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10.1093/cid/ciaa1933

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suck abstract from ncbi


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pmid33395482      Clin+Infect+Dis 2021 ; 73 (9): e3019-e3026
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  • Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Encephalitis Is a Cytokine Release Syndrome: Evidences From Cerebrospinal Fluid Analyses #MMPMID33395482
  • Pilotto A; Masciocchi S; Volonghi I; De Giuli V; Caprioli F; Mariotto S; Ferrari S; Bozzetti S; Imarisio A; Risi B; Premi E; Benussi A; Foca E; Castelli F; Zanusso G; Monaco S; Stefanelli P; Gasparotti R; Zekeridou A; McKeon A; Ashton NJ; BlennoW K; Zetterberg H; Padovani A
  • Clin Infect Dis 2021[Nov]; 73 (9): e3019-e3026 PMID33395482show ga
  • BACKGROUND: Recent findings indicated that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related neurological manifestations involve cytokine release syndrome along with endothelial activation, blood brain barrier dysfunction, and immune-mediated mechanisms. Very few studies have fully investigated the cerebrospinal fluid (CSF) correlates of SARS-CoV-2 encephalitis. METHODS: Patients with polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infection and encephalitis (COV-Enc), encephalitis without SARS-CoV-2 infection (ENC), and healthy controls (HC) underwent an extended panel of CSF neuronal (neurofilament light chain [NfL], T-tau), glial (glial fibrillary acidic protein [GFAP], soluble triggering receptor expressed on myeloid cells 2 [sTREM2], chitinase-3-like protein 1 [YKL-40]) and inflammatory biomarkers (interleukin [IL]-1beta, IL-6, Il-8, tumor necrosis factor [TNF] alpha, CXCL-13, and beta2-microglobulin). RESULTS: Thirteen COV-Enc, 21 ENC, and 18 HC entered the study. In COV-Enc cases, CSF was negative for SARS-CoV-2 real-time PCR but exhibited increased IL-8 levels independently from presence of pleocytosis/hyperproteinorracchia. COV-Enc patients showed increased IL-6, TNF- alpha, and beta2-microglobulin and glial markers (GFAP, sTREM2, YKL-40) levels similar to ENC but normal CXCL13 levels. Neuronal markers NfL and T-tau were abnormal only in severe cases. CONCLUSIONS: SARS-CoV-2-related encephalitis were associated with prominent glial activation and neuroinflammatory markers, whereas neuronal markers were increased in severe cases only. The pattern of CSF alterations suggested a cytokine-release syndrome as the main inflammatory mechanism of SARS-CoV-2-related encephalitis.
  • |*COVID-19[MESH]
  • |*Encephalitis[MESH]
  • |Cytokine Release Syndrome[MESH]
  • |Glial Fibrillary Acidic Protein[MESH]
  • |Humans[MESH]


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