zithromax and Guillain-Barre-Syndrome

Scrub typhus is a vector-borne disease caused by Orientia tsutsugamushi. Clinical manifestations generally occur due to vasculitis and inflammation and can have variable degrees of systemic involvement. Meningoencephalitis and cerebellitis are well-known neurological manifestations of scrub typhus, but the occurrence of Guillain-Barré syndrome is extremely rare. The authors report a 7-y-old boy who developed fever followed by rapidly progressive ascending quadriparesis with areflexia and whose etiological workup revealed positive IgM scrub typhus antibody, as well as, a high OXK titer (1:80). Nerve-conduction studies in all four limbs were suggestive of demyelinating neuropathy. He showed complete recovery after treatment with intravenous immunoglobulin (2 g/kg) and azithromycin.

Topics: Azithromycin; Guillain-Barre Syndrome; Humans; Immunoglobulin M; Immunoglobulins, Intravenous; Male; Orientia tsutsugamushi; Scrub Typhus

The new coronavirus 2019 epidemic declared in China on December 31, 2019 soon spread to the rest of the world, becoming the subject of an unprecedented health pandemic according to the World Health Organization's declaration of March 11, 2020. It is a disease that has the potential to cause multiple systemic infections. We report here the case of an acute polyradiculoneuritis of the Guillain-Barré type (GBS) indicative of a COVID-19 infection. This is a 41 year old patient seen for ascending, symmetrical and bilateral, progressive and acute tetraparesis with in a context of influenza syndrome and digestive infections treated 2 weeks earlier. During a COVID-19 infection, certain inflammatory cells stimulated by the virus produce inflammatory cytokines creating immune-mediated processes. The same mechanism is observed in GBS being also an immune-mediated disorder. The management of this disease in COVID-19 positive patients does not differ from that of patients who do not carry the virus. The risk of respiratory distress in COVID-19 positive patients becomes twice as great in patients with GBS who test positive for COVID-19 at the same time. Monitoring for hemodynamic disorders and respiratory distress in a neuro-intensive care unit may be fruitful.

Topics: Adult; Atrial Fibrillation; Azithromycin; Betacoronavirus; Chloroquine; Clinical Laboratory Techniques; Combined Modality Therapy; Contraindications, Drug; Coronavirus Infections; COVID-19; COVID-19 Testing; Early Diagnosis; Guillain-Barre Syndrome; Humans; Male; Muscle Weakness; Nasopharynx; Olfaction Disorders; Oxygen Inhalation Therapy; Pandemics; Pneumonia, Viral; Quadriplegia; Respiration, Artificial; SARS-CoV-2; Urinary Incontinence