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\begin{document}

\title{Childhood Guillain-Barre\selectlanguage{ngerman}´ syndrome in the SARS-CoV-2 Era: Is there any
causative relation?\selectlanguage{english}}



\author[1]{Elham Pourbakhtyaran}%
\author[1]{Morteza Heidari}%
\author[1]{Masood  Ghahvechi Akbar}%
\author[1]{Mahmoud  Mohammadi}%
\author[1]{Reza Shervin  Badv}%
\author[1]{Gholam Reza Zamani}%
\author[1]{Ali Reza  Tavasoli}%
\author[1]{Zahra  Rezaei}%
\author[1]{Setareh Mamishi}%
\author[1]{Elmira  Haji Esmaeil Memar }%
\author[1]{Seyyed Mohammad Mahdi Hosseiny }%
\author[1]{Homa Ghabeli}%
\author[1]{Roya Haghighi}%
\author[1]{Mahmoud Reza  Ashrafi}%
\affil[1]{Tehran University of Medical Sciences}%


\vspace{-1em}



  
  \date{May 18, 2024}


\begingroup
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\selectlanguage{english}
\begin{abstract}
We reported an association between SARS-CoV-2 infection and
Guillain-Barre\selectlanguage{ngerman}´ syndrome (GBS). From 37 patients with GBS, Previous
SARS-CoV-2 infection clues, including fever, cough, and diarrhea were
recorded in 18 patients. Among them, SARS-CoV-2 IgG was detected in 7
patients, considered confirmed cases. SARS-CoV-2 PCR was positive in
just 1 patient.%
\end{abstract}\selectlanguage{ngerman}%



\sloppy


\selectlanguage{ngerman}\textbf{Childhood Guillain-Barre´ syndrome in the SARS-CoV-2 Era: Is
there any causative relation?}

Elham Pourbakhtyaran \selectlanguage{english}\textsuperscript{a, +}, Morteza
Heidari\selectlanguage{english}\textsuperscript{a, b, +}, Masoud Ghahvehchi Akbari
\textsuperscript{c}, Mahmoud Mohammadi \textsuperscript{a}, Reza Shervin
Badv\textsuperscript{a}, Gholam Reza Zamani \textsuperscript{a}, Ali
Reza Tavasoli \textsuperscript{a, b}, Zahra Rezaei \textsuperscript{a},
Setareh Mamishi \textsuperscript{d}, Elmira Haji Esmaeil
Memar\textsuperscript{e}, Seyyed Mohammad Mahdi Hosseiny
\textsuperscript{f}, Homa Ghabeli \textsuperscript{a}, Roya Haghighi
\textsuperscript{a}, Mahmoudreza Ashrafi \textsuperscript{a,}*

\textsuperscript{a} Department of Pediatric Neurology, Pediatrics Center
of Excellence, Children's Medical Center, Tehran University of Medical
Sciences, Tehran, Iran.\textsuperscript{b} Myelin Disorders Clinic,
Pediatric Neurology Division, Children's Medical Center, Pediatrics
Center of Excellence, Tehran University of Medical Sciences, Tehran,
Iran.\textsuperscript{c} Department of Physical Medicine and
Rehabilitation, Pediatrics Center of Excellence, Children's Medical
Center, Tehran University of Medical Sciences, Tehran,
Iran.\textsuperscript{d} Pediatric Infectious Disease Research Center,
Tehran University of Medical Sciences, Tehran, Iran.\textsuperscript{e}
Pediatrics Center of Excellence, Children's Medical Center, Tehran
University of Medical Sciences, Tehran, Iran.\textsuperscript{f}
Department of Pediatric Neurology, School of Medicine, Hamadan
University of medical sciences, Hamadan, Iran.

\selectlanguage{english}\textbf{+ Elham Pourbakhtyaran and Morteza Heidari have an equal
contribution as the first author}

\textbf{*Corresponding Author:}

Mahmoudreza Ashrafi, MD, Professor of Pediatric Neurology

Pediatrics Center of Excellence, Department of Pediatric Neurology,
Children's Medical Center, Tehran University of Medical Sciences, Gharib
St, Tehran, 1419733141, Iran.

Email address: ashrafim@tums.ac.ir

\textbf{Abstract}

We reported an association between SARS-CoV-2 infection and
Guillain-Barre' syndrome (GBS). From 37 patients with GBS, Previous
SARS-CoV-2 infection clues, including fever, cough, and diarrhea were
recorded in 18 patients. Among them, SARS-CoV-2 IgG was detected in 7
patients, considered confirmed cases. SARS-CoV-2 PCR was positive in
just 1 patient. Consistent with previous studies, we found no increase
in patient recruitment during the pandemic compared to previous years,
however, our study indicated that SARS-CoV-2 is associated with poorer
outcomes. Studies with more sample size are required to determine if
there is a causative association or not.

\textbf{Keywords:} Guillain-Barre' syndrome, SARS-CoV-2, Pediatric

\textbf{Introduction}

As previous reports of neurologic manifestations of coronaviruses, it
was expected that we would find these neurological disorders in the
severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including
headache, seizures, cerebrovascular disorders and Guillain-Barre
Syndrome (GBS).(1)(2) \selectlanguage{english}

GBS is an immune-mediated peripheral neuropathy, typically characterized
by rapidly progressive bilateral and often symmetrical loss of sensory
and motor functions of the limbs. It might also involve respiratory or
cranial nerve-innervated muscles. (3) GBS is usually preceded by an
infection that often has been caused by \emph{Campylobacterjejuni} or
other bacterial or viral agents. (4) GBS has been associated with
respiratory viral pathogens such as human coronaviruses(5); therefore,
an outbreak of some viral infections may lead to increased admission of
GBS patients.

Based on clinical and electrophysiologic studies, GBS is divided into
several subtypes, including acute inflammatory demyelinating
polyradiculoneuropathy (AIDP), two axonal forms of GBS including acute
motor-sensory axonal neuropathy (AMSAN) and acute motor axonal
neuropathy (AMAN) and Miller Fisher syndrome (MFS).(6) Preceding
infections may result in special clinical and electrophysiological
subtypes of GBS.(7)

Recently, after the pandemic, there are some neurologic complications in
children, associated with the severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2). Of forty-nine adult patients with GBS, eight
(16\%) had a confirmed and three (6\%) a probable SARS-CoV-2 infection.
(7) A 6-year-old male ad been reported with a rapid progression axonal
GBS and positive SARS-CoV-2 infection. (8) SARS-CoV-2-GBS outcome is
worse compared to other GBS patients, and the prevalence/incidence of
GBS most likely increased since the outbreak of the pandemic. (9)

During the SARS-CoV-2 pandemic, we assumed that the incidence of GBS had
increased, and the subtypes may change, therefore, we set up a
prospective study for neurological manifestations of SARS-CoV-2
infections in the Children's Medical Center (CMC), Tehran, which is one
of the largest referral pediatric centers in Iran. We report the
clinical finding, electrophysiological subtype, and disease course of
all GBS patients during the 17 months period of study.

\textbf{Materials and methods}

This prospective study was performed in Children Medical Center, Tehran,
Iran, from March 2020 to August 2021. All patients' parents had assigned
the consent form. This study was approved by the Ethics Committee of
Tehran University of Medical Sciences, (Ethic code: IR.TUMS.VCR.REC.
1399.326)

All admitted children that fulfill the diagnostic criteria for GBS
(National Institute of Neurological Disorders and Stroke) enrolled
during the study period.(8) Exclusion criteria for this study were as
follows: other neurological diseases, which could affect brain function,
sequelae neurologic deficits that could affect the evaluation of GBS
severity.

Demographic data, associated symptoms, GBS severity according to
disability scores (1) on admission and discharge time, clinical and
electrophysiologic features, SARS-CoV-2 status, and other important data
were recorded in a structured questionnaire. All patients with GBS
underwent standard treatment by IVIG as indicated. Data analyzed with
suitable statistical methods.

Clinical suspicion of SARS-CoV-2 infection, laboratory, radiological,
and serological evidence recorded for all patients.
Reverse-transcription polymerase chain reaction (RT-PCR) of
nasopharyngeal swab specimen and serum antibodies (IgM and IgG) were
requested for all patients. Patients with positive SARS-CoV-2 PCR or
antibodies defined as confirmed SARS-CoV-2 cases and those with clinical
symptoms including fever, diarrhea, and upper respiratory complaints or
imaging finding in favor of SARS-CoV-2 or contact with confirmed
SARS-CoV-2 cases before neurologic signs considered as probable
SARS-CoV-2 cases.(9)

\textbf{Results}

Of 37 patients with GBS, 28 were male and 9 were female. The mean age
was 8.19\selectlanguage{ngerman}±3.49 years, ranging from 2.5 to 15 years. The frequency of
previous SARS-CoV-2 infection clues, including fever, cough, and
diarrhea was 48\%. SARS-CoV-2 PCR or antibodies was detected in 7
patients (19\%), considered as confirmed cases. Among them, SARS-CoV-2
PCR was positive in just 1 patient. The overall frequency of confirmed
plus probable SARS-CoV-2 in GBS patients was 60 \% (N=22). The median
time from the onset of infection to neurological symptoms was 11.25±8.44
days (ranging from 2 to 30 days). Demographic data and clinical findings
according to SARS-Cov-2 infection status are noted in table1.

All patients underwent electrophysiological examination and acute axonal
type motor polyneuropathy was the most prevalent type in both SARS-CoV-2
positive and negative patients. The second frequent type was acute
segmental demyelinating motor polyradiculoneuropathy. The disability
scale in most of the patients on admission and on discharge was 3 in
43.2\% and 54.1\%, respectively.

AMAN was the most frequent subtype of GBS in all our patients (65\%),
apart from SARS-CoV-2 infection status. The second frequent subtype was
AIDP (32\%) and the AMSAN subtype was detected in just one SARS-CoV-2
infection-negative patient. These findings were not significantly
different between SARS-CoV-2 infection positive and negative cases.

GBS disability scale 4 \selectlanguage{english}[?] of 6 and at presentation, in confirmed patients
with SARS-CoV-2 infection was 57\%, in comparison to 20\% in SARS-CoV-2
infection negative patients, with was statistically significant. GBS
disability scale (DS) on admission was 5 out of 6. One patient was an
obese 8-year-old boy with a history of fever 14 days before weakness
onset SARS-CoV-2 IgG was positive. During 24 hours of lower limb
weakness, the ascending process involved the respiratory system and he
was intubated for about 2 weeks and then underwent tracheostomy for 2
months later. Another patient was a 15-year-old girl with a history of
lupus erythematous and URI symptoms around 3 weeks before weakness,
however, SARS-CoV-2 antibodies or PCR was negative. She had ascending
weakness and diplopia, after one week of the disease, she underwent
intubation for 3 weeks and then tracheostomy for 1.5 months later. Both
patients had refractory hypertension and tachycardia. Treatment was
challenging and they received IVIG. After 4 weeks of treatment, they
received high dose of methylprednisolone, due to poor response to IVIG.
Electrophysiology study was in favor of acute motor axonal neuropathy in
both of them. They had the longest hospital admission time which was
around 90 and 60 days, respectively.

The mean of hospital admission time, among confirmed SARS-CoV-2
infection patients, was 19.7 days, and among confirmed plus probable
SARS-CoV-2 infection was 11.8 days. These amounts are significantly
higher than 5.5 days in SARS-CoV-2 infection-negative patients
(p-value\textless{}0.05). Hospital stay was longer in around 8-year-old
patients, with a mean of 20 days. Acute axonal type motor polyneuropathy
was associated with the longest admission time (mean 11.78+-20.32 days,
ranging from 4 to 89 days). This variable was longer in SARS-CoV-2
positive in comparison to those with negative SARS-CoV-2.

\textbf{Discussion}

In a study of 81 patients, most patients were diagnosed with AIDP. Three
of the patients died at the end of the first month. Three patients had
recurrent GBS. 74 patients received IVIG while eight patients were
treated with plasma exchange after IVIG because of ineffective
treatment. 7 of the patients were followed without treatment. (4)

Among 49 children with GBS, rapid progression to maximum paralysis was
seen in the male gender, while the older age group in pediatrics is
expected to endure residual paralysis at 60 days after disease onset.
Patients in colder seasons were more likely to have residual paralysis
too, compared to warmer seasons. (5)

Among 30 children with GBS diagnosis, in Iran, 12 participants were
diagnosed with acute inflammatory demyelinating polyradiculoneuropathy
and 18 patients were diagnosed with acute motor axonal neuropathy.(6)
GBS is usually preceded by an infectious viral or bacterial process (4).
Here, we investigated the association between SARS-CoV-2 and GBS in
children. We performed a study from March 2014 to 2017, in a tertiary
children's hospital that enrolled 69 children with GBS. The prevalence
of GBS in the new study, during the SARS-CoV-2 pandemic, is higher,
however, this difference is not statistically valuable.

The male to female ratio in our study was 3.1, and among confirmed
cases, this ratio was 2.5. in a study by M. Ashrafi et al. (10), in
2008, in Iran, this ratio was 1.05, which may reflect the higher male
involvement during SARS-CoV-2 pandemic.

The frequency (60\%) of a preceding SARS-CoV-2 infection track(confirmed
plus probable cases) in our study population was higher than estimates
in a multicenter study by Luijten LWG, et al.(11) on adults with GBS,
which was 22\%. This may reflect the higher incidence of SARS-CoV-2
infection in Iran, during that time, which was about 1 million in 80
million population according to an official report of the ministry of
health and medical education of Iran.

Disability scale 4 \selectlanguage{english}[?] of 6 and at presentation, in confirmed patients
with SARS-CoV-2 infection was 57\%, in comparison to 20\% in SARS-CoV-2
infection negative patients, with was statistically significant. Just
as, we had one intubated patient in confirmed and one in probable cases.
These findings along with the longest hospital admission time in
SARS-CoV-2 infection patients may reflect a poorer prognosis among
SARS-CoV-2 infection patients.

AMAN was the most frequent subtype of GBS in all our patients (65\%),
apart from SARS-CoV-2 infection status. This
finding\textbackslash{}sout, is concordant with a study of M. Ashrafi et
al.(12), in Iran and different from studies of other countries, with
AIDP predominance.(13) The second frequent subtype was AIDP (32\%) and
AMSAN was detected in just one SARS-CoV-2 infection negative patient.
These findings were not significantly different between SARS-CoV-2
infection positive and negative cases.

\textbf{Conclusion}

Consistent with previous studies, we found no increase in GBS patient
recruitment during the pandemic compared to previous years, however, our
study indicated that SARS-CoV-2 is associated with poorer outcomes.
Studies with more sample size are required to determine if there is a
causative association or not.

\textbf{Declarations}

\textbf{Funding}

The authors declare that they have no funding.

\textbf{Conflicts of interest/Competing interests}

The authors declare that they have no conflict of interest

\textbf{Availability of data and materials}

The datasets used and/or analyzed during the current study are available
from the corresponding author on reasonable request.

\textbf{Ethics approval and consent to participate}

Ethics approval obtained from the Tehran University of Medical Sciences
(approval number: IR.TUMS.VCR.REC.1399.326). Participants provided
written informed consent for inclusion in the study, in accordance with
the ethical guidelines by the ethics committee of Tehran University of
Medical Sciences.

\textbf{CRediT authorship contribution statement}

\textbf{M.A., M.H.:} ~Conceptualization, Methodology,
Software.~\textbf{E.P., M.H., A.R.T.} : Data curation, Writing- Original
draft preparation.~\textbf{RSB, M.M, G.R.Z., M.G.A., E.H.E.M., R.H.} :
Visualization, Investigation.~\textbf{M.A., S.M., M.H.:}
Supervision.\textbf{S.M.M.H., H.G., Z.R.} : Software, Validation.
\textbf{E.P., M.H.:} ~Writing- Reviewing and Editing. All authors read
and approved the final manuscript.

\textbf{Acknowledgments}

We thank all the participating patients for their generous contributions
to this study.

\textbf{Authors' information}

\textbf{ORCID}

Morteza Heidari: https://orcid.org/0000-0002-7487-569X

Elham Pourbakhtyaran: https://orcid.org/0000-0001-5685-2753

\textbf{LEGEND}

\textbf{Table1:} frequency of demographic and clinical findings
according to SARS-CoV-2 infection status

\textbf{References}

1. Ashrafi MR, Azizimalamiri R, Badv RS, Tavasoli AR, Nikkhah A,
Montazerlotfelahi H, et al. Coronavirus, its neurologic manifestations,
and complications. Iran J Pediatr. 2020;30(2):1--4.

2. Ashrafi MR, Mohammadi M, Zamani G, Khosroshahi N, Badv RS, Tavasoli
A, et al. We need well-designed multicenter studies to investigate
neurologic manifestations of coronavirus disease 2019. Curr J Neurol.
2020;19(3):150--1.

3. van Koningsveld R, Steyerberg EW, Hughes RA, Swan A V., van Doorn PA,
Jacobs BC. A clinical prognostic scoring system for Guillain-Barre
syndrome. Lancet Neurol. 2007;6(7):589--94.

4. Gonzalez-Suarez I, Sanz-Gallego I, Rodriguez de Rivera FJ, Arpa J.
Guillain-Barre Syndrome: Natural history and prognostic factors: A
retrospective review of 106 cases. BMC Neurol. 2013;13:2--7.

5. Robinson CP, Busl KM. Neurologic Manifestations of Severe Respiratory
Viral Contagions. Crit Care Explor. 2020;2(4):e0107.

6. Hung PL, Chang WN, Huang LT, Huang SC, Chang YC, Chang CJ, et al. A
clinical and electrophysiologic survey of childhood Guillain- Barre
syndrome. Pediatr Neurol. 2004;30(2):86--91.

7. Jacobs BC, Van Doorn PA, Schmitz PIM, Tio-Gillen AP, Herbrink P,
Visser LH, et al. Campylobacter jejuni infections and anti-GM1
antibodies in Guillain- Barre syndrome. Ann Neurol. 1996;40(2):181--7.

8. Asbury AK, Cornblath DR. Assessment of current diagnostic criteria
for Guillain\selectlanguage{english}-Barre syndrome. Ann Neurol. 1990;27(1 S):S21--4.

9. European Centre for Disease Prevention and Control. Case definition
for coronavirus disease 2019 (COVID-19) as of 29 M 2020. A 1 S 2020.
https://www. ecdc. europa. eu. en/covid-19/surveillance/case-definition.
No Title.

10. Ashrafi MR, Sagheb S, Mohammadi M, Vakili A, Nasirian A, Zamani GR.
Clinical short term outcome of Guillain-Barre syndrome in children. Iran
J Pediatr. 2008;18(1):11--9.

11. Luijten LWG, Leonhard SE, van der Eijk AA, Doets AY, Appeltshauser
L, Arends S, et al. Guillain-Barre syndrome after SARS-CoV-2 infection
in an international prospective cohort study. Brain. 2021;

12. Ashrafi MR, Mohammadalipoor A, Naeini AR, Amanat M, Tavasoli AR,
Heidari M, et al. Clinical Characteristics and Electrodiagnostic
Features of Guillain-Barre Syndrome Among the Pediatric Population. J
Child Neurol. 2020;35(7):448--55.

13. Tekgul H, Serdaroglu G, Tutuncuoglu S. Outcome of Axonal and
Demyelinating Forms of Guillain-Barre ' Syndrome in Children.
2003;8994(02):295--9.

\textbf{Table1:} Frequency of demographic and clinical findings
according to SARS-Cov-2 infection status\selectlanguage{english}
\begin{longtable}[]{@{}lllll@{}}
\toprule
\begin{minipage}[b]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[b]{0.17\columnwidth}\raggedright\strut
SARS-CoV-2 negative(N=15)\strut
\end{minipage} & \begin{minipage}[b]{0.17\columnwidth}\raggedright\strut
Confirmed SARS-CoV-2 (N=7)\strut
\end{minipage} & \begin{minipage}[b]{0.17\columnwidth}\raggedright\strut
Confirmed and Probable SARS-CoV-2(N=22)\strut
\end{minipage} & \begin{minipage}[b]{0.17\columnwidth}\raggedright\strut
Total (N=37)\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Sex\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Sex\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Sex\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Sex\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Male Female\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
12(80\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
5(71\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
16(72)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
28(76\%)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3(20\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2(29\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
6(28\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
9(24\%)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textsuperscript{*}Previous suspected symptoms\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textsuperscript{*}Previous suspected symptoms\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textsuperscript{*}Previous suspected symptoms\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textsuperscript{*}Previous suspected symptoms\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Fever Diarrhea URI\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
2(28\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
8(36\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
8(22\%)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1(14\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
6(27\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
6(16\%)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2(28\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
10(45\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
10(27\%)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textsuperscript{**}Disability scale on admission\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textsuperscript{**}Disability scale on admission\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textsuperscript{**}Disability scale on admission\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textsuperscript{**}Disability scale on admission\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
5(33\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
6(27\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
11(30\%)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
7(47\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3(43\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
9(41\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
16(43\%)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
4\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3(20\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3(43\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
5(23\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
8(22\%)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
5\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1(14\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2(9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2(5\%)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
6\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Electrodiagnostic findings\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Electrodiagnostic findings\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Electrodiagnostic findings\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Electrodiagnostic findings\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
AIDP\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
4(26\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2(29\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
8(36\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
12(32\%)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
AMAN\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
10(67\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
5(71\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
14(64\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
24(65\%)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
AMSAN\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1(17\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1(3\%)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Disability scale at discharge\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Disability scale at discharge\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Disability scale at discharge\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Disability scale at discharge\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1(4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1(3\%)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
5(33\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1(14\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
6(27\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
11(30\%)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
7(47\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
4(57\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
13(60\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
20(54\%)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
4\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3(20\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2(29\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2(9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
5(13\%)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
5\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
6\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

\textsuperscript{*} Please notice that the number of symptoms does not
refer to number of patients, necessarily, as one patient may have more
than one symptom. Two confirmed patients had no symptoms.

\textsuperscript{**} Disability Score

0 Healthy

1 Minor symptom and capable of running

2 Able to walk 5m or more without assistance, but unable to run

3 Able to walk 5 m across an open space with help

4 Bedridden or chairbound

5 Requiring assisted ventilation for at least part of the day

6 Death

\selectlanguage{english}
\FloatBarrier
\end{document}

