An Uncommon Etiology of Progressive Multifocal Leuckoencephalopathy Poses Diagnostic Challenges in Sub-Saharan Africa: A Study of Six Case Series

BackgroundPatients hospitalised with COVID-19 often have ongoing morbidity affecting activities of daily living (ADLs), employment, and mental health.However, functional outcomes in patients with COVID-19 neurological or psychiatric complications are poorly understood.We aimed to assess post-discharge functional outcomes of these patients relative to those with isolated respiratory COVID-19. Design/MethodsWe conducted a UK multicentre case-control study of patients hospitalised with COVID-19 (controls) and those with acute neurological or psychiatric complications (cases).Data were collected from clinical records and participants followed-up at 13-16 months for assessment of ADLs, employment, anxiety, and depression. ResultsBetween March 2020-July 2022, for 651 patients (362 [56%] cases and 289 [44%] controls), where data were available, a higher proportion of cases than controls had impairment in ADLs (199 [68.9%] vs 101 [51.8%],OR [95%CI] 2.01 [1.40-2.98])and reported symptoms impacting employment (159 [58.2%] vs 69 [35.6%],OR 2.53 [1.72-3.71]).There was no significant difference in depression or anxiety between overall.For cases, impairment of ADLs was associated with increased risk in females, age >50 years and hypertension ).Those receiving either statins or angiotensin converting enzyme inhibitors had a lower risk (OR 0.09 [0.03-0.37],and 0.17 [0.03-0.84];AUROC 0.794 [0.71-0.88]). ConclusionsPatients with neurological or psychiatric complications of COVID-19 had worse functional outcomes than those with respiratory COVID-19 alone in terms of ADLs and employment.Female sex, age >50 years, and hypertension were associated with worse outcomes, and statins or ACE inhibitors with better outcomes.