease, encephalopathy, meningoencephalitis, peripheral neuropathy, and myositis/myopathy have been reported to date. In daily clinical practice, it is important to consider COVID-19 as a differential diagnosis, because these symptoms may be the first warning signs.