#MSCOVID19: Dear ABN, SARS-COV2 may be neutrotropic

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In the ABN guidelines it states SARS-COV-2 is not neurotropic and whilst some of the neurological conditions may be secondary to effects on blood vessels in the brain, as they can express ACE2 which the virus uses to infect. There does appear to be neurological issues associated with COVID19. So if you are taking natalizumab keep an eye out for this.

Data from BrainSeq2. It shows ACE2 in brain blood vessels, whilst ACE2 is low throughout the human CNS cells, it makes the point of blood vessel expression.

Besides the heart, kidneys, and testes having been found as initial sites of angiotensin-converting enzyme 2 (ACE2) expression, endothelial and neuronal presence was confirmed, with ultimate consensus stating the receptor is almost ubiquitous. Although message show a clear presence of ACE2 receptor in various human neuronal regions, imunohistochemistry for ACE2 receptor of central nervous system (CNS) tissue, though with limited description, failed to show neuronal or glial positivity but did confirm it in the brain vasculature (Hammin et al. 2004). Some of the neurological conditions could also be secondary to other events. and remember the neurological events are infrequent just like JC viral infection of the brain is relatively infrequent.

Letter to the Editor Regarding the Viewpoint “Evidence of the COVID-19 Virus Targeting the CNS: Tissue Distribution, Host-Virus Interaction, and Proposed Neurotropic Mechanism”.Toljan K.ACS Chem Neurosci. 2020 Apr 15;11(8):1192-1194. doi: 10.1021/acschemneuro.0c00174. Epub 2020 Apr 8.

Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, Chang J, Hong C, Zhou Y, Wang D, Miao X, Li Y, Hu B JAMA Neurol. 2020 Apr 10. doi: 10.1001/jamaneurol.2020.1127. [Epub ahead of print]PMID: 32275288

IMPORTANCE: The outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China, is serious and has the potential to become an epidemic worldwide. Several studies have described typical clinical manifestations including fever, cough, diarrhea, and fatigue. However, to our knowledge, it has not been reported that patients with COVID-19 had any neurologic manifestations.

MAIN OUTCOMES AND MEASURES:Clinical data were extracted from electronic medical records, and data of all neurologic symptoms were checked by 2 trained neurologists. Neurologic manifestations fell into 3 categories: central nervous system manifestations (dizziness, headache, impaired consciousness, acute cerebrovascular disease, ataxia, and seizure), peripheral nervous system manifestations (taste impairment, smell impairment, vision impairment, and nerve pain), and skeletal muscular injury manifestations.

RESULTS: Of 214 patients (mean [SD] age, 52.7 [15.5] years; 87 men [40.7%]) with COVID-19, 126 patients (58.9%) had nonsevere infection and 88 patients (41.1%) had severe infection according to their respiratory status. Overall, 78 patients (36.4%) had neurologic manifestations. Compared with patients with nonsevere infection, patients with severe infection were older, had more underlying disorders, especially hypertension, and showed fewer typical symptoms of COVID-19, such as fever and cough. Patients with more severe infection had neurologic manifestations, such as acute cerebrovascular diseases (5 [5.7%] vs 1 [0.8%]), impaired consciousness (13 [14.8%] vs 3 [2.4%]), and skeletal muscle injury (17 [19.3%] vs 6 [4.8%]).

CONCLUSIONS AND RELEVANCE:Patients with COVID-19 commonly have neurologic manifestations. During the epidemic period of COVID-19, when seeing patients with neurologic manifestations, clinicians should suspect severe acute respiratory syndrome coronavirus 2 infection as a differential diagnosis to avoid delayed diagnosis or misdiagnosis and lose the chance to treat and prevent further transmission.

Concomitant neurological symptoms observed in a patient diagnosed with coronavirus disease 2019. Yin R, Feng W, Wang T, Chen G, Wu T, Chen D, Lv T, Xiang D. J Med Virol. 2020 Apr 15. doi: 10.1002/jmv.25888. [Epub ahead of print]

Nervous system involvement after infection with COVID-19 and other coronaviruses.Wu Y, Xu X, Chen Z, Duan J, Hashimoto K, Yang L, Liu C, Yang C.Brain Behav Immun. 2020 Mar 30:S0889-1591(20)30357-3. doi: 10.1016/j.bbi.2020.03.031

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