Peripheral neuropathy in COVID-19 is due to immune-mechanisms, pre-existing risk factors, anti-viral drugs, or bedding in the Intensive Care Unit

ABSTRACT

Background: This mini-review aims to summarize and discuss previous and recent advances in the clinical presentation, pathophysiology, diagnosis, treatment, and outcome of SARS-CoV-2-associated peripheral neuropathies. Methods: Literature review. Results: Altogether, 105 articles about SARS-CoV-2-associated neuropathy describing 261 patients were retrieved. Peripheral neuropathy in patients with COVID-19 is frequent and predominantly due to immune mechanisms or neurotoxic side effects of drugs used to treat the symptoms of COVID-19 and, to a lesser extent, due to the compression of peripheral nerves resulting from prolonged bedding in the Intensive Care Unit (ICU) and pre-existing risk factors such as diabetes. SARS-CoV-2 does not cause viral neuropathy. Neurotoxic drugs such as daptomycin, linezolid, lopinavir, ritonavir, hydro-chloroquine, cisatracurium, clindamycin, and glucocorticoids should be administered with caution and patients should be appropriately bedded in the ICU to prevent SARS-CoV-2-associated neuropathy. Patients with Guillain-Barré syndrome (GBS) benefit from immunoglobulins, plasma exchange, and steroids. Conclusions: Neuropathies of peripheral nerves in patients with COVID-19 are frequent and mostly result from immune mechanisms or neurotoxic side effects of drugs used to treat the symptoms of COVID-19 and, to a lesser extent, from the compression of peripheral nerves due to prolonged bedding on the ICU. SARS-CoV-2 does not cause infectious neuropathy.

RESUMO

Introdução: A presente minirrevisão tem como objetivo resumir e discutir os avanços dos aspectos clínicos, fisiopatológicos, de diagnóstico, tratamento e evolução das neuropatias dos nervos periféricos associadas à COVID-19. Métodos: Revisão da literatura. Resultados: Foram avaliados 105 artigos sobre neuropatia associada à COVID-19. Nesses estudos, 261 pacientes apresentaram boa evolução. As neuropatias dos nervos periféricos em pacientes com COVID-19 são frequentes e se devem, principalmente, aos mecanismos immunológicos ou efeitos colaterais neurotóxicos dos medicamentos utilizados para o tratamento da COVID-19, a fatores de risco pré-existentes, como diabetes e, em menor parte, à compressão dos nervos periféricos nos leitos da UTI. A COVID-19 não causa neuropatia viral. Os medicamentos neurotóxicos, como daptomicina, linezolida, lopinavir, ritonavir, hidro-cloroquina, cisatracúrio, clindamicina e glicocorticoides devem ser administrados com cautela, e os pacientes deve ser adequadamente admitidos nos leitos da UTI para prevenir o desenvolvimento de neuropatia associada à COVID-19. Pacientes com síndrome de Guillain-Barré (GBS) se beneficiam de imunoglobulinas, plasmaférese e esteroides. Conclusões: As neuropatias dos nervos periféricos em pacientes com COVID-19 são raras e predominantemente devidas aos efeitos colaterais neurotóxicos das mecanismos immunológicos ou drogas utilizadas para o tratamento de COVID-19 e, em menor parte, devido à compressão dos nervos periféricos nos leitos da UTI. A COVID-19 não causa neuropatia infeciosa.

Keywords:

Guillain-Barre Syndrome - Polyneuropathies - Drug-Related Side Effects and Adverse Reactions - Mononeuritis Multiplex - SARS-CoV-2

Palavras-chave:

Síndrome de Guillain-Barré - Polineuropatias - Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos - Mononeuropatias - SARS-CoV-2

• References

• 1 Bal A, Agrawal R, Vaideeswar P, Arava S, Jain A. COVID-19: An up-to-date review - from morphology to pathogenesis. Indian J Pathol Microbiol. 2020 Jul-Sep;63(3):358-66. https://doi.org/10.4103/IJPM.IJPM_779_20
• 2 da Rosa Mesquita R, Francelino Silva Junior LC, Santos Santana FM, Farias de Oliveira T, Campos Alcântara R, Monteiro Arnozo G, et al. Clinical manifestations of COVID-19 in the general population: systematic review. Wien Klin Wochenschr. 2020 Nov:1-6. https://doi.org/10.1007/s00508-020-01760-4.
• 3 Maramattom BV, Bhattacharjee S. Neurological Complications with COVID-19: A Contemporaneous Review. Ann Indian Acad Neurol. 2020 Jul-Aug;23(4):468-76. https://doi.org/10.4103/aian.AIAN_596_20
• 4 Finsterer J, Scorza FA. Guillain-Barre syndrome in 220 patients with COVID-19. Egypt J Neurol Psychiatr Neurosurg. 2021;57(1):55. https://doi.org/10.1186/s41983-021-00310-7
• 5 Bureau BL, Obeidat A, Dhariwal MS, Jha P. Peripheral Neuropathy as a Complication of SARS-Cov-2. Cureus. 2020 Nov;12(11):e11452. https://doi.org/10.7759/cureus.11452
• 6 Cabañes-Martínez L, Villadóniga M, González-Rodríguez L, Araque L, Díaz-Cid A, Ruz-Caracuel I, et al. Neuromuscular involvement in COVID-19 critically ill patients. Clin Neurophysiol. 2020 Dec;131(12):2809-16. https://doi.org/10.1016/j.clinph.2020.09.017
• 7 Needham E, Newcombe V, Michell A, Thornton R, Grainger A, Anwar F, et al. Mononeuritis multiplex: an unexpectedly frequent feature of severe COVID-19. J Neurol. 2020 Nov:1-5. https://doi.org/10.1007/s00415-020-10321-8
• 8 Faqihi F, Alharthy A, Memish ZA, Kutsogiannis DJ, Brindley PG, Karakitsos D. Peripheral neuropathy in severe COVID-19 resolved with therapeutic plasma exchange. Clin Case Rep. 2020 Oct;8(12):3234-9. https://doi.org/10.1002/ccr3.3397
• 9 Bellinghausen AL, LaBuzetta JN, Chu F, Novelli F, Rodelo AR, Owens RL. Lessons from an ICU recovery clinic: two cases of meralgia paresthetica after prone positioning to treat COVID-19-associated ARDS and modification of unit practices. Crit Care. 2020 Sep;24(1):580. https://doi.org/10.1186/s13054-020-03289-4
• 10 Sánchez-Soblechero A, García CA, Sáez Ansotegui A, Fernández-Lorente J, Catalina-Álvarez I, Grandas F, et al. Upper trunk brachial plexopathy as a consequence of prone positioning due to SARS-CoV-2 acute respiratory distress syndrome. Muscle Nerve. 2020 Nov;62(5):E76-E78. https://doi.org/10.1002/mus.27055
• 11 Abdelnour L, Eltahir Abdalla M, Babiker S. COVID 19 infection presenting as motor peripheral neuropathy. J Formos Med Assoc. 2020 Jun;119(6):1119-20. https://doi.org/10.1016/j.jfma.2020.04.024
• 12 Odriozola A, Ortega L, Martinez L, Odriozola S, Torrens A, Corroleu D, et al. Widespread sensory neuropathy in diabetic patients hospitalized with severe COVID-19 infection. Diabetes Res Clin Pract. 2020 Dec:108631. https://doi.org/10.1016/j.diabres.2020.108631
• 13 García-Moncó JC, Cabrera-Muras A, Collía-Fernández A, Erburu-Iriarte M, Rodrigo-Armenteros P, Oyarzun-Irazu I, et al. Neurological reasons for consultation and hospitalization during the COVID-19 pandemic. Neurol Sci. 2020 Nov;41(11):3031-8. https://doi.org/10.1007/s10072-020-04714-w.
• 14 Miller C, O'Sullivan J, Jeffrey J, Power D. Brachial plexus neuropathies during the COVID-19 pandemic: a retrospective case series of 15 patients in critical care. Phys Ther. 2021 Jan;101(1):pzaa191. https://doi.org/10.1093/ptj/pzaa191
• 15 Kushlaf HA. Emerging toxic neuropathies and myopathies. Neurol Clin. 2011 Aug;29(3):679-87. https://doi.org/10.1016/j.ncl.2011.05.009
• 16 Pilania RK, Arora A, Agarwal A, Jindal AK, Aggarwal K, Krishnan G, et al. Linezolid-induced mitochondrial toxicity presenting as retinal nerve fiber layer microcysts and optic and peripheral neuropathy in a patient with chronic granulomatous disease. Retin Cases Brief Rep. 2021 May;15(3):224-9. https://doi.org/10.1097/ICB.20210030202100300777
• 17 Khanlou H, Valdes-Sueiras M, Farthing C. Peripheral neuropathy induced by lopinavir-saquinavir-ritonavir combination therapy in an HIV-infected patient. J Int Assoc Physicians AIDS Care (Chic). 2007 Sep;6(3):155. https://doi.org/10.1177/1545109707302756.
• 18 Lorber M. A case of possible darunavir/ritonavir-induced peripheral neuropathy: case description and review of the literature. J Int Assoc Provid AIDS Care. 2013 May-Jun;12(3):162-5. https://doi.org/10.1177/2325957412471993
• 19 Becerra-Cuñat JL, Coll-Cantí J, Gelpí-Mantius E, Ferrer-Avellí X, Lozano-Sánchez M, Millán-Torné M, et al. Miopatía y neuropatía inducida por cloroquina: tetraparesia progresiva con arreflexia que simula una polirradiculoneuropatía. A propósito de dos casos. Rev Neurol. 2003 Mar;36(6):523-6. https://doi.org/10.33588/rn.3606.2002407
• 20 Fodale V, PraticÒ C, Girlanda P, Baradello A, Lucanto T, Rodolico C, et al. Acute motor axonal polyneuropathy after a cisatracurium infusion and concomitant corticosteroid therapy. Br J Anaesth. 2004 Feb;92(2):289-93. https://doi.org/10.1093/bja/aeh040
• 21 Thomas RJ. Neurotoxicity of antibacterial therapy. South Med J. 1994 Sep;87(9):869-74. https://doi.org/10.1097/00007611-199409000-00001
• 22 Sugiura F, Kojima T, Oguchi T, Urata S, Yuzawa Y, Sakakibara A, Hayashi H, Nishimoto N, Ishiguro N. A case of peripheral neuropathy and skin ulcer in a patient with rheumatoid arthritis after a single infusion of tocilizumab. Mod Rheumatol. 2009;19(2):199-203. https://doi.org/10.1007/s10165-008-0132-2
• 23 Zorowitz RD. ICU-acquired weakness: a rehabilitation perspective of diagnosis, treatment, and functional management. Brust. 2016 Oct;150(4):966-971. https://doi.org/10.1016/j.chest.2016.06.006
• 24 Ghasemiyeh P, Borhani-Haghighi A, Karimzadeh I, Mohammadi-Samani S, Vazin A, Safari A, Qureshi AI. Major Neurologic Adverse Drug Reactions, Potential Drug-Drug Interactions and Pharmacokinetic Aspects of Drugs Used in COVID-19 Patients with Stroke: A Narrative Review. Ther Clin Risk Manag. 2020 Jun 30;16:595-605. https://doi.org/10.2147/TCRM.S259152
• 25 Rifino N, Censori B, Agazzi E, Alimonti D, Bonito V, Camera G, et al. Neurologic manifestations in 1760 COVID-19 patients admitted to Papa Giovanni XXIII Hospital, Bergamo, Italy. J Neurol. 2020 Oct:1-8. https://doi.org/10.1007/s00415-020-10251-5
• 26 Filosto M, Cotti Piccinelli S, Gazzina S, Foresti C, Frigeni B, Servalli MC, et al. Guillain-Barré syndrome and COVID-19: an observational multicentre study from two Italian hotspot regions. J Neurol Neurosurg Psychiatry 2020 Nov:jnnp-2020-324837. https://doi.org/10.1136/jnnp-2020-324837
• 27 Malik GR, Wolfe AR, Soriano R, Rydberg L, Wolfe LF, Deshmukh S, et al. Injury-prone: peripheral nerve injuries associated with prone positioning for COVID-19-related acute respiratory distress syndrome. Br J Anaesth. 2020 Dec;125(6):e478-e80. https://doi.org/10.1016/j.bja.2020.08.045