Reader Response: CSF Biomarkers in Patients With COVID-19 and Neurologic Symptoms: A Case Series

We read with interest the article by Edén et al.1 assessing the CSF biomarkers of intrathecal inflammation (CSF white blood cell counts, neopterin, β2-microglobulin [β2M], and immunoglobulin G index), blood-brain barrier integrity (albumin ratio), and axonal injury (CSF neurofilament light chain protein [NfL]) in COVID-19 patients with neurologic symptoms. The results illustrate evidence of significant CSF inflammation with raised soluble markers without any cellular response, unlike other viral CNS infections. As far as intrathecal markers such as neopterin and β2M are concerned, these are nonspecific and are produced by macrophages during the activation of cell-mediated immune response. These are often found significantly raised in various conditions such as HIV infection,2 relapsing-remitting or chronic progressive multiple sclerosis,3 and head trauma,4 putting forth questions about its value as a disease-specific marker.

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