Mengcui Gui,1,2 Peicai Fu,1,2 Lijun Luo,3 Qunhui Liu,4 Jun Chen,5 Zhongmou Han,6 Liying Chang,7 Hui Chen,8 Daokai Gong,9 Juan Chen,10 Yafang Liu,11 Rong Zhang,12 Ming Zhang,13 Mingqing Xiang,14 Xiaohua Yang,15 Jing Lin,1,2 Bitao Bu,1,2 Zhijun Li1,2 

1Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People’s Republic of China; 2Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China; 3Department of Neurology, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, Hubei, 430022, People’s Republic of China; 4Department of Neurology, the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi Clinical College of Wuhan University, Enshi, Hubei, 445099, People’s Republic of China; 5Department of Neurology, Taihe Hospital, Affiliated Hospital of Hubei University of Medicine, Shiyan, Hubei, 442099, People’s Republic of China; 6Department of Neurology, Yichang Central People’s Hospital, 1st Affiliated Hospital of China Three Gorges University, Yichang, Hubei, 443002, People’s Republic of China; 7Department of Neurology, Xiangyang Central Hospital, Hubei University of Arts and Science, Xiangyang, Hubei, 441106, People’s Republic of China; 8Department of Neurology, the People’s Hospital of Laifeng County, Enshi, Hubei, 445799, People’s Republic of China; 9Department of Neurology, Jingzhou Central Hospital, Yangtze University, Jingzhou, Hubei, 441021, People’s Republic of China; 10Department of Neurology, Minda Hospital of Hubei Minzu University, Enshi, Hubei, 445099, People’s Republic of China; 11Department of Neurology, Huangshi Central Hospital, Hubei Polytechnic University, Huangshi, Hubei, 435000, People’s Republic of China; 12Department of Neurology, Hubei Aerospace Hospital, Xiaogan, Hubei, 432009, People’s Republic of China; 13Department of Neurology, Jingmen Hospital of Traditional Chinese Medicine, Jingmen, Hubei, 448001, People’s Republic of China; 14Department of Neurology, the First People’s Hospital of Jingzhou, 1st Affiliated Hospital of Yangtze University, Jingzhou, Hubei, 434000, People’s Republic of China; 15Department of Neurology, the First People’s Hospital of Tianmen, Affiliated Hospital of Hubei University of Science and Technology, Tianmen, Hubei, 431701, People’s Republic of China

Correspondence: Zhijun Li, Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People’s Republic of China, Email Lizhijun@tjh.tjmu.edu.cn

Purpose: The largest nationwide outbreak of Omicron, a severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) variant, occurred between December 2022 and February 2023 in China. This multicenter case-control study investigated the clinical features of GBS during this period.
Methods: The clinical characteristics of patients diagnosed with GBS associated with SARS-CoV-2 were assessed during an Omicron outbreak at 14 referral hospitals in Hubei Province, Southern China. In the case-control study, patients with GBS were identified and diagnosed between 2021 and 2022 at Tongji Hospital in Wuhan, Hubei province.
Results: Forty-one patients were diagnosed with GBS during the Omicron outbreak. The median patient age was 57.5 years, and 51.2% were male. The median period between the preceding infection and onset of neurological symptoms was 10 days. The majority of the patients (38 cases [92.7%]) presented with classic sensorimotor neuropathy, with the lower limbs involved more often; 17 cases (41.5%) were accompanied by cranial neuropathies, which was most observed with the bilateral or unilateral facial paralysis (13 cases [31.7%]). Albuminocytologic dissociation was observed in 27 patients (71.1%), and mild pleocytosis was found in five patients (12.2%), with a maximum of 22 cells/mm3. Thirty-two patients finished the electrophysiological studies, and axonal variants were confirmed in 21 cases predominantly as acute motor-sensory axonal neuropathy (40.6%) or acute motor axonal neuropathy (25.0%). Anti-ganglioside antibodies were detected in 19 patients (46.3%). Intravenous immunoglobulin administration improved the patients’ symptoms.
Conclusion: The characteristics of SARS-CoV-2–associated GBS during the Omicron outbreak appear clinically as sensorimotor neuropathy, with a predominant electrophysiological axonal form. A mainly classic post-infectious immune-mediated mechanism may be involved in this process, such as a temporal profile of clinical symptoms, axon-associated autoantibodies, and improvement by immunotherapy.

Keywords: Guillain–Barré syndrome, omicron, sensorimotor neuropathy, axonal variants, post-infectious, immune-mediated mechanism