Encephalitis as a rare manifestation of novel COVID-19 disease, a para-infection or post-infection complication: A systematic review

Abstract

Objective. The novel coronavirus disease (COVID-19) is a global pandemic. Although the main clinical manifestations of the COVID-19 infection are confined to the respiratory system, there is evidence suggesting the COVID-19 potential to develop central nervous system complications. As there are limited reports of encephalitis associated with COVID-19 in the literature, in this systematic review, we will discuss the characteristics of encephalitis in patients with COVID-19. Material and methods. PubMed, Scopus, ProQuest, ScienceDirect, and Cochrane all from December 1, 2019, to May 25, 2020, were searched for related published articles. The keywords (in the title/abstract) “COVID-19” OR “novel Coronavirus” OR “SARS-CoV-2” AND “encephalitis” OR “meningoencephalitis” OR “encephalopathy” OR neurological complications” were used. We included all the case reports, case series, and letters to the editors. Outcomes. Through the search strategy, we identified nine related articles about encephalitis associated with COVID-19. Based on our results, although encephalitis is mainly presented in patients with severe COVID-19, it could occur in patients without respiratory symptoms and it might precede the typical features of COVID-19. Additionally, we did not find any exclusive age group or comorbidities predisposed the patients to encephalitis development. Conclusion. An increasing number of reports of COVID-19 patients with encephalitis raises the concern that SARS-CoV-2 is a neuropathogen that could target the brain regardless of respiratory symptoms.

Keywords

• covid-19
• sars-cov-2
• encephalitis
• meningoencephalitis
• encephalopathy