Department of Neurology, University of Ulm, 89081 Ulm, Germany.
Institute of Epidemiology and Medical Biometry, Ulm University, 89075 Ulm, Germany.
Cells. 2020 Sep 25;9(10):2169. doi: 10.3390/cells9102169.
To investigate whether and how cerebrospinal fluid (CSF) findings can contribute to distinguish tick-borne encephalitis (TBE) from herpes simplex virus (HSV) and varicella zoster virus (VZV) induced central nervous system (CNS) infections (HSV-I, VZV-I). Chart review and identification of TBE, HSV- I, and VZV-I was carried out, fulfilling the following criteria: (1) clinical signs of encephalitis and/or meningitis, (2) complete CSF analysis and confirmed viral etiology by either PCR or antibody testing in CSF, (3) hospitalized patients, and (4) available brain magnetic resonance imaging (MRI). Fifty-nine patients with 118 CSF/serum pairs were included. These comprised 21 with TBE (35 CSF/serum pairs), 20 (40 CSF/serum pairs) with HSV-I, and 18 (43 CSF/serum pairs) with VZV-I. In contrast to HSV-I and VZV-I, CSF cell differentiation in TBE showed more often an increased (>20%) proportion of granulocytes ( < 0.01) and a more frequent quantitative intrathecal IgM synthesis ( = 0.001 and < 0.01, respectively), while the second was even more pronounced when follow-up CSF analyses were included ( < 0.001). CSF findings help to distinguish TBE from other viral infections. In cases with CSF pleocytosis and a positive history for a stay in or near an endemic area, TBE antibodies in CSF and serum should be determined, especially if granulocytes in CSF cell differentiation and/or an intrathecal IgM synthesis is present.
为了探究脑脊液（CSF）检查结果能否有助于鉴别蜱传脑炎（TBE）与单纯疱疹病毒（HSV）和水痘带状疱疹病毒（VZV）引起的中枢神经系统（CNS）感染（HSV-I、VZV-I），我们进行了病例回顾并对 TBE、HSV-I 和 VZV-I 进行了鉴定，符合以下标准：（1）脑炎和/或脑膜炎的临床体征，（2）完整的 CSF 分析以及通过 CSF 中的 PCR 或抗体检测确认病毒病因，（3）住院患者，以及（4）有脑磁共振成像（MRI）结果。共有 59 名患者的 118 份 CSF/血清对符合纳入标准，其中包括 21 例 TBE（35 份 CSF/血清对）、20 例 HSV-I（40 份 CSF/血清对）和 18 例 VZV-I（43 份 CSF/血清对）。与 HSV-I 和 VZV-I 不同，TBE 的 CSF 细胞分化更常表现为粒细胞比例增加（>20%）（<0.01）和定量性鞘内 IgM 合成（分别为=0.001 和<0.01），而当纳入后续 CSF 分析时，后一种情况更为明显（<0.001）。CSF 检查结果有助于鉴别 TBE 与其他病毒感染。在 CSF 有核细胞增多且有居住于或临近流行地区病史的情况下，应检测 CSF 和血清中的 TBE 抗体，尤其是如果 CSF 细胞分化中存在粒细胞和/或鞘内 IgM 合成时。
