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.
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Studies assessing prognosis using hard endpoints in the post-acyclovir era showed neurological impairment in 20-60% of VZV patients upon hospital discharge, 55% after one month, 51% after three months, and 71% after one year after the acute episode.
“Studies assessing prognosis using hard endpoints in the post-acyclovir era showed neurological impairment in 20–60% of patients upon hospital discharge [62–64], 55% after one month, 51% after three months and 71% after one year [62, 65] after the acute episode.”
From Cognitive decline following acute viral infections: literature review and projections for post-COVID-19 (2022) · cites this paper as [65]
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- Authors
- Grahn, A., Hagberg, L., Nilsson, S., Blennow, K., Zetterberg, H., & Studahl, M.
- Affiliations
- Sahlgrenska University Hospital (SE)
- Chalmers University of Technology (SE)
- Corresponding author
- Grahn, Anna
- Venue
- Journal of Neurology
- Published
- 2013-03-08
- Volume
- 260
- Issue
- 7
- Pages
- 1813-1821
- ISSN
- 0012-1037 (ISSN-L)
- 0340-5354
- 1432-1459
- OpenAlex
- W1982670669
- Cited by
- 67
- References
- 42
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 4 · 2023: 6 · 2022: 3 · 2021: 7 · 2020: 5 · 2019: 4 · 2018: 2 · 2017: 5 · 2016: 4 · 2015: 6 · 2014: 6 · 2013: 5
- FWCI
- 5.10
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of Neurology (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Chalmers Research (Chalmers University of Technology) (submittedVersion)
- Funders
- Göteborgs Läkaresällskap
- Sahlgrenska Akademin
- Topics
- Health Sciences › Medicine › Epidemiology › Herpesvirus Infections and Treatments
- Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Viral Infections and Immunology Research
- Keywords
- varicella-zoster virus, central nervous system infection, cerebrospinal fluid biomarkers, glial fibrillary acidic protein, neurofilament light chain, S100β, neuronal injury, astrocyte activation, brain damage, viral load
- MeSH terms
- Adult, Brain, Female, Glial Fibrillary Acidic Protein, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Herpesvirus 3, Human, Biomarkers, Neurofilament Proteins, Encephalitis, Varicella Zoster, S100 Calcium Binding Protein beta Subunit
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