title: Cerebrospinal fluid biomarkers in patients with varicella-zoster virus CNS infections.
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.
authors.affiliation: Department of Infectious Diseases, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Östra, SE-416 85 Göteborg, Sweden. anna.m.grahn@vgregion.se
authors.forename: Anna
authors.initials: A
authors.lastname: Grahn
authors.forename: Lars
authors.initials: L
authors.lastname: Hagberg
authors.forename: Staffan
authors.initials: S
authors.lastname: Nilsson
authors.forename: Kaj
authors.initials: K
authors.lastname: Blennow
authors.forename: Henrik
authors.initials: H
authors.lastname: Zetterberg
authors.forename: Marie
authors.initials: M
authors.lastname: Studahl
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000134:cerebrospinal fluid; D001921:Brain / Q000473:pathology; D020804:Encephalitis, Varicella Zoster / Q000134:cerebrospinal fluid* / Q000473:pathology; D005260:Female; D005904:Glial Fibrillary Acidic Protein / Q000134:cerebrospinal fluid*; D014645:Herpesvirus 3, Human; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016900:Neurofilament Proteins / Q000134:cerebrospinal fluid*; D064568:S100 Calcium Binding Protein beta Subunit / Q000134:cerebrospinal fluid*
chemical_list: D015415:Biomarkers; D005904:Glial Fibrillary Acidic Protein; D016900:Neurofilament Proteins; D064568:S100 Calcium Binding Protein beta Subunit; C044882:neurofilament protein L