AUTHOR: SEOK WOO YANG, MD & PhD
CONTACT: soplab@outlook.kr
DATE: 2020.04.03
CONTENT:
There are many reports about the potential neural damage by COVID-19 coronaviruses in light of SARS coronaviruses.
As a cause of the sudden death by COVID-19, the neural injury at the brainstem and brain spread through the olfactory nerve is presumed to play a role in respiratory failure. [1]
One interesting fact in the patients with COVID-19 is the loss of smell and taste, about which the author suggested the possibility of provocation of inherent herpes neuritis in the trigeminal ganglion within the brain.[2]
In the endemic area of COVID-19, the author has treated many patients with bronchitis.
Among them, some patients had fevers. Interestingly they all had concurrent herpetic mucosal change in their oral pharynx. The herpes mucosal change was various from the overt herpes aphthous minute ulcer to discoloration of the pharynx, the latter of which may be equivocal among physicians. After being treated with acyclovir and antibiotics, acetaminophen, mucolytics, a physiologic dose steroid for bronchitis, the fevers were subsided after 1-day treatment.
Concerning another cause of sudden death by COVID-19, we need to focus on the possibility of the brainstem injury by inherent herpes neuritis in the brainstem or hypothalamus.[1]
But there is no statistical study about the presence of herpes viral infection in the brainstem or hypothalamus as yet.
The author experienced some cases with unknown fever, which at last proved to be herpes neuritis probably at the brainstem or/and hypothalamus involved in temperature control. The proof of herpes neuritis was measured by clinical improvement in response to acyclovir, valaciclovir, or famciclovir.
Like these cases, if patients have inherent herpes neuritis in the brainstem or hypothalamus and are newly affected with COVID-19, the antiviral immunity may be weakened, the condition of which provokes latent inherent herpes infection and aggravates COVID-19 coronaviral infection in the brainstem or hypothalamus. As a result of this event, the brainstem or hypothalamic injury may be induced and leading to the death of patients.
Unfortunately, this hypothesis can not be proved with MRI or blood tests. As the author's clinical experiences for several years, many patients with no abnormality in MRI or blood tests complained of their herpetic symptoms and eventually they were treated and clinically improved by taking in anti-herpetic drugs.
With the above facts on the concurrent and inherent herpes neuritis in the brainstem, the author thinks that the early prescription of acyclovir during treating bronchitis in the cases suspicious of COVID-19 may play a role in decreasing the mortality rate in the cases affected with the underlying herpes neuritis in the brainstem.
P.S.
About which to choose in antiherpetic drugs like acyclovir or famciclovir in the suspicious herpes neuritis in the patients with COVID-19, the author prefers to prescribing acyclovir as a first-line treatment. Famciclovir can be considered when there is no remarkable clinical improvement, even after using acyclovir.
REFERENCE:
[1] Li YC, Bai WZ, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may play
a role in the respiratory failure of COVID-19 patients. J Med Virol. 2020 Feb 27.
[2] Yang SW. Herpes Neuritis Should Be Checked After Treating With Hydroxychloroquine or Chloroquine: Medical Inference.
https://gracelive.tistory.com/64?category=838022.