College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar.
Cells. 2022 Oct 13;11(20):3212. doi: 10.3390/cells11203212.
This systematic review focused on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients that had detected SARS-CoV-2 virus in cerebrospinal fluid (CSF). A systematic literature search was carried out in PubMed, Embase, Scopus, Web of Science, Medrxiv, and Biorxiv databases from inception to 19 December 2021. Case reports or case series involving patients with proved SARS-CoV-2 presence in CSF by polymerize chain reaction were included. Our search strategy produced 23 articles documenting a total of 23 patients with positive SARS-CoV-2 in the CSF. Fever (55%) was the most common symptom, followed by headaches (41%), cough (32%), and vomiting/nausea (32%). The majority of the cases included was encephalitis (57%), 8 of which were confirmed by magnetic resonance imaging. The second most prevalent presentation was meningitis. The cerebral spinal fluid analysis found disparities in protein levels and normal glucose levels in most cases. This study demonstrates that SARS-CoV-2 can enter the nervous system via various routes and cause CNS infection symptoms. SARS-CoV-2 has been shown to infect the CNS even when no respiratory symptoms are present and nasopharyngeal swabs are negative. As a result, SARS-CoV-2 should be considered as a possible cause of CNS infection and tested for in the CSF.
本系统评价主要关注在脑脊液（CSF）中检测到严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）的 SARS-CoV-2 患者。从开始到 2021 年 12 月 19 日，我们在 PubMed、Embase、Scopus、Web of Science、Medrxiv 和 Biorxiv 数据库中进行了系统文献检索。纳入了通过聚合酶链反应证实 SARS-CoV-2 存在于 CSF 中的病例报告或病例系列。我们的搜索策略产生了 23 篇文章，总共记录了 23 例 CSF 中 SARS-CoV-2 阳性的患者。发热（55%）是最常见的症状，其次是头痛（41%）、咳嗽（32%）和呕吐/恶心（32%）。大多数病例为脑炎（57%），其中 8 例经磁共振成像证实。第二常见的表现是脑膜炎。脑脊液分析发现大多数病例的蛋白水平和正常葡萄糖水平存在差异。本研究表明，SARS-CoV-2 可以通过多种途径进入神经系统并引起中枢神经系统感染症状。SARS-CoV-2 甚至在没有呼吸道症状和鼻咽拭子阴性的情况下也会感染中枢神经系统。因此，应将 SARS-CoV-2 视为中枢神经系统感染的可能原因，并在 CSF 中进行检测。
