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Scientists report possible case of Parkinson’s related to Covid-19

Publicado em 22 setembro 2020

Por Ana Bottallo | Folha de S.Paulo

SÃO PAULO, SP (FOLHAPRESS) – After the discovery that Sars-CoV-2 can invade and even attack human brain cells, a new report indicates a possible effect …

SÃO PAULO, SP (FOLHAPRESS) – After the discovery that Sars-CoV-2 can invade and even attack human brain cells, a new report indicates a possible effect of this invasion: Parkinson’s disease.

The case was recorded in a letter sent for publication in The Lancet by researchers at the Shaare Zedek Medical Center and the Hebrew University of Jerusalem in Israel.

Because it is a report, and not a scientific study, the ad consists of a single patient observed during the months of March to May this year. The authors say it is not possible to say with certainty that Sars-CoV-2 led to the disease, but reports of other viruses causing Parkinson’s, such as influenza A, Epstein-Barr, varicella-zoster, hepatitis C and even the West Nile virus are known in the medical literature.

The patient, a 45-year-old man, appeared on March 17 at the University Hospital Samson Assuta Ashdod with symptoms of dry cough and muscle pain that had started six days ago, two days after returning to the country from a trip to the United States . He reported that during the flight back there was a person with a severe cough sitting next to him. A few days later, he said he had a loss of smell.

After the positive result on the RT-PCR exam, the man remained in an exclusive ward for Covid-19. On the 25th and 30th of March, two new RT-PCR tests were negative and he was discharged, and that’s when he started to report Parkinson’s characteristic symptoms.

First, he described difficulties in writing text messages and speaking, as well as episodes of tremor in his right hand. At home, he continued to experience these symptoms and then went to the neurology department at Shaare Zedek Medical Center about two months after receiving Covid-19’s diagnosis.

The medical evaluation found speech difficulties, stiffness in the neck and in the right and left arm. Brain, blood and serological imaging tests showed normal levels of blood and defense cells in the body, and no significant changes were found in the image.

A new PET Scan test confirmed Parkinson’s condition due to changes in dopaminergic neurons, responsible for the production of dopamine.

Parkinson’s disease is related to the degeneration of cells at the base of the so-called dopaminergic system, associated with motor and cognitive functions. According to Augusto Penalva, a neurologist at the Instituto de Infectologia Emílio Ribas, it was a matter of time before Covid-related parkinson’s cases emerged.

“It is not really Parkinson’s disease, but what we call parkisonism, which is Parkinson’s symptomatology within an infectious disease context, which is well known in many circumstances. In AIDS itself, some neurological manifestations of HIV, such as cognitive and motor slowness are associated with parkinsonism. “

He explains that Sars-CoV-2 does not have a very specific cell specificity, being able to invade any cell containing the ECA2 molecule (angiotensin-converting enzyme 2) as a gateway, which favors the involvement of not only one, but several cell types of the central nervous system.

“In an expansion of the infection, with more than 30 million cases of Covid-19 in the world, it is evident that this would manifest itself because it [o vírus] it doesn’t have that great cell specificity. “

Penalva is also coordinator of a national study on neurological manifestations at Covid-19, the neurocovbr. The doctor explains that two cases of parkinsonism associated with Covid have been reported in the country, and one of the reports has already been published.

“We do not publish all the manifestations because the literature is already saturated with isolated cases. We are now working with cohorts to assess the effects and mechanisms of the late neurological manifestation of Sars-CoV-2.”

One of these effects is the compartmentalization of the virus in the brain long after there is no more detectable virus in the respiratory system. The neurologist tells a case of a patient in which it was possible to isolate the Sars-CoV-2 virus from the CSF three months after the end of the respiratory manifestation.

“We are now studying the consequences of this because the virus may not manifest this primary destructive effect, but it can alter homeostasis, and we don’t know what it can cause. Another point is the apparent low inflammation it causes in the brain, without generating a immune response. So what it can do and change in these cells we are still trying to understand. “

It is possible, he says, that due to the invasion of the virus in the brain long after it is no longer detectable in the airways, the number of people who actually contracted the disease is much greater, as there is still no evidence of the presence of antibodies to Sars-CoV-2 in this organ, unlike the lungs and heart.

“When you think about an infection issue, you need to think far beyond the acute infection. The persistence of this virus in the body can eventually modify the system and even adapt there.”

The neurocovbr national study receives support from Fapesp (São Paulo State Research Support Foundation) and CNPq (National Council for Scientific and Technological Development) and is carried out in São Paulo, at the Emílio Ribas Institute of Infectology, Albert Einstein and Santa Hospital Home, in Brasília, at UNB university hospital and Hospital Sírio-Libanês de Brasília and in Fortaleza, at Fortaleza General Hospital.