key: cord-340279-bq5owwot authors: Espíndola, Otávio de Melo; Siqueira, Marilda; Soares, Cristiane Nascimento; Lima, Marco Antonio Sales Dantas de; Leite, Ana Claudia Celestino Bezerra; Araujo, Abelardo Queiroz Campos; Brandão, Carlos Otávio; Silva, Marcus Tulius Teixeira title: Patients with COVID-19 and neurological manifestations show undetectable SARS-CoV-2 RNA levels in the cerebrospinal fluid date: 2020-06-04 journal: Int J Infect Dis DOI: 10.1016/j.ijid.2020.05.123 sha: doc_id: 340279 cord_uid: bq5owwot Abstract We report that patients with COVID-19 displaying distinct neurological disorders have undetectable or extremely low levels of SARS-CoV-2 RNA in the cerebrospinal fluid, indicating that viral clearance precede the neurological involvement. This finding points to the need for the development of more sensitive molecular tests and the investigation of other neurotropic pathogens to exclude concurrent neuroinfection. 1 1 Highlights 2 • SARS-CoV-2 RNA is mainly undetectable in the cerebrospinal fluid. 3 • SARS-CoV-2 clearance in the cerebrospinal fluid may precede the neurological involvement. 4 • Common neuropathogens should be investigated in the CSF of COVID-19 patients. (Table 1) . CSF analysis showed normal to mild elevated protein levels, and 86 pleocytosis was particularly observed in the cases of meningoencephalitis (Table 2) . Indeed, CNS 87 infiltrate was predominantly constituted by mononuclear cells, which is compatible with viral infection 88 (Table 2) (Table 1) Status of SARS-CoV-2 in 127 cerebrospinal fluid of patients with COVID-19 and stroke Guillain-Barré syndrome related 130 to COVID-19 infection Two patients with 132 acute meningo-encephalitis concomitant to SARS-CoV-2 infection Management of Viral Central 134 Nervous System Infections: A Primer for Clinicians Guillain-Barré syndrome as 137 a complication of SARS-CoV-2 infection Plasmapheresis treatment in COVID-19-139 related autoimmune meningoencephalitis: Case series Neurologic Features in Severe 141 SARS-CoV-2 Infection