Encephalopathy and Encephalitis Associated with Cerebrospinal Fluid Cytokine Alterations and Coronavirus Disease, Atlanta, Georgia, USA, 2020

Emerg Infect Dis. 2020 Sep;26(9):2016-2021. doi: 10.3201/eid2609.202122. Epub 2020 Jun 2.


There are few detailed investigations of neurologic complications in severe acute respiratory syndrome coronavirus 2 infection. We describe 3 patients with laboratory-confirmed coronavirus disease who had encephalopathy and encephalitis develop. Neuroimaging showed nonenhancing unilateral, bilateral, and midline changes not readily attributable to vascular causes. All 3 patients had increased cerebrospinal fluid (CSF) levels of anti-S1 IgM. One patient who died also had increased levels of anti-envelope protein IgM. CSF analysis also showed markedly increased levels of interleukin (IL)-6, IL-8, and IL-10, but severe acute respiratory syndrome coronavirus 2 was not identified in any CSF sample. These changes provide evidence of CSF periinfectious/postinfectious inflammatory changes during coronavirus disease with neurologic complications.

Keywords: Atlanta; COVID-19; CSF; Georgia; SARS-CoV-2; United States; cerebrospinal fluid; coronavirus disease; coronaviruses; cytokines; encephalitis; encephalopathy; meningitis/encephalitis; respiratory infections; serologic analysis; severe acute respiratory syndrome coronavirus 2; viruses; zoonoses.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Betacoronavirus*
  • Brain Diseases / cerebrospinal fluid
  • Brain Diseases / virology*
  • COVID-19
  • Coronavirus Infections / cerebrospinal fluid
  • Coronavirus Infections / complications*
  • Coronavirus Infections / virology
  • Cytokines / cerebrospinal fluid*
  • Encephalitis, Viral / cerebrospinal fluid
  • Encephalitis, Viral / virology*
  • Fatal Outcome
  • Female
  • Georgia
  • Humans
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / cerebrospinal fluid
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / virology
  • SARS-CoV-2


  • Cytokines