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Title: Incidence, clinical characteristics, risk factors and outcomes of meningoencephalitis in patients with COVID-19
Author: Fragiel, Marcos
Miró i Andreu, Òscar
Llorens, Pere
Jiménez, Sònia
Piñera Salmerón, Pascual
Burillo Putze, Guillermo
Martín, Alfonso
Martín Sánchez, Francisco Javier
García Lamberechts, Eric Jorge
Jacob, Javier
Alquézar Arbé, Aitor
Llopis Roca, Ferran
Pedraza García, Jorge
Calvo López, Ricardo
Maza Vera, María Teresa
Lucas Imbernón, Francisco Javier
González Martinez, Félix
Juárez, Ricardo
Expósito Rodriguez, Marcos
Martinez Bautista, Beatriz Maria
Niembro Valdés, Ana Patricia
Sanchez Nicolas, Jose Andres
Ferreras Amez, José María
Porta Etessam, Jesús
Calvo, Elpidio
González del Castillo, Juan
Spanish Investigators on Emergency Situations TeAm (SIESTA) network
Keywords: COVID-19
Malalties cerebrals
Brain diseases
Issue Date: 9-Mar-2021
Publisher: Springer Nature
Abstract: We investigated the incidence, clinical characteristics, risk factors, and outcome of meningoencephalitis (ME) in patients with COVID-19 attending emergency departments (ED), before hospitalization. We retrospectively reviewed all COVID patients diagnosed with ME in 61 Spanish EDs (20% of Spanish EDs, COVID-ME) during the COVID pandemic. We formed two control groups: non-COVID patients with ME (non-COVID-ME) and COVID patients without ME (COVID-non-ME). Unadjusted comparisons between cases and controls were performed regarding 57 baseline and clinical characteristics and 4 outcomes. Cerebrospinal fluid (CSF) biochemical and serologic findings of COVID-ME and non-COVID-ME were also investigated. We identified 29 ME in 71,904 patients with COVID-19 attending EDs (0.40‰, 95%CI=0.27-0.58). This incidence was higher than that observed in non-COVID patients (150/1,358,134, 0.11‰, 95%CI=0.09-0.13; OR=3.65, 95%CI=2.45-5.44). With respect to non-COVID-ME, COVID-ME more frequently had dyspnea and chest X-ray abnormalities, and neck stiffness was less frequent (OR=0.3, 95%CI=0.1-0.9). In 69.0% of COVID-ME, CSF cells were predominantly lymphocytes, and SARS-CoV-2 antigen was detected by RT-PCR in 1 patient. The clinical characteristics associated with a higher risk of presenting ME in COVID patients were vomiting (OR=3.7, 95%CI=1.4-10.2), headache (OR=24.7, 95%CI=10.2-60.1), and altered mental status (OR=12.9, 95%CI=6.6-25.0). COVID-ME patients had a higher in-hospital mortality than non-COVID-ME patients (OR=2.26; 95%CI=1.04-4.48), and a higher need for hospitalization (OR=8.02; 95%CI=1.19-66.7) and intensive care admission (OR=5.89; 95%CI=3.12-11.14) than COVID-non-ME patients. ME is an unusual form of COVID presentation (<0.5‰ cases), but is more than 4-fold more frequent than in non-COVID patients attending the ED. As the majority of these MEs had lymphocytic predominance and in one patient SARS-CoV-2 antigen was detected in CSF, SARS-CoV-2 could be the cause of most of the cases observed. COVID-ME patients had a higher unadjusted in-hospital mortality than non-COVID-ME patients.
Note: Reproducció del document publicat a:
It is part of: European Journal of Clinical Microbiology & Infectious Diseases, 2021
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Appears in Collections:Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)
Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))

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