Cerebrospinal Fluid Analysis Post-COVID-19 Is Not Suggestive of Persistent Central Nervous System Infection

Abstract

This study was undertaken to assess whether SARS-CoV-2 causes a persistent central nervous system infection. SARS-CoV-2-specific antibody index and SARS-CoV-2 RNA were studied in cerebrospinal fluid following COVID-19. Cerebrospinal fluid was assessed between days 1 and 30 (n = 12), between days 31 and 90 (n = 8), or later than 90 days (post-COVID-19, n = 20) after COVID-19 diagnosis. SARS-CoV-2 RNA was absent in all patients, and in none of the 20 patients with post-COVID-19 syndrome were intrathecally produced anti-SARS-CoV-2 antibodies detected. The absence of evidence of SARS-CoV-2 in cerebrospinal fluid argues against a persistent central nervous system infection as a cause of neurological or neuropsychiatric post-COVID-19 syndrome. ANN NEUROL 2022;91:150-157.

FIGURE 1

Patient enrollment flow chart. The total number of screened patients at 2 tertiary university hospitals in Germany (Cologne/Berlin) between April 2020 and April 2021 are shown as well as the patients excluded, resulting in the total of 40 patients analyzed for the purpose of this study. AI = antibody‐specific index; CSF = cerebrospinal fluid.

FIGURE 2

Anti–SARS‐CoV‐2 antibodies (Ab) in serum and cerebrospinal fluid (CSF) over time. (A) Anti–SARS‐CoV‐2 serum and (B) CSF specific antibodies significantly decrease when assessing patients within the first 30 days (acute COVID‐19, n = 12), between days 31 and 90 (ongoing COVID‐19, n = 8) and later than 90 days (post–COVID‐19, n = 20) after their SARS‐CoV‐2 infection. (C) Intrathecally produced antibodies could not be identified for any of the post–COVID‐19 patients. CI = confidence interval; RU = relative units.