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Cerebrospinal fluid biomarkers in patients with varicella-zoster virus CNS infections

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Abstract

Varicella-zoster virus (VZV) is one of our most common viruses causing central nervous system (CNS) infection with sometimes severe neurological complications. Glial fibrillary acidic protein (GFAp), light subunit of neurofilament protein (NFL) and S-100β protein are cerebrospinal fluid (CSF) biomarkers that have been used to estimate the severity of brain damage and outcome in various CNS diseases. So far, these biomarkers have not been utilised to investigate glial pathology and neuronal damage in patients with VZV CNS infections. In this prospective study, we measured CSF GFAp, NFL and S-100β as markers of brain damage in 24 patients with acute neurological manifestations and VZV DNA detected in CSF by PCR and compared with a control group (n = 14). Concentrations of CSF NFL and GFAp were increased in patients with VZV CNS infection compared with controls (p = 0.002 and p = 0.03) while levels of S-100β were reduced. In patients with VZV encephalitis the elevations of CSF NFL and GFAp were more pronounced compared with patients with other VZV CNS syndromes. No correlations between the levels of biomarkers and viral load, neurological sequels or clinical outcome were found in this limited number of patients. These results indicate that VZV induces neuronal damage and astrogliosis with more severe brain damage in patients with VZV encephalitis than in patients with other neurological complications caused by this virus.

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Acknowledgments

The study was supported by Sahlgrenska Academy at the University of Gothenburg (ALFGBG-212871), Western Gotaland Foundation for Research and Development and Gothenburg Medical Society. We also thank Kenny Brandström at Skaraborg Hospital, Skövde, Katarina Lund at Northern Älvsborg County Hospital, Uddevalla and Susanne Woxenius at Östra Hospital, Sahlgrenska, Gothenburg all at Department of Infectious diseases for helpful assistance in including the patients in this study.

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Authors declare no conflicts of interests.

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Authors and Affiliations

  1. Department of Infectious Diseases, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Östra, SE-416 85, Göteborg, Sweden

    Anna Grahn, Lars Hagberg & Marie Studahl

  2. Department of Mathematical Statistics, Chalmers University of Technology, SE-412 96, Göteborg, Sweden

    Staffan Nilsson

  3. Department of Clinical Neuroscience, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Mölndal, SE-431 80, Göteborg, Sweden

    Kaj Blennow & Henrik Zetterberg

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  1. Anna Grahn
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Correspondence to Anna Grahn.

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Grahn, A., Hagberg, L., Nilsson, S. et al. Cerebrospinal fluid biomarkers in patients with varicella-zoster virus CNS infections. J Neurol 260, 1813–1821 (2013). https://doi.org/10.1007/s00415-013-6883-5

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