Hospital Geral de Fortaleza
Neurology

Author Of 3 Presentations

COVID-19 Late Breaking Abstracts

LB1241 - Incidence and clinical outcome of COVID-19 in a cohort of 11.560 Brazilian patients with Multiple Sclerosis (ID 2127)

Abstract

Background

Little information is available regarding the incidence and clinical outcome of the SARS-CoV-2 infection in patients with multiple sclerosis (pwMS).

Objectives

To determine incidence and severity of COVID-19 among pwMS, and to describe the impact of COVID-19 on MS clinical features.

Methods

This observational study was prospectively performed on a cohort of 11.560 Brazilian pwMS from 47 MS referral centers that registered patients with flu-like symptoms at the REDONE.br platform, from March 13th to June 4th 2020. Inclusion criteria were: i) MS diagnosis according to revised McDonald criteria and ii) clinical symptoms compatible with COVID-19 (cough, fever and asthenia). It was considered COVID-19 confirmed cases those with positive serological or SARS-CoV-2 polymerase chain reaction (PCR) test. Disease severity was classified as mild (home treatment), moderate (hospitalization) and critical (intensive care unit admission). Data related to demographic profile, comorbidity, COVID-19 symptoms, MS treatment and relapse were collected. Univariate and multi-variable regression logistic analysis were performed to identify the variables associated with a higher severity risk in COVID-19 patients.

Results

The incidence of COVID-19 for pwMS patients was 27.7/10.000 patients and for the general Brazilian population was 29.2/10.000 inhabitants at the same time interval (Risk Ratio [RR] 0.92, Confidence Interval (CI) 0.65-1.31, P=0.64). A total of 94 patients (82% female), aged 40 ±10.25 years, presenting 9.9±8.6 years of MS disease duration, developed COVID-19, 66% of them were classified as probable and 34% as confirmed cases by RT-PCR or antibody testing. Most pwMS presented mild (87%) COVID-19 form, that did not require hospitalization, whereas the remaining patients exhibited moderate (11%) and critical (2%) forms. Among critical patients, two developed sepsis and one pwMS (also diagnosed with cancer) died. Eighty (85%) patients maintained MS disease modifying treatment (DMT) during COVID-19 pandemic, and 14 (15%) patients were not in use of any DMT. New neurological manifestations included headache (54%) and anosmia or ageusia (46%). Thirteen (14%) patients evolved with worsening of previous MS symptoms, and a single case had MS relapse five days after infection. Age over 50 years (P=0.024), hypertension (P=0.036) and chronic pulmonary disease (P=0.021) were associated with COVID-19 severity at the univariate analysis. Applying multi-variable analyses, age over 50 years (P=0.010, OR 3.922, 95%CI 1.383-11.121) and the presence of more than one comorbidity (P=0.011; OR 37.329; 95%CI 2.279-611.445) were associated with unfavorable COVID-19 outcome.

Conclusions

Incidence of COVID-19 in Brazilian pwMS was not different from that observed for the general Brazilian population. Most pwMS exhibited mild COVID-19, despite the maintenance of MS treatment. There was MS relapse in only one patient.

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COVID-19 Late Breaking Abstracts

LB1247 - Clinical features of COVID-19 in patients with neuromyelitis optica spectrum disorders  (ID 2133)

Abstract

Background

Brazil is currently considered one of the main epicenters of the coronavirus disease 2019 (COVID-19). There are many concerns related to neuromyelitis optica spectrum disorders (NMOSD) patients. In addition to the older age of onset, higher disability and the higher rate of hospitalization compared to MS, many of the commonly used preventive therapies for NMOSD are cell depleting immunosuppressants with increased risk of viral and bacterial infections.

Objectives

To describe the frequency and clinical characteristics of COVID-19 in neuromyelitis optica spectrum disorder (NMOSD) patients in Brazil.

Methods

The Brazilian Study Group NMOSD of the Brazilian Academy of Neurology has set up the registration of COVID-19 cases in NMOSD patients, using a designed web-based case report form, encompassing neuroimmunology centers and individual neurologists across the country. Data collected between March 19thand July 31th 2020 were uploaded at the REDONE.br platform. Inclusion criteria were: (i) NMOSD diagnosis according to 2015 International Panel; (ii) confirmed SARS-Cov-2 infection (RT-PCR or serology) or clinical suspicion of COVID-19 diagnosed according to CDC/CSTE case definition. Demographic data, NMOSD clinical characteristics pre and post infection, comorbidities, immunosuppressive treatment, COVID-19 clinical features and severity were described.

Results

Among the 2,061 NMOSD patients inscribed at the REDONE.br platform, 34 patients (29 women) aged 37.1 years (range 8-77), with disease onset at 31.2 years (range 4-69) and disease duration of 5.9 years (range 0.2-20.5), developed COVID-19 (18 confirmed and 16 probable cases). Most patients exhibiting mild disease was treated at home (76.5%) and 4 patients needed treatment at intensive care units (severe cases); one patient died. Four patients had NMOSD relapse during the infection; one with partial recovery.

Conclusions

The clinical features of COVID-19 in NMOSD patients were described, stressing the combination of comorbidities and immunosuppression. Mild COVID-19 was the main presentation. Collaborative studies using shared NMOSD data are needed to suitably define factors related to COVID-19 outcome.

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COVID-19 Late Breaking Abstracts

LB1281 - Experience of a northeast Brazilian demyelinating disorders center in remote screening of COVID-19 during the sars-cov-2 pandemic. (ID 2181)

Abstract

Background

The coronavirus disease 2019 (COVID-19) crisis and the need to evaluate patients from distance due to social isolation has brought telemedicine into a new light. In response to the pandemic, our center for multiple sclerosis (MS) and other demyelinating disorders rapidly switched from in-person to remote telehealth care, initially to monitor disease activity and provide a COVID-19 remote screening.

Objectives

To apply remote screening for COVID-19 cases and asses the outcome for those that matched the clinical criteria, comparing the findings with the ongoing international data.

Methods

From April 1 to August 1, patients with MS and other demyelinating disorders in a reference center at Fortaleza-Brazil were submitted by phone call to clinical COVID-19 criteria. The criteria were: 1) Classical triad off fever, dry cough, and myalgia/fatigue/asthenia, 2) Sudden hyposmia or hypogeusia in the absence of nasal obstruction, 3) 2 of 4: fever, dry cough, myalgia/fatigue/asthenia, diarrhea/abdominal pain, hyposmia/hypogeusia with nasal obstruction. A follow-up call was made in 4 weeks average to assess the outcome.

Results

From 468 registered patients, 349 were successfully contacted by phone calls. 60 patients were defined as suspects, 53 answered the follow-up call. Of those, 84.9% were female and 67.9% were relapsing-remitting MS patients. The most common disease modifying drug in use was dimethyl fumarate (16.9%) and fingolimod (15.1%), the less being natalizumab (3.8%). 11.1% of them interrupted the current treatment during the crisis. The majority (77.4%) had no comorbidities and the most prevalent symptoms were headache (49%), myalgia (49%), hyposmia (45.2%) fever (43%), cough (43%) and hypogeusia (41%). About 45.2% reached medical care, but 58.5% were submitted to some sort of COVID-19 treatment, what implies in cases of self-medication, the most common being azithromycin (50.9%) and the less, chloroquine (9.4%). 2 patients were admitted to hospital care and there were no deaths. 26.4% were confirmed cases, 13.2% were discarded and 60.4% remained as suspects due to lack of diagnostic tests. 96.2% of the patients were asymptomatic by the follow up call.

Conclusions

We converted most of our patient care to telehealth encounters and were able to effectively submit them to a COVID-19 screening. The experience and the findings suggest that the strategy is feasible and effective. Although we had difficulties to apply laboratory diagnostic tests, our data was compatible with the ongoing literature and suggested that individuals with MS and other demyelinating disorders had similar COVID-19 clinical course as the general population.

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