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Clinical Features of COVID-19 on Patients With Neuromyelitis Optica Spectrum Disorders
Samira Luisa Apostolos-Pereira1, Lis Campos Ferreira1, Mateus Boaventura1
1From the Hospital das Clínicas (S.L.A., M.B., G.D.S., L.B., C.C.D.D., D.C.), FM-USP, São Paulo; Universidade Federal de Sergipe and Univ. Tiradentes (L.C.F.), Aracaju; Hospital Univ. Getúlio Vargas (N.A.d.C.S.), Manaus; Hospital Geral de Fortaleza (G.J.M., J.A.d.A., M.S.P., L.S.M.); Universidade Federal da Bahia/Ebserh (T.F.), Salvador; Hospital Ophir Loyola (H.L.S., L.C.R.), Belém; FUNAD (B.E.S.), João Pessoa; UNICAMP (C.R.A.), Campinas; Universidade Federal de São Paulo (E.M.L., L.d.S.A.), UNIFESP; Universidade Metropolitana de Santos (A.A.F.d.C., Y.D.F.); Santa Casa (A.P.G.), Belo Horizonte; Hospital da Restauração (M.I.d.M., A.J.P.), Recife; Santa Casa (R.P.C., M.F.M.), São Paulo; Hospital de Base do Distrito Federal (R.M.D.), Brasília; Hospital Santa Marcelina (A.C.P.), São Paulo; Private Service (A.K.), Cuiabá; Clínica AMO (A.M.), Salvador; Hospital Universitário Gaffree e Guinle (C.C.F.V.), Rio de Janeiro; Santa Casa (D.R.K.M.), Londrina; Universidade Federal de Goiás (D.S.D.), Goiânia; Private Service (E.R.C.-F.), Belo Horizonte; Faculdade de Medicina de Botucatu (F.C.G.D.R, D.G.B.), UNESP; Santa Casa and ABEM-Assoc. Brasileira de Esclerose Múltipla (G.S.d.O.), São Paulo; Universidade Estácio de Sá and Universidade Federal Fluminenses (G.A.C.), Rio de Janeiro; Universidade Federal Fluminense (H.H.R.), Campinas; Universidade Federal do Mato Grosso (H.H.S., J.A.F., L.S.), Cuiabá; Private Service (H.K.S.), Curitiba; IAMSPE (H.R.S.N.), São Paulo; Private Service (L.C.C.), São Paulo; Faculdade de Medicina de Marília (L.D.M.); Univ. da Região de Joinville (Univille) (M.V.M.G.); Santa Casa (M.L.V.P.), Rio de Janeiro; Univ. Federal R G Norte (M.E.T.D.), Natal; Univ. Federal Ciências da Saúde de Porto Alegre (M.d.C.R.); PUC (P.D.d.G.), Sorocaba; Hospital Israelita Albert Einstein (R.B.T.), São Paulo; Univ. Federal de Uberlândia (R.d.R.M.); Hospital Beneficência Portuguesa (S.G.), São Paulo; Hospital Memorial São José (S.S.), rede D'OR, Recife; Univ. Federal do Rio de Janeiro (S.N.M., V.C.S.R.P.); Private Service (S.N.M.), Florianópolis; Univ. Federal de Goiás (T.A.G.J.R.), Goiânia; Hospital Neurológico de Goiânia (V.M.C.); Pontifícia Universidade Católica de Campinas (M.M.d.M.P.); Hospital Universitário da Universidade Federal de Santa Catarina (A.W.d.N.J.), Florianópolis; Faculdade de Medicina de Ribeirão Preto (E.A.D.), USP; Hospital Sírio-Libanês (T.A.), São Paulo; and Faculty of Medicine (F.v.G.), University of Brasilia, Brazil.
Background And Objectives:
To describe the clinical features and disease outcomes of coronavirus disease 2019 (COVID-19) in patients with neuromyelitis optica spectrum disorder (NMOSD).
Methods:
The Neuroimmunology Brazilian Study Group has set up the report of severe acute respiratory syndrome (SARS-CoV2) cases in patients with NMOSD (pwNMOSD) using a designed web-based case report form. All neuroimmunology outpatient centers and individual neurologists were invited to register their patients across the country. Data collected between March 19 and July 25, 2020, were uploaded at the REDONE.br platform. Inclusion criteria were as follows: (1) NMOSD diagnosis according to the 2015 International Panel Criteria and (2) confirmed SARS-CoV2 infection (reverse transcription-polymerase chain reaction or serology) or clinical suspicion of COVID-19, diagnosed according to Center for Disease Control / Council of State and Territorial Epidemiologists (CDC/CSTE) case definition. Demographic and NMOSD-related clinical data, comorbidities, disease-modifying therapy (DMT), COVID-19 clinical features, and severity were described.
Results:
Among the 2,061 pwNMOSD followed up by Brazilian neurologists involved on the registry of COVID-19 in pwNMOSD at the REDONE.br platform, 34 patients (29 women) aged 37 years (range 8-77), with disease onset at 31 years (range 4-69) and disease duration of 6 years (range 0.2-20.5), developed COVID-19 (18 confirmed and 16 probable cases). Most patients exhibited mild disease, being treated at home (77%); 4 patients required admission at intensive care units (severe cases); and 1 patient died. Five of 34 (15%) presented neurologic manifestations (relapse or pseudoexacerbation) during or after SARS-CoV2 infection.
Discussion:
Most NMOSD patients with COVID-19 presented mild disease forms. However, pwNMOSD had much higher odds of hospitalization and intensive care unit admission comparing with the general Brazilian population. The frequency of death was not clearly different. NMOSD disability, DMT type, and comorbidities were not associated with COVID-19 outcome. SARS-CoV2 infection was demonstrated as a risk factor for NMOSD relapses. Collaborative studies using shared NMOSD data are needed to suitably define factors related to COVID-19 severity and neurologic manifestations.
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