International Journal of General Medicine (Dec 2021)
Characteristics of Patients with SARS-CoV-2 Positive Cerebrospinal Fluid: A Systematic Review
Abstract
Maryam A Salman,1 Saad I Mallah,1 Wasay Khalid,1 Laura Ryan Moran,2 Yousef AI Abousedu,3 Ghufran A Jassim4 1School of Medicine, Royal College of Surgeons in Ireland, Busaiteen, Kingdom of Bahrain; 2School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; 3Department of Neurosurgery, Ibn Sina Hospital, Kuwait City, Kuwait; 4Department of Family Medicine, Royal College of Surgeons in Ireland, Busaiteen, Kingdom of BahrainCorrespondence: Ghufran A JassimDepartment of Family Medicine, Royal College of Surgeons in Ireland, Busaiteen, Kingdom of BahrainTel +97316660125Email [email protected]: The coronavirus disease 2019 (COVID-19) has been shown to affect several systems, notably the respiratory system. However, there has been considerable evidence implicating the nervous system in COVID-19 infection. This study aims to investigate the clinical characteristics of patients whose cerebrospinal fluid (CSF) tested positive for SARS-CoV-2.Methods: A comprehensive search of PubMed, EMBASE, Scopus, WHO Coronavirus database, bioRxiv, medRxiv, and Web of Science databases was carried out in August 2020. Original studies involving patients who tested positive for SARS-COV-2 in their CSF were included. Key search terms encompassed all variations of “COVID-19” AND “Cerebrospinal Fluid”.Results: A total of 525 studies were identified. Fifty-six full-text articles were assessed, of which 14 were included. In total, 14 patients tested positive for SARS-CoV-2 in their CSF. 21.4% (3/14) of patients had negative nasopharyngeal (NP) swabs despite a positive CSF sample. About 14.2% (2/14) of patients who initially had positive NP swabs developed neurological deterioration after a supposed recovery as indicated by their negative NP swabs, but their CSF still tested positive for SARS-CoV-2. Common symptoms were headache (42.8%; 6/14), fever (35.6%; 5/14), vomiting (28.6%; 4/14), cough (28.6; 4/14), visual disturbances (28.6%; 4/14), diarrhea (21.4%; 3/14), and seizures (21.4%; 3/14). Four patients (28.6%) were admitted to ICU, one (7.14%) was admitted to a rehabilitation facility, and two (14.3%) died.Conclusion: Physicians should be familiar with the presenting neurological features of COVID-19, and be aware that they can occur despite a negative NP swab. The results of this study are intended to aid in the development of informed guidelines to diagnose and treat COVID-19 patients with neurological manifestations.Keywords: COVID-19, SARS-CoV-2, CNS, CSF, central nervous system, cerebrospinal fluid
