A first case of meningitis/encephalitis associated with SARS-Coronavirus-2
Previous research showed that the novel coronavirus of 2019 (COVID-19), can lead to physical symptoms that are associated with the brain, such as headache, nausea and vomiting. This publication has described the first case of a 24-year-old man with COVID-19 and
meningitis. Meningitis is the inflammation of the protective layer that surrounds the brain and spinal cord. If a patient with meningitis is not treated quickly and appropriately, it can be a life-threatening emergency. As we know, COVID-19 has also shown to be harmful to health and can cause serious illness and death. Therefore, it is concerning for clinicians that as COVID-19 becomes more widespread, that these patients may also show signs of problems in the brain.
On the first day of symptoms, this patient reported having a headache, general tiredness and a fever. This led to him visiting a doctor who gave a diagnosis of the flu, prescribing the patient with medication that is used to treat viral infections (laninamivir) and reduce fever
(antipyretics). Upon worsening of these symptoms, a few days later he experienced a more troublesome headache and sore throat. He was then given an x-ray of the chest and a blood test, though these appeared to be normal. These problems persisted for the next couple of days where he was then found unconscious and had vomited. In the ambulance on the way to hospital the patient experienced seizures and had a stiff neck. In hospital, multiple investigations were completed to measure the patient’s level of consciousness (Glasgow coma scale), the health of the chest and brain using scans (computerised tomography [CT] and magnetic resonance imaging [MRI]) and by taking a sample of fluid from the spine. The examinations concluded that the patient should be treated in intensive care, for meningitis and pneumonia associated with COVID-19 infection.
The main finding of this study is that COVID-19 has the potential to have a dangerous impact on a patient’s brain. This supports early research on coronaviruses, that showed that they can cause serious harm outside of the respiratory system that we use to breathe. Recent findings also suggest that this may be because there are specific receptors in the brain that allow for COVID-19 to invade its cells and cause illness. For COVID-19 patients, clinicians should now be advised to assess for problems in the sinuses where meningitis can enter the brain and cause inflammation. This is also important to understand that COVID-19 infection may first present itself by problems relating to the brain, rather than typical signs of breathing illness such as a persistent cough and shortness of breath. Initial symptoms of COVID-19 have now shown to include headache and sickness which may suggest the presence of infection in a patient.
Moriguchi T, Harii N, Goto J, Harada D, Sugawara H, Takamino J et al, 2020 A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. International Journal of Infectious Diseases