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SARS-CoV-2 proteins

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    Surveillance study of acute neurological manifestations among 439 Egyptian patients with COVID-19 MESHD in Assiut and Aswan university hospitals

    Authors: Eman Mohamed khedr; Noha Abo-Elfetoh; Enas Deaf; Hebatallah M Hassan; Mariam T Amin; Radwa K Soliman; Alaa A Attia; Amro A Zarzour; Mohamed Zain; Aliae Mohamed-Hussein; Maiada K Hashem; Sahar M Hassany; Ahmed Aly; Ahmed Shoap; Mostafa Saber

    doi:10.1101/2020.10.28.20221879 Date: 2020-11-03 Source: medRxiv

    Background: COVID 19 can be accompanied by acute neurological complications of both central and peripheral nervous systems (CNS and PNS). In this study we estimate the frequency of such complications among hospital in-patients with COVID-19 MESHD in Assiut and Aswan University Hospitals. Material and Methods: We screened all patients with suspected COVID-19 MESHD admitted from 1 June to 10 August 2020 to the university hospitals of Assiut and Aswan in Upper Egypt. Clinical and laboratory data, CT/MRI of chest and brain, and neurophysiology were performed for each patient if indicated. Results: 439 patients had confirmed/probable COVID-19 MESHD; neurological manifestations occurred in 222. Of these 117 had acute neurological disease MESHD; the remainder had non-specific neuropsychiatric symptoms such as headache MESHD, vertigo MESHD, and depression MESHD. The CNS was affected in 75 patients: 55 had stroke MESHD; the others had convulsions MESHD (5), encephalitis MESHD (6), hypoxic encephalopathy MESHD (4), cord myelopathy MESHD (2), relapse of RR-MS (2), and meningoencephalitis MESHD (1). The PNS was affected in 42 patients: the majority had anosmia and ageusia MESHD (31); the others had GBS MESHD (4), peripheral neuropathy MESHD (3), myasthenia gravis MESHD (2), or myositis MESHD (2). Fever MESHD, respiratory symptoms MESHD and headache MESHD, were the most common general symptoms. Hypertensions MESHD, Diabetes Mellitus MESHD, ischemic MESHD heart disease MESHD were the most common comorbidities in patients with CNS affection. Conclusion: In COVID-19 MESHD, both the CNS and PNS are affected. Stroke MESHD was the most common complication for CNS and anosmia MESHD and/or ageusia were common for PNS diseases MESHD. However there were 6 cases encephalitis MESHD, 2 cases of spinal cord myelopathy MESHD, 2 cases of MG and 2 cases of myositis MESHD.

    Reversible Lesion of the Corpus Callosum Associated With COVID-19 MESHD: A Case Report and Review of Literature

    Authors: Yagmur Inalkac Gemici; Irem Tasci

    doi:10.21203/rs.3.rs-81684/v1 Date: 2020-09-21 Source: ResearchSquare

    Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may affect the central nervous system (CNS) and peripheral nervous system (PNS). Major CNS manifestations of SARS-CoV-2 include seizures MESHD, meningitis MESHD, meningoencephalitis MESHD, ischemic stroke MESHD, hemorrhagic stroke MESHD, anosmia MESHD, hypogeusia MESHD, acute disseminated encephalomyelitis MESHD, hemorrhagic necrotizing encephalopathy MESHD, and nonfocal phenomena including lethargy, agitation MESHD, confusion MESHD, headache MESHD, and ataxia MESHD. The reversible splenial lesion syndrome MESHD ( MERS MESHD) was first described in 2004. Although MERS was initially recognized as a benign phenomenon, a second type of MERS was identified in later years, which has a poor prognosis and potentially serious sequela. MERS can be caused by numerous etiologies including viruses. In this report, we present a patient with SARS-CoV-2 who presented with ataxia MESHD and dizziness MESHD as the clinical symptoms of MERS, which is a rare clinical phenomenon and can be caused by numerous etiologies.

    Varicella Zoster Virus Induced Acute Retinal Necrosis Following Acute Meningoencephalitis in a Patient with Presumed COVID-19 MESHD

    Authors: Kiana Hassanpour; Faezeh Khorasanizadeh; Hamid Ahmadieh; Mahmood Nabavi; Narsis Daftarian; Alireza Ramezani

    doi:10.21203/rs.3.rs-54356/v1 Date: 2020-08-05 Source: ResearchSquare

    Background: To report the coincidence of acute retinal necrosis syndrome MESHD ( ARN MESHD) following acute meningoencephalitis MESHD and presumed coronavirus disease 2019 MESHD ( COVID-19 MESHD) in an immunocompetent patient. Case presentation: A 58-year old female presented to our emergency department complaining of sudden unilateral visual loss MESHD following a recent hospitalization for a viral meningoencephalitis MESHD. Magnetic resonance imaging (MRI), cerebrospinal fluid ( CSF HGNC) analysis, polymerase chain reaction (PCR) of the aqueous humor, reverse transcriptase polymerase chain reaction (RT-PCR) of the nasopharyngeal swab specimen, chest computed tomography (CT), and fundus photography were performed for the patient. Ophthalmic examination revealed severe ocular inflammation MESHD and yellowish patches of necrotizing retinitis MESHD in the right eye compatible with the diagnosis of ARN MESHD. The result of PCR on the aqueous humor was positive for VZV. The patient received one intravitreal ganciclovir injection and 10 days intravenous ganciclovir followed by oral acyclovir. The patient underwent COVID-19 MESHD screening tests; chest CT-scan showed the features highly suggestive for COVID-19 MESHD while the RT-PCR was negative two times. Two months later, BCVA reached 20/70 in the right eye. The anterior chamber reaction and KPs resolved and the vitreous haziness significantly decreased Conclusion: A case of VZV induced ARN MESHD following acute meningoencephalitis MESHD was observed in association with presumed COVID-19 MESHD. This could be an incidental finding in the pandemic era of COVID-19 MESHD; however, it could also suggest that COVID-19 MESHD might trigger ARN MESHD in cases having latent herpes family viruses. 

    Indication for SARS-CoV-2 serology: first month follow-up

    Authors: Alix T. Coste; Katia Jaton; Matthaios Papadimitriou-Olivgeris; Antony Croxatto; Gilbert Greub

    doi:10.1101/2020.06.30.20140715 Date: 2020-07-03 Source: medRxiv

    SARS-CoV-2 detection is mainly performed by RT-PCR but recently serological tests were made available. A first one month follow-up of the SARS-CoV-2 serology records was performed in our laboratory to precise the diversity and proportion of the SARS-CoV-2 serology test indications and to identify new valid indications ( meningoencephalitis MESHD, vasculitis MESHD, etc)

    Meningoencephalitis associated with COVID-19 MESHD: A systematic review

    Authors: Ritwick Mondal; Upasana Ganguly; Shramana Deb; Gourav Shome; Subhasish Pramanik; Deebya Bandyopadhyay; Durjoy Lahiri

    doi:10.1101/2020.06.25.20140145 Date: 2020-06-26 Source: medRxiv

    Background and aims: With the growing number of COVID-19 MESHD cases in recent times, the varied range of presentations is progressively becoming an addressing issue among clinicians. A significant set of patients with extra pulmonary symptoms has been reported worldwide. Neurological involvement in the form of altered mental status, loss of consciousness MESHD in considerable amounts has drawn attention of physicians all across the globe. Here we venture out to summarise the clinical profile, investigations and radiological findings among patients with SARS-CoV-2 associated meningoencephalitis MESHD in the form of a systematic review, which may aid clinicians in early diagnosis and prognostic evaluation of the disease. Methodology: This review was carried out based on the existing PRISMA (Preferred Report for Systemic Review and Meta analyses) consensus statement. The data for this review was collected from four databases: Pubmed/Medline, NIH Litcovid, Embase and Cochrane library and Preprint servers up till 10th June, 2020. Search strategy comprised of a range of keywords from relevant medical subject headings which includes "SARS-COV-2", " COVID-19 MESHD", " meningoencephalitis MESHD" etc. All peer reviewed, case control, case report, pre print articles satisfying our inclusion criteria were involved in the study. The inclusion prerequisites comprised of confirmed SARS-CoV-2 cases with neurological manifestations, previous cases of SARS-CoV MESHD, MERS-CoV with neurological involvement provided all the studies were published in English language. Quantitative data was expressed in mean+/-SD, while the qualitative date in percentages. Paired t test was used for analysing the data based on differences between mean and respective values with a p value of <0.05 considered to be statistically significant. Results: A total of 43 cases were involved from 24 studies after screening from databases and preprint servers, out of which 29 of them had completed investigation profile and were included in the final analysis. Clincial and Laboratory findings as well as neuroimaging findings (CT, MRI and MRS MESHD) revealed consistent presentations towards association of COVID-19 MESHD with meningoencephalitis MESHD. Epileptogenic pictures were also evident on EEG (electroencephalogram) findings. Conclusion: SARS-CoV-2 has been isolated from CSF HGNC as well as cerebrum of cases with meningoencephalitis MESHD depicting the natural tendency of the virus to invade the central nervous system. Speculations about retrograde olfactory transport or alternative haematogenous spread seem to be correlating with above findings. This review may raise the index of suspicion about COVID-19 MESHD among clinicians while attending patients with neurological manifestations.

    Neurological manifestations of COVID-19 MESHD: A systematic review

    Authors: Xiangliang Chen; Sarah Laurent; Oezguer A. Onur; Nina N. Kleineberg; Gereon R. Fink; Finja Schweitzer; Clemens Warnke

    doi:10.21203/rs.3.rs-37601/v1 Date: 2020-06-23 Source: ResearchSquare

    Objective: To study the frequency of neurological symptoms MESHD and complications in COVID-19 MESHD patients in a systematic review of the literature. Methods: Relevant studies were identified through electronic explorations of PubMed, medRxiv, and bioRxiv. Besides, three Chinese databases were searched. A snowballing method searching the bibliographies of the retrieved references was applied to identify potentially relevant articles. Articles published within one year prior to April 20th, 2020 were screened with no language restriction imposed. Databases were searched for terms related to SARS-CoV-2/ COVID-19 MESHD and neurological manifestations, using a pre-established protocol registered on the International Prospective Register of Systematic Reviews database (ID: CRD42020187994).Results: A total of 2441 articles were screened for relevant content, of which 92 full-text publications were included in the analyses of neurological manifestations of COVID-19 MESHD. Headache MESHD, dizziness MESHD, taste and smell dysfunctions MESHD, and impaired consciousness MESHD were the most frequently described neurological symptoms, the latter more often among patients with a severe or critical disease MESHD course. To date, only smaller cohort studies or single cases have reported cerebrovascular MESHD events, seizures MESHD, meningoencephalitis MESHD, and immune-mediated neurological diseases MESHD, not suitable for quantitative analysis. Conclusions: The most frequent neurological symptoms MESHD reported in association with COVID-19 MESHD are non-specific for the infection with SARS-CoV-2. Although SARS-CoV-2 may have the potential to gain direct access to the nervous system, so far, SARS-CoV-2 was detected in the cerebrospinal fluid in two cases only. Standardized international registries are needed to clarify the clinical relevance of the neuropathogenicity of SARS-CoV-2 MESHD

    Fatal Central Nervous System Co-Infection with SARS-CoV-2 and Tuberculosis in a Healthy Child

    Authors: Bishara J. Freij; Bassam M. Gebara; Rabail Tariq; Ay-Ming Wang; John Gibson; Nidal El-Wiher; Graham Krasan; Paul M. Patek; Kelly A. Levasseur; Mitual Amin; Joseph M. Fullmer

    doi:10.21203/rs.3.rs-33272/v1 Date: 2020-06-04 Source: ResearchSquare

    Background. Central and peripheral nervous system symptoms MESHD and complications are being increasingly recognized among individuals with pandemic SARS-CoV-2 infections MESHD SARS-CoV-2 infection MESHDs, but actual detection of the virus or its RNA in the central nervous system has rarely been sought or demonstrated. Severe or fatal illnesses are attributed to SARS-CoV-2, generally without attempting to evaluate for alternative causes or co-pathogens.Case presentation. A five-year-old girl with fever MESHD and headache MESHD was diagnosed with acute SARS-CoV-2-associated meningoencephalitis MESHD based on the detection of its RNA on a nasopharyngeal swab, cerebrospinal fluid analysis, and magnetic resonance imaging findings. Serial serologic tests for SARS-CoV-2 IgG and IgA showed seroconversion, consistent with an acute infection. Mental status and brain imaging findings gradually worsened despite antiviral therapy and intravenous dexamethasone. Decompressive suboccipital craniectomy for brain herniation with cerebellar biopsy on day 30 of illness, shortly before death, revealed SARS-CoV-2 RNA in cerebellar tissue using the Centers for Disease Control and Prevention 2019-nCoV Real-Time Reverse Transcriptase-PCR Diagnostic Panel. On histopathology, necrotizing granulomas MESHD with numerous acid-fast bacilli were visualized, and Mycobacterium tuberculosis MESHD complex DNA was detected by PCR. Ventricular cerebrospinal MESHD fluid that day was negative for mycobacterial DNA. She had no known exposures to tuberculosis MESHD and no chest radiographic findings to suggest it. All 6 family members had normal chest radiographs and negative interferon-γ release assay results. The source of her tuberculous infection MESHD was not identified, and further investigations by the local health department were not possible because of the State of Michigan-mandated lockdown for control of SARS-CoV-2 spread.Conclusion. The detection of SARS-CoV-2 RNA in cerebellar tissue and the demonstration of seroconversion in IgG and IgA assays was consistent with acute SARS-CoV-2 infection of the central nervous infection MESHD. However, the cause of death MESHD was brain herniation from her rapidly progressive central nervous system tuberculosis MESHD. SARS-CoV-2 may mask or worsen occult tuberculous infection MESHD with severe or fatal consequences.

    Neurological Involvement of Coronavirus Disease 2019 MESHD: A Systematic Review

    Authors: Malik Ghannam; Qasem Alshaer; Mustafa Al-Chalabi; Lara Zakarna; Jetter Robertson; Georgios Manousakis

    doi:10.21203/rs.3.rs-31183/v1 Date: 2020-05-23 Source: ResearchSquare

    Background: In December 2019, unexplained cases of pneumonia MESHD emerged in Wuhan, China, which were found to be secondary to the novel coronavirus SARS-CoV-2. On March 11, 2020, the WHO declared the Coronavirus Disease 2019 MESHD (COVID-2019) outbreak, a pandemic. Although the most common presentations of COVID-19 MESHD are fever MESHD, cough MESHD and shortness of breath MESHD, several clinical observations indicate that COVID-19 MESHD does affect the central and peripheral nervous system.  Methods: We conducted a systematic literature search from December 01, 2019 to May 14, 2020 using multiple combinations of keywords from PubMed and Ovid Medline databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included articles with cases of COVID-19 MESHD that were evident for neurological involvement.  Results: We were able to identify 82 cases of COVID-19 MESHD with neurological complications. The mean age was 62.28 years. 37.8% of the patients were women (n = 31). 48.8% of the patients (n=40) had cerebrovascular insults, 28% (n=23) had neuromuscular disorders MESHD, 18.3% of the patients (n=15) had encephalitis MESHD or encephalopathy MESHD, and 2.4% (n=2) presented with status epilepticus MESHD. Conclusions: Neurological manifestations of COVID-19 MESHD infection are not rare, especially large vessel stroke MESHD, Guillain barre syndrome MESHD and meningoencephalitis MESHD. Moving forward, further studies are needed to clarify the prevalence of the neurological complications of COVID-19 MESHD, investigate their biological backgrounds, and test treatment options. Physicians should be cautious not to overlook other neurological diagnoses that can mimic COVID-19 MESHD during the pandemic.

    COVID-19 MESHD associated meningoencephalitis complicated with intracranial hemorrhage. A case report.

    Authors: Mohammad Alolama; Anas Rashid; Debora Garozzo

    doi:10.21203/rs.3.rs-28203/v1 Date: 2020-05-10 Source: ResearchSquare

    Introduction: The Coronavirus pandemic that started in December 2019 is mainly related to clinical pictures consistent with respiratory symptoms; nevertheless, reports about neurological complications have recently appeared in the medical literature.The case: we describe a case of a 36 years old Coronavirus-positive patient that was admitted on emergency basis; his clinical presentation included neurological symptoms such as drowsiness MESHD and mild confusion MESHD. Imaging revealed findings consistent with meningoencephalitis MESHD complicated by intracerebral hematoma MESHD and subdural hematoma MESHD. The latter was surgically evacuated after it became chronic and evidence of Coronavirus was found in the fluid.  Conclusion: our experience confirms that neurological complications MESHD might be a likely event in COVID-19 MESHD. Although uncommon, the possible occurrence of meningoencephalitis MESHD should be kept in mind by physicians involved in the management of COVID-19 MESHD patients. Early recognition of brain involvement may provide better prognosis, preventing evolution into intracerebral hemorrhagic MESHD events.

    Hemisensory paresthesia as the initial symptom of a SARS-Coronavirus-2 infection. A Case report.

    Authors: Myriam Herrnberger; Nadine Durmazel; Frank Birklein

    doi:10.21203/rs.3.rs-26305/v1 Date: 2020-04-30 Source: ResearchSquare

    Neurological symptoms MESHD might be associated with a Covid-19 MESHD infection. There are frequent reports in the last weeks. The neurological symptoms range from harmless side effects of a viral infection to meningoencephalitis MESHD and acute haemorrhagic necrotizing encephalopathy MESHD.Our patient reported burning headache MESHD and paresthesia as the initial symptoms mainly without other signs of viral infection like cough or fever MESHD. Such an initial neurological presentation seems to be rare. Most cases have neurological symptoms MESHD which can be expected after severe systemic viral infections MESHD like fever MESHD associated headache MESHD. Many COVID-19 MESHD patients with mild disease are at home and the further course is unknown. Our case shows, that neurological symptoms can be the first manifestation of an COVID-19 MESHD disease. While restricted paraesthesia has been reported in SARS-CoV-2 infection MESHD SARS-CoV-2 infection MESHDs, hemisymptoms have not been described as initial symptoms. 

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