Guillain-Barre Syndrome, a Rare Neurological Disorder, Linked to COVID-19
By Sherry H-Y. Chou, Aarti Sarwal and Neha S. Dangayach
The patient in the case report (let's call him Tom) was 54 and in good health. For two days in May, he felt unwell and was too weak to get out of bed. When his family finally brought him to the hospital, doctors found that he had a fever and signs of a severe infection, or sepsis. He tested positive for SARS-CoV-2, the virus that causes COVID-19 infection. In addition to symptoms of COVID-19, he was also too weak to move his legs.
When a neurologist examined him, Tom was diagnosed with Guillain-Barre Syndrome, an autoimmune disease that causes abnormal sensation and weakness due to delays in sending signals through the nerves. Usually reversible, in severe cases it can cause prolonged paralysis involving breathing muscles, require ventilator support and sometimes leave permanent neurological deficits. Early recognition by expert neurologists is key to proper treatment.
We are neurologists specializing in intensive care and leading studies related to neurological complications from COVID-19. Given the occurrence of Guillain-Barre Syndrome in prior pandemics with other corona viruses like SARS and MERS, we are investigating a possible link between Guillain-Barre Syndrome and COVID-19 and tracking published reports to see if there is any link between Guillain-Barre Syndrome and COVID-19.
Some patients may not seek timely medical care for neurological symptoms like prolonged headache, vision loss and new muscle weakness due to fear of getting exposed to virus in the emergency setting. People need to know that medical facilities have taken full precautions to protect patients. Seeking timely medical evaluation for neurological symptoms can help treat many of these diseases.
What Is Guillain-Barre Syndrome?
Guillain-Barre syndrome occurs when the body's own immune system attacks and injures the nerves outside of the spinal cord or brain – the peripheral nervous system. Most commonly, the injury involves the protective sheath, or myelin, that wraps nerves and is essential to nerve function.
Without the myelin sheath, signals that go through a nerve are slowed or lost, which causes the nerve to malfunction.
To diagnose Guillain-Barre Syndrome, neurologists perform a detailed neurological exam. Due to the nerve injury, patients often may have loss of reflexes on examination. Doctors often need to perform a lumbar puncture, otherwise known as spinal tap, to sample spinal fluid and look for signs of inflammation and abnormal antibodies.
Studies have shown that giving patients an infusion of antibodies derived from donated blood or plasma exchange – a process that cleans patients' blood of harmful antibodies - can speed up recovery. A very small subset of patients may need these therapies long-term.
The majority of Guillain-Barre Syndrome patients improve within a few weeks and eventually can make a full recovery. However, some patients with Guillain-Barre Syndrome have lingering symptoms including weakness and abnormal sensations in arms and/or legs; rarely patients may be bedridden or disabled long-term.
Guillain-Barre Syndrome and Pandemics
As the COVID-19 pandemic sweeps across the globe, many neurologic specialists have been on the lookout for potentially serious nervous system complications such as Guillain-Barre Syndrome.
Though Guillain-Barre Syndrome is rare, it is well known to emerge following bacterial infections, such as Campylobacter jejuni, a common cause of food poisoning, and a multitude of viral infections including the flu virus, Zika virus and other coronaviruses.
Studies showed an increase in Guillain-Barre Syndrome cases following the 2009 H1N1 flu pandemic, suggesting a possible connection. The presumed cause for this link is that the body's own immune response to fight the infection turns on itself and attacks the peripheral nerves. This is called an "autoimmune" condition. When a pandemic affects as many people as our current COVID-19 crisis, even a rare complication can become a significant public health problem. That is especially true for one that causes neurological dysfunction where the recovery takes a long time and may be incomplete.
Though there is clear clinical suspicion that COVID-19 can lead to Guillain-Barre Syndrome, many important questions remain. What are the chances that someone gets Guillain-Barre Syndrome during or following a COVID-19 infection? Does Guillain-Barre Syndrome happen more often in those who have been infected with COVID-19 compared to other types of infections, such as the flu?
The only way to get answers is through a prospective study where doctors perform systematic surveillance and collect data on a large group of patients. There are ongoing large research consortia hard at work to figure out answers to these questions.
Understanding the Association Between COVID-19 and Guillain-Barre Syndrome
While large research studies are underway, overall it appears that Guillain-Barre Syndrome is a rare but serious phenomenon possibly linked to COVID-19. Given that more than 10.7 million cases have been reported for COVID-19, there have been 10 reported cases of COVID-19 patients with Guillain-Barre Syndrome so far – only two reported cases in the U.S., five in Italy, two cases in Iran and one from Wuhan, China.
It is certainly possible that there are other cases that have not been reported. The Global Consortium Study of Neurological Dysfunctions in COVID-19 is actively underway to find out how often neurological problems like Guillain-Barre Syndrome is seen in hospitalized COVID-19 patients. Also, just because Guillain-Barre Syndrome occurs in a patient diagnosed with COVID-19, that does not imply that it was caused by the virus; this still may be a coincident occurrence. More research is needed to understand how the two events are related.
Due to the pandemic and infection-containment considerations, diagnostic tests, such as a nerve conduction study that used to be routine for patients with suspected Guillain-Barre Syndrome, are more difficult to do. In both U.S. cases, the initial diagnosis and treatment were all based on clinical examination by a neurological experts rather than any tests. Both patients survived but with significant residual weakness at the time these case reports came out, but that is not uncommon for Guillain-Barre Syndrome patients. The road to recovery may sometimes be long, but many patients can make a full recovery with time.
Though the reported cases of Guillain-Barre Syndrome so far all have severe symptoms, this is not uncommon in a pandemic situation where the less sick patients may stay home and not present for medical care for fear of being exposed to the virus. This, plus the limited COVID-19 testing capability across the U.S., may skew our current detection of Guillain-Barre Syndrome cases toward the sicker patients who have to go to a hospital. In general, the majority of Guillain-Barre Syndrome patients do recover, given enough time. We do not yet know whether this is true for COVID-19-related cases at this stage of the pandemic. We and colleagues around the world are working around the clock to find answers to these critical questions.
Sherry H-Y. Chou is an Associate Professor of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh.
Aarti Sarwal is an Associate Professor, Neurology, Wake Forest University.
Neha S. Dangayach is an Assistant Professor of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai.
Disclosure statement: Sherry H-Y. Chou receives funding from The University of Pittsburgh Clinical Translational Science Institute (CTSI), the National Institute of Health, and the University of Pittsburgh School of Medicine Dean's Faculty Advancement Award. Sherry H-Y. Chou is a member of Board of Directors for the Neurocritical Care Society. Neha S. Dangayach receives funding from the Bee Foundation, the Friedman Brain Institute, the Neurocritical Care Society, InCHIP-UConn Center for mHealth and Social Media Seed Grant. She is faculty for emcrit.org and for AiSinai. Aarti Sarwal does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
Reposted with permission from The Conversation.
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By Tara Lohan
Warming temperatures on land and in the water are already forcing many species to seek out more hospitable environments. Atlantic mackerel are swimming farther north; mountain-dwelling pikas are moving upslope; some migratory birds are altering the timing of their flights.
Numerous studies have tracked these shifting ranges, looked at the importance of wildlife corridors to protect these migrations, and identified climate refugia where some species may find a safer climatic haven.
"There's a huge amount of scientific literature about where species will have to move as the climate warms," says U.C. Berkeley biogeographer Matthew Kling. "But there hasn't been much work in terms of actually thinking about how they're going to get there — at least not when it comes to wind-dispersed plants."
Kling and David Ackerly, professor and dean of the College of Natural Resources at U.C. Berkeley, have taken a stab at filling this knowledge gap. Their recent study, published in Nature Climate Change, looks at the vulnerability of wind-dispersed species to climate change.
It's an important field of research, because while a fish can more easily swim toward colder waters, a tree may find its wind-blown seeds landing in places and conditions where they're not adapted to grow.
Kling is careful to point out that the researchers weren't asking how climate change was going to change wind; other research suggests there likely won't be big shifts in global wind patterns.
Instead the study involved exploring those wind patterns — including direction, speed and variability — across the globe. The wind data was then integrated with data on climate variation to build models trying to predict vulnerability patterns showing where wind may either help or hinder biodiversity from responding to climate change.
One of the study's findings was that wind-dispersed or wind-pollinated trees in the tropics and on the windward sides of mountain ranges are more likely to be vulnerable, since the wind isn't likely to move those dispersers in the right direction for a climate-friendly environment.
The researchers also looked specifically at lodgepole pines, a species that's both wind-dispersed and wind-pollinated.
They found that populations of lodgepole pines that already grow along the warmer and drier edges of the species' current range could very well be under threat due to rising temperatures and related climate alterations.
"As temperature increases, we need to think about how the genes that are evolved to tolerate drought and heat are going to get to the portions of the species' range that are going to be getting drier and hotter," says Kling. "So that's what we were able to take a stab at predicting and estimating with these wind models — which populations are mostly likely to receive those beneficial genes in the future."
That's important, he says, because wind-dispersed species like pines, willows and poplars are often keystone species whole ecosystems depend upon — especially in temperate and boreal forests.
And there are even more plants that rely on pollen dispersal by wind.
"That's going to be important for moving genes from the warmer parts of a species' range to the cooler parts of the species' range," he says. "This is not just about species' ranges shifting, but also genetic changes within species."
Kling says this line of research is just beginning, and much more needs to be done to test these models in the field. But there could be important conservation-related benefits to that work.
"All these species and genes need to migrate long distances and we can be thinking more about habitat connectivity and the vulnerability of these systems," he says.
The more we learn, the more we may be able to do to help species adapt.
"The idea is that there will be some landscapes where the wind is likely to help these systems naturally adapt to climate change without much intervention, and other places where land managers might really need to intervene," he says. "That could involve using assisted migration or assisted gene flow to actually get in there, moving seeds or planting trees to help them keep up with rapid climate change."
Tara Lohan is deputy editor of The Revelator and has worked for more than a decade as a digital editor and environmental journalist focused on the intersections of energy, water and climate. Her work has been published by The Nation, American Prospect, High Country News, Grist, Pacific Standard and others. She is the editor of two books on the global water crisis. http://twitter.com/TaraLohan
Reposted with permission from The Revelator.
The last Ice Age eliminated some giant mammals, like the woolly rhino. Conventional thinking initially attributed their extinction to hunting. While overhunting may have contributed, a new study pinpointed a different reason for the woolly rhinos' extinction: climate change.
The last of the woolly rhinos went extinct in Siberia nearly 14,000 years ago, just when the Earth's climate began changing from its frozen conditions to something warmer, wetter and less favorable to the large land mammal. DNA tests conducted by scientists on 14 well-preserved rhinos point to rapid warming as the culprit, CNN reported.
"Humans are well known to alter their environment and so the assumption is that if it was a large animal it would have been useful to people as food and that must have caused its demise," says Edana Lord, a graduate student at the Center for Paleogenetics in Stockholm, Sweden, and co-first author of the paper, Smithsonian Magazine reported. "But our findings highlight the role of rapid climate change in the woolly rhino's extinction."
The study, published in Current Biology, notes that the rhino population stayed fairly consistent for tens of thousands of years until 18,500 years ago. That means that people and rhinos lived together in Northern Siberia for roughly 13,000 years before rhinos went extinct, Science News reported.
The findings are an ominous harbinger for large species during the current climate crisis. As EcoWatch reported, nearly 1,000 species are expected to go extinct within the next 100 years due to their inability to adapt to a rapidly changing climate. Tigers, eagles and rhinos are especially vulnerable.
The difference between now and the phenomenon 14,000 years ago is that human activity is directly responsible for the current climate crisis.
To figure out the cause of the woolly rhinos' extinction, scientists examined DNA from different rhinos across Siberia. The tissue, bone and hair samples allowed them to deduce the population size and diversity for tens of thousands of years prior to extinction, CNN reported.
Researchers spent years exploring the Siberian permafrost to find enough samples. Then they had to look for pristine genetic material, Smithsonian Magazine reported.
It turns out the wooly rhinos actually thrived as they lived alongside humans.
"It was initially thought that humans appeared in northeastern Siberia fourteen or fifteen thousand years ago, around when the woolly rhinoceros went extinct. But recently, there have been several discoveries of much older human occupation sites, the most famous of which is around thirty thousand years old," senior author Love Dalén, a professor of evolutionary genetics at the Center for Paleogenetics, said in a press release.
"This paper shows that woolly rhino coexisted with people for millennia without any significant impact on their population," Grant Zazula, a paleontologist for Canada's Yukon territory and Simon Fraser University who was not involved in the research, told Smithsonian Magazine. "Then all of a sudden the climate changed and they went extinct."
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Transitioning to renewable energy can help reduce global warming, and Jennie Stephens of Northeastern University says it can also drive social change.
For example, she says that locally owned businesses can lead the local clean energy economy and create new jobs in underserved communities.
"We really need to think about … connecting climate and energy with other issues that people wake up every day really worried about," she says, "whether it be jobs, housing, transportation, health and well-being."
To maximize that potential, she says the energy sector must have more women and people of color in positions of influence. Research shows that leadership in the solar industry, for example, is currently dominated by white men.
"I think that a more inclusive, diverse leadership is essential to be able to effectively make these connections," Stephens says. "Diversity is not just about who people are and their identity, but the ideas and the priorities and the approaches and the lens that they bring to the world."
So she says by elevating diverse voices, organizations can better connect the climate benefits of clean energy with social and economic transformation.
Reposted with permission from Yale Climate Connections.