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New SARS-CoV2 coronavirus can cause meningitis
More than 1.6 million people worldwide have already been infected with the Sars-CoV-2 coronavirus. Tens of thousands have died of or with the lung disease COVID-19, which the pathogen triggers. According to new knowledge, the novel virus can also cause life-threatening meningitis.
A neural infection pathway from SARS-CoV2 has been reported in the specialist media for a few days, which was assumed to be very likely and could explain the neurological symptoms of many people affected by COVID-19. A case report now provides the evidence, reports the German Society for Neurology (DGN) in a current release.
Neurological complaints in COVID-19
The number of infections with the new coronavirus SARS-CoV2 is still increasing. Not all people who are infected with the pathogen show symptoms.
Some patients experience only mild complaints, but others have severe courses of COVID-19.
In the recent past, researchers have also frequently discovered neurological complaints in COVID-19.
A case report from Japan, which was published in the journal "International Journal of Infectious Diseases", showed that a young man suffered from meningitis caused by the new pathogen. According to the DGN, SARS-CoV-2-RNA was detected in the nerve water, but the nasopharyngeal smear was negative.
Corona viruses can penetrate the brain
As explained in the communication, it is known from recent publications that SARS-CoV-2, like the already known coronaviruses SARS and MERS, can also penetrate the central nervous system (CNS) or the brain, especially the brain stem.
This could explain why in addition to the typical symptoms of COVID-19 diseases, fever, sore throat and cough - by the way in some cases also without any respiratory complaints - neurological symptoms such as loss of sense of smell and taste, headache, fatigue, nausea, vomiting and consciousness disorders occur.
The case in question from Japan, in which SARS-CoV-2 triggered a meningitis in a young man, caused a sensation.
"As was to be expected from the experience at SARS and MERS, this case history shows impressively that the nervous system can be affected by COVID-19 diseases, even in very young patients," explains Professor Peter Berlit, Essen, Secretary General of the DGN .
According to the information, viral infections as triggers of meningitis / meningitis (meningitis / encephalitis) are not uncommon per se, the DGN published an S1 guideline on this in 2018. The present case report now shows that there is also SARS-CoV2 meningitis.
Doctor suspected flu
According to the DGN, the currently published case report reports that the affected 24-year-old man had visited a doctor twice in the first eight days of his illness because of fatigue, headache, nausea and fever.
The doctor suspected flu and prescribed an influenza (Laninamivir) and antipyretic medication. A chest X-ray had been normal. According to the report, the young man was passed out by the family on the ninth day of the illness.
Several epileptic seizures occurred during the patient transport, so he had to be intubated and ventilated. A pronounced neck stiffness was diagnosed in the hospital, a main symptom of meningitis (meningitis).
The imaging examination with MRI then showed the findings of meningoencephalitis (meningitis and meningitis) with hyperintensities along the right lateral ventricular wall as well as on the right mesiotemporal and in the hippocampus region.
Thoracic CT also showed evidence of viral pneumonia (pneumonia). Nevertheless, the nasopharynx smear was negative on SARS-CoV-2, but specific SARS-CoV-2-RNA could be detected in the nerve water (CSF). The diagnosis of other meningitis-causing viruses was negative according to the DGN.
"Not a purely pneumological clinical picture"
“What is special about this case is that the virus detection in the nerve water was positive, but not in the nasopharynx. This indicates that the new type of corona virus has obviously spread via the neural route of infection, ”says Berlit.
The neural route of infection has already been demonstrated in animal experiments in other corona viruses. The viruses are passed from neuron to neuron via the synapses. The case studies now provide evidence that SARS-CoV2 can also spread to people via this route of infection.
An Italian neurologist from Milan, the epicenter of the pandemic in Europe, also reported in the specialist journal "Neurology" that some COVID-19 patients had primarily neurological symptoms - she therefore recommends to every patient who presents with neurological symptoms to routinely test for SARS-CoV2.
"Due to the new data situation, there is growing evidence that Covid-19 is not a purely pneumological clinical picture," says Berlit. "Even with leading neurological symptoms, the novel pathogen must be considered." (Ad)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
- German Society for Neurology: SARS-CoV2 can cause meningitis, (accessed: April 10, 2020), German Society for Neurology
- Moriguchi T, Harii N, Goto J et al .: A first Case of Meningitis / Encephalitis associated with SARS-Coronavirus-2; in: International Journal of Infectious Diseases, (published: March 2020), International Journal of Infectious Diseases
- Li YC, Bai WZ, Hashikawa T: The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients; in: Journal of Medical Virology, (published: February 27, 2020), Journal of Medical Virology
- German Society of Neurology: Guideline: Viral Meningoencephalitis, (accessed: April 10, 2020), German Society for Neurology
- Anna Bersano, Leonardo Pantoni: On being a neurologist in Italy at the time of the COVID-19 outbreak; in: Neurology, (published: April 3, 2020), Neurology