Neurologic syndrome due to MERS: Is there a possibility that the virus can cross the blood-brain barrier to cause a neurological problem?

Dear Sir,

Middle East respiratory syndrome (MERS) is a new emerging coronavirus infection that is presently a big global public health problem. This infection can manifest as acute respiratory illness, which can end up in respiratory failure and death. ^[1] This multiorgan disorder can be seen in severe cases but the neurological complication has been rarely reported. Recently, Arabi et al. reported on the neurological problem due to MERS, which leads to the question about whether the MERS virus can cause a neurological disorder. ^[2] Generally, the blood-brain barrier has the protective property to prevent a virus from entering the central nervous system (CNS). The size of the MERS virus is about 150 nm to 320 nm. For the blood-brain barrier, the pore size is less than 1 nm. Based on this fact, it is not possible for passive flow to let the MERS virus enter the brain and this could be the explanation behind why there has been no reported neurological problem. Regarding the cases reported by Arabi et al., there might have been some underlying defect of the blood-brain barrier or the neurological problem might have been due to other etiologies.

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DOI: 10.4103/1755-6783.162654