Immune Response in the CSF in Viral Infections

Abstract

The local humoral immune response in inflammatory diseases of the central nervous system (CNS) is reflected by an increase in gamma-globulin in the cerebrospinal fluid (CSF) and, more significantly, by the occurrence of oligoclonal gamma-banding. In the detection of local immunoglobulin synthesis, the possibility of changes in the serum gamma-globulin and increased permeability of the blood-CSF barrier to proteins has to be taken into consideration. This chapter evaluates the gamma-globulin reaction in various acute, prolonged, and chronic CNS-infections of viral or presumed viral origin. In addition, the degree of the concomitant blood-CSF barrier disturbance is determined. By stereotyped changes of the CSF-protein spectrum, two pathologic reactions can be defined: the pattern of local immune response, and the pattern of blood-CSF barrier disturbance. The chapter focuses on the local immune response that leads to increase of gamma3-globulin and synthesis of oligoclonal gamma-fractions. In acute aseptic meningitis, minimal or no abnormal gamma-globulin increases are observed. In acute para- and postinfectious encephalitis, however, a marked local humoral immune response may occur. The most striking increases in gamma-globulin can be noticed in herpes simplex virus encephalitis during phases of clinical improvement.