Monitoramento das neuroinfecções durante a pandemia de COVID-19 em uma unidade terciária de saúde em Manaus

Abstract

Infectious diseases, caused by pathogens such as bacteria, viruses, parasites, and fungi, represent a significant challenge to global health in terms of morbidity and mortality. In this context, viruses stand out for their contribution to the emergence and resurgence of infectious diseases, triggering important clinical manifestations ranging from febrile and respiratory syndromes to, more concerningly, nervous system disorders. The latter can lead to a series of symptoms, including headache, fever, neck stiffness, sensory alterations, muscle weakness, and cognitive dysfunctions. Therefore, the objective was to examine the cerebrospinal fluid (CSF) of patients with neurological manifestations during the COVID-19 pandemic in a tertiary healthcare unit in Manaus. This descriptive observational study employed real-time polymerase chain reaction (qPCR) to analyze cerebrospinal fluid (CSF) samples from patients who presented neurological manifestations during the COVID-19 pandemic, from March 2020 to July 2022. In addition to screening for SARS-CoV-2 RNA in the CSF, a diagnostic panel was adapted to investigate other viruses capable of causing nervous system infections, including dengue, Zika, Chikungunya, West Nile virus, Enterovirus, Herpesvirus, SARS-CoV-2 and JCV. The results revealed evidence of viral infection in 35 patients (16.9%) with neurological manifestations, with viruses of the Herpesviridae family predominating in 28 cases (80%), polyomaviruses in 5 cases (14.2%), and 5 coinfections (14.2%). Analysis of biomarkers such as neopterin, light chain neurofilament and total tau protein, provided insights into neuroinfections. This work underscores the importance of laboratory neurological surveillance in identifying and treating viral infections affecting the nervous system early, including those that may occur during a pandemic such as COVID-19. The findings have significant implications for differential diagnosis, clinical management, and the development of therapeutic strategies for patients with neurological manifestations of infectious origin.