Guillain Barré syndrome associated with COVID-19- lessons learned about its pathogenesis during the first year of the pandemic, a systematic review.

Abstract

The disease caused by the coronavirus SARS-CoV-2 (COVID-19), which emerged in China in December 2019, has become a global pandemic in just a few months. The concomitant presentation of COVID-19 and some autoimmune diseases has also been reported, among which is Guillain Barr´e Syndrome (GBS). GBS is considered an immune mediated neuropathy preceded 1 to 6 weeks in 70% of cases by a bac terial or a viral infection. In many cases associated with Campylobacter jejuni (the predominant pathogen) the presence of antiganglioside an tibodies is observed. This supports a post-infectious mechanism, with molecular mimicry and antibody cross-response. However, in GBS associated with Zika virus infection, an earlier onset is seen, and asso ciated antiganglioside antibodies are rarely present, suggesting a para infectious pathogenetic mechanism. There is contradictory infor mation on whether GB associated with COVID-19 has also characteris tics that may indicate a para-infectious pathogenetic process. To review the accumulated evidence about the pathogenic mechanism of this association, we carried out a review of the literature with a selection of the clinical cases reported until February 1st 2021, adding one owncase. We selected studies reporting adult patients with all: Guillain-Barr´e syndrome, according to diagnostic criteria of the GBS Classification Group [8]; SARS-CoV-2 infection confirmed by nasopharyngeal reverse transcription polymerase chain reaction, antigen-detecting rapid diag nostic tests or serum antibody test; Detailed individual clinical description; A minimum of 6/8 points using the Joanna Briggs Institute Critical Appraisal Checklist for Case Reports and for Case Series studies.