Conclusion

Here, we report a case of GBS associated with malaria and COVID-19 co-infection. Considering that, both diseases are associated with GBS, on this case; it was challenging to attribute the GBS either one of the infections. Furthermore, GBS is considered a rare condition, this could be far from true but due to under-diagnosis and under-reporting. This urges for further studies to investigate the burden and risk factors associated with GBS in Sudan.
The current report demonstrates the first case of GBS that is associated with COVID-19 and malaria coinfection in Sudan. Therefore, healthcare providers need to be vigilant toward the neurological manifestation of all infectious diseases that associated with neurological syndromes including GBS for the early detection and a better case management.
References:
1 Shahrizaila N, Lehmann HC, Kuwabara S. Guillain-Barré syndrome.The lancet 2021; 397 : 1214–28.
2 Willison HJ, Jacobs BC, van Doorn PA. Guillain-barre syndrome.The Lancet 2016; 388 : 717–27.
3 Ap R, Se L, Sk H, et al. Guillain-Barré Syndrome Outbreak in Peru 2019 Associated With Campylobacter jejuni Infection.Neurology(R) neuroimmunology & neuroinflammation 2021;8 . DOI:10.1212/NXI.0000000000000952.
4 Aryal R, Karki S, Rajbhandari S, et al. Guillain‐Barré syndrome associated with Coronavirus disease 2019: A case from Nepal. Clin Case Rep 2022; 10 : e05638.
5 Trivedi S, Chakravarty A. Neurological Complications of Malaria.Curr Neurol Neurosci Rep 2022; 22 : 499–513.
6 Capasso A, Ompad DC, Vieira DL, Wilder-Smith A, Tozan Y. Incidence of Guillain-Barré Syndrome (GBS) in Latin America and the Caribbean before and during the 2015–2016 Zika virus epidemic: A systematic review and meta-analysis. PLOS Neglected Tropical Diseases 2019;13 : e0007622.
7 Keesen TSL, Almeida RP de, Gois BM, et al. Guillain-Barré syndrome and arboviral infection in Brazil. The Lancet Infectious Diseases 2017; 17 : 693–4.
8 Panda S, Sharma S, Bajpai N, Gopalakrishnan M, Kombade SP, Nag VL. A Rare Fatal Cause of Acute Areflexic Quadriparesis in the Tropics.Neurol India 2020; 68 : 1196–200.
9 Khan AS, Smith CV. Rift Valley fever: still an emerging infection after 3500 years. The Lancet Global Health 2016; 4 : e773–4.
10 Campbell GL, Marfin AA, Lanciotti RS, Gubler DJ. West Nile virus.The Lancet Infectious Diseases 2002; 2 : 519–29.
11 Leonhard SE, Tan CY, van der Eijk AA, et al. Antecedent infections in Guillain-Barré syndrome in endemic areas of arbovirus transmission: A multinational case-control study. Journal of the Peripheral Nervous System 2021; 26 : 449–60.
12 Johnson TP, Nath A. Neurological syndromes driven by postinfectious processes or unrecognized persistent infections. Current Opinion in Neurology 2018; 31 : 318.
13 Fasanaro A, Scoleri G, Pizza V, Gaeta G, Fasanaro A. Guillain-Barré syndrome as presenting manifestation of visceral leishmaniasis.The Lancet 1991; 338 : 1142.
14 Dardiotis E, Sokratous M, Tsouris Z, et al. Association between Helicobacter pylori infection and Guillain-Barré Syndrome: A meta-analysis. European Journal of Clinical Investigation 2020;50 : e13218.
15 Ahmed A, Dietrich I, LaBeaud AD, Lindsay SW, Musa A, Weaver SC. Risks and Challenges of Arboviral Diseases in Sudan: The Urgent Need for Actions. Viruses 2020; 12 . DOI:10.3390/v12010081.
16 Elduma AH, LaBeaud AD, A. Plante J, Plante KS, Ahmed A. High Seroprevalence of Dengue Virus Infection in Sudan: Systematic Review and Meta-Analysis. Tropical Medicine and Infectious Disease 2020;5 : 120.
17 Ahmed A, Eldigail M, Elduma A, et al. First report of epidemic dengue fever and malaria co-infections among internally displaced persons in humanitarian camps of North Darfur, Sudan.International Journal of Infectious Diseases 2021; 108 : 513–6.
18 Ahmed A, Elduma A, Magboul B, Higazi T, Ali Y. The First Outbreak of Dengue Fever in Greater Darfur, Western Sudan. Tropical Medicine and Infectious Disease 2019; 4 : 43.
19 Ahmed A, Ali Y, Elmagboul B, et al. Dengue Fever in the Darfur Area, Western Sudan. Emerging Infect Dis 2019; 25 : 2126.
20 Ahmed A, Ali Y, Mohamed NS. Arboviral diseases: the emergence of a major yet ignored public health threat in Africa. The Lancet Planetary Health 2020; 4 : e555.
21 Ahmed A, Abubakr M, Sami H, Mahdi I, Mohamed NS, Zinsstag J. The First Molecular Detection of Aedes albopictus in Sudan Associates with Increased Outbreaks of Chikungunya and Dengue. International Journal of Molecular Sciences 2022; 23 : 11802.
22 Ahmed A, Ali Y, Salim B, Dietrich I, Zinsstag J. Epidemics of Crimean-Congo Hemorrhagic Fever (CCHF) in Sudan between 2010 and 2020.Microorganisms 2022; 10 : 928.
23 Ahmed A, Mohamed NS, EL-Sadig SM, et al. COVID-19 in Sudan.The Journal of Infection in Developing Countries 2021;15 : 204–8.
24 Aljak ER, Eldigail M, Mahmoud I, et al. The first laboratory-confirmed imported infections of SARS-CoV-2 in Sudan.Transactions of The Royal Society of Tropical Medicine and Hygiene 2020; published online Dec 15. DOI:10.1093/trstmh/traa151.
25 Soghaier MA, Abdelgadir DM, Abdelkhalig SM, et al. Evidence of pre-existing active Zika virus circulation in Sudan prior to 2012.BMC Research Notes 2018; 11 . DOI:10.1186/s13104-018-4027-9.
26 Depoortere E, Kavle J, Keus K, Zeller H, Murri S, Legros D. Outbreak of West Nile virus causing severe neurological involvement in children, Nuba Mountains, Sudan, 2002. Tropical Medicine & International Health 2004; 9 : 730–6.
27 Mohamed AK, Elhassan NM, Awhag ZA, et al. Prevalence of Helicobacter pylori among Sudanese patients diagnosed with colon polyps and colon cancer using immunohistochemistry technique. BMC Res Notes 2020; 13 : 322.
28 Mohamed NS, Osman HA, Muneer MS, et al. Identifying asymptomatic Leishmania infections in non-endemic villages in Gedaref state, Sudan. BMC Research Notes 2019; 12 : 566.
29 Mohamed NS, Ali Y, Muneer MS, Siddig EE, Sibley CH, Ahmed A. Malaria epidemic in humanitarian crisis settings the case of South Kordofan state, Sudan. The Journal of Infection in Developing Countries2021; 15 : 168–71.
30 Ahmed A, Elbashir A, Mohamed AA, et al. Socioeconomic impacts of elimination of onchocerciasis in Abu-Hamed focus, northern Sudan: lessons after elimination. BMC Research Notes 2020; 13 : 256.
31 Elagali A, Ahmed A, Makki N, et al. Spatiotemporal mapping of malaria incidence in Sudan using routine surveillance data. Sci Rep 2022; 12 : 14114.
32 Ahmed A, El-Amin R, Musa AM, et al. Guillain-Barre syndrome associated with COVID-19 infection: A case series. Clinical Case Reports 2023; 11 : e6988.
33 van der Meché FGA, van Doorn PA. Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy: Immune mechanisms and update on current therapies. Annals of Neurology 1995; 37 : 14–31.
34 Kotepui M, Phunphuech B, Phiwklam N, Chupeerach C, Duangmano S. Effect of malarial infection on haematological parameters in population near Thailand-Myanmar border. Malaria Journal 2014; 13 : 218.
35 Ghahramani S, Tabrizi R, Lankarani KB, et al. Laboratory features of severe vs. non-severe COVID-19 patients in Asian populations: a systematic review and meta-analysis. European journal of medical research 2020; 25 : 1–10.
36 Wijesundere A. Guillain-Barré syndrome in Plasmodium falciparum malaria. Postgraduate medical journal 1992; 68 : 376.
37 Berkowitz AL, Thakur KT. Acute inflammatory demyelinating polyradiculoneuropathy following malaria. Journal of Clinical Neuroscience 2014; 21 : 704–6.
38 Gangula RS, Stanley W, Vandanapu A, Prabhu MM. Guillain-Barre syndrome with falciparum malaria and scrub typhus mixed infection-an unusual combination. Journal of Clinical and Diagnostic Research: JCDR 2017; 11 : OD10.
39 Marcus R. What Is Guillain-Barré Syndrome? JAMA 2023;329 : 602.
40 Ahmed A, Ali Y, Siddig EE, et al. Hepatitis E Virus Outbreak among Tigray War Refugees from Ethiopia, Sudan. Emerg Infect Dis2022; 28 : 1722–4.
41 Ahmed A, Ali Y, Elduma A, et al. Unique Outbreak of Rift Valley Fever in Sudan, 2019. Emerg Infect Dis 2020; 26 : 3030–3.
42 Ahmed A, Mahmoud I, Eldigail M, Elhassan RM, Weaver SC. The Emergence of Rift Valley Fever in Gedaref State Urges the Need for a Cross-Border One Health Strategy and Enforcement of the International Health Regulations. Pathogens 2021; 10 : 885.
43 Ahmed A. Urgent call for a global enforcement of the public sharing of health emergencies data: lesson learned from serious arboviral disease epidemics in Sudan. Int Health 2020; 12 : 238–40.
44 Ali Y, Ahmed A, Siddig EE, Mohamed NS. The role of integrated programs in the prevention of COVID-19 in a humanitarian setting.Transactions of The Royal Society of Tropical Medicine and Hygiene 2021; published online Aug 6. DOI:10.1093/trstmh/trab119.