A Specific Pattern of Routine Cerebrospinal Fluid Parameters Might Help to Identify Cases of West Nile Virus Neuroinvasive Disease

Johann Otto Pelz; Christoph Mühlberg; Isabel Friedrich; Lorenz Weidhase; Silke Zimmermann; Melanie Maier; Corinna Pietsch

doi:10.3390/v16030341

A Specific Pattern of Routine Cerebrospinal Fluid Parameters Might Help to Identify Cases of West Nile Virus Neuroinvasive Disease

Viruses. 2024 Feb 22;16(3):341. doi: 10.3390/v16030341.

Authors

Johann Otto Pelz¹, Christoph Mühlberg¹, Isabel Friedrich¹, Lorenz Weidhase², Silke Zimmermann³, Melanie Maier⁴, Corinna Pietsch⁴

Affiliations

¹ Department of Neurology, University Hospital Leipzig, 04103 Leipzig, Germany.
² Medical Intensive Care Unit, University Hospital Leipzig, 04103 Leipzig, Germany.
³ Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, 04103 Leipzig, Germany.
⁴ Department of Virology, Institute of Medical Microbiology and Virology, University Hospital Leipzig, 04103 Leipzig, Germany.

Abstract

Background: Viral meningitis/encephalitis (ME) is a rare but potentially harmful disease. The prompt identification of the respective virus is important to guide not only treatment but also potential public health countermeasures. However, in about 40% of cases, no virus is identified despite an extensive diagnostic workup. The aim of the present study was to analyze demographic, seasonal, and routine cerebrospinal fluid (CSF) parameters in cases of viral ME and assess their utility for the prediction of the causative virus.

Methods: Demographic data, season, and routine CSF parameters (total leucocytes, CSF cell differentiation, age-adjusted CSF/serum albumin ratio, and total immunoglobulin ratios) were retrospectively assessed in cases of viral ME.

Results: In total, 156 cases of acute viral ME (74 female, median age 40.0 years) were treated at a tertiary-care hospital in Germany. Specific viral infections were detected in 93 (59.6%) cases. Of these, 14 (9.0%) cases were caused by herpes simplex virus (HSV), 36 (23.1%) by varicella-zoster virus (VZV), 27 (17.3%) by enteroviruses, 9 (5.8%) by West Nile virus (WNV), and 7 (4.5%) by other specific viruses. Additionally, 64 (41.0%) cases of ME of unknown viral etiology were diagnosed. Cases of WNV ME were older, predominantly male, showed a severe disruption of the blood-CSF-barrier, a high proportion of neutrophils in CSF, and an intrathecal total immunoglobulin M synthesis in the first CSF sample. In a multinominal logistic regression analysis, the accuracy of these CSF parameters together with age and seasonality was best for the prediction of WNV (87.5%), followed by unknown viral etiology (66.7%), VZV (61.8%), and enteroviruses (51.9%).

Conclusions: Cases with WNV ME showed a specific pattern of routine CSF parameters and demographic data that allowed for their identification with good accuracy. These findings might help to guide the diagnostic workup in cases with viral ME, in particular allowing the timely identification of cases with ME due to WNV.

Keywords: West Nile virus; cerebrospinal fluid; climate change; encephalitis; immunoglobulin M; meningitis.

MeSH terms

Adult
Antibodies, Viral
Encephalitis, Viral*
Enterovirus Infections*
Female
Herpesvirus 3, Human
Humans
Male
Meningitis, Viral* / diagnosis
Retrospective Studies
Viruses*
West Nile Fever* / diagnosis
West Nile virus*

Substances

Antibodies, Viral

Grants and funding

The costs for the publication were funded in parts by the Open Access Publishing Fund of Leipzig University supported by the German Research Foundation within the program Open Access Publication Funding.