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ABSTRACT
Background
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) neuroinvasion can cause irreversible central nervous system (CNS) sequelae. This study seeks to highlight the importance of SARS-CoV-2 CNS involvement in a province (Gauteng) with one of the highest burden of SARS-CoV-2 infections in South Africa. To understand the degree of CNS SARS-CoV-2, this study determined the prevalence of SARS-CoV-2 IgG/IgM and presence of SARS-CoV-2 RNA in CSF samples collected at a tertiary hospital in Gauteng.
Method
The study was a descriptive study using stored (-70ºC) CSF samples. A total of 908 stored CSF samples collected between 2020 and 2021 were included, and were all screened for SARS-CoV-2 IgG and IgM using the COVID-19 IgG/IgM Rapid test cassettes. Quantitative reverse transcription PCR using the Luna Probe One-Step Reaction Mix with specific primers and probe was used to detect SARS-CoV-2 RNA in CSF that tested positive by serology. Additional data was collected from patient files.
Result
Nine (0.99%) CSFs tested positive for SARS-CoV-2 IgG. Of the nine, only one tested positive for both IgG and IgM. From the nine that tested positive by serology, 5/9 (55.56%) tested positive for CSF SARS-CoV-2 RNA. From the five CSFs that tested positive for SARS-CoV-2 RNA, three had negative respiratory SARS-CoV-2 tests and two were never tested for respiratory SARS-CoV-2. All requested microbiology tests were negative.
Conclusion
A low prevalence of SARS-CoV-2 is demonstrated in this study. The fact that three of the CSF samples had SARS-CoV-2 while the respiratory samples did not, supports the neuroinvasion capabilities of SARS-CoV-2. SARS-CoV-2 neuroinvasion might occur without any respiratory manifestation. It is important to do CSF SARS-CoV-2 tests in COVID-19 patients whom the cause of CNS complication could not be established.