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Progressive multifocal leucoencephalopathy and viral antibody titres
R S Knight1, N M Hyman, S D Gardner
1Department of Neurology, Radcliffe Infirmary, Oxford, UK.
Abstract:
Progressive multifocal leucoencephalopathy (PML) is caused by a papovavirus but serum antibody titres are generally considered unhelpful in clinical diagnosis because antibodies to the commonest causal agent (JC virus) are frequently found in normal adults. There is little published information about CSF titres but usually they have not been useful. Two cases of PML, confirmed by autopsy, are described where CSF antibody to JC virus was measured. In one case the JC antibody titre was significantly higher in the CSF than the serum and we suggest that this finding is diagnostically useful. In this case there was a transient stabilization of the disease following treatment with cytarabine with a change in antibody titres suggestive of reduced viral replication in the central nervous system and a host response to the infection. In the other case, which was untreated, rising serum antibody levels indicated active infection with a host response.
Insights
CSF antibody titres to JC virus may aid in diagnosing progressive multifocal leucoencephalopathy (PML). Elevated CSF antibody levels, particularly when higher than serum titres, can indicate active JC virus infection within the central nervous system.
Area of Science:
- Neurovirology
- Immunology
Background:
- Progressive multifocal leucoencephalopathy (PML) is a demyelinating disease of the central nervous system caused by the JC virus (a papovavirus).
- Serum antibody titres to JC virus are common in the general population, limiting their diagnostic utility for PML.
- Cerebrospinal fluid (CSF) antibody titres have been poorly documented and generally considered unhelpful.
Observation:
- This study describes two autopsy-confirmed cases of PML.
- JC virus antibody levels in both serum and CSF were measured.
- In one case, CSF JC virus antibody titres were significantly higher than serum titres.
Findings:
- A significantly higher JC virus antibody titre in CSF compared to serum suggests diagnostic utility in PML.
- In the treated case, transient disease stabilization correlated with changes in antibody titres, indicating reduced viral replication and host response.
- In the untreated case, rising serum antibody levels suggested active JC virus infection and a host immune response.
Implications:
- Measuring CSF JC virus antibody titres may offer a valuable diagnostic marker for PML.
- Antibody titre dynamics can provide insights into viral replication and host response during PML.
- These findings could inform future diagnostic strategies and therapeutic monitoring for PML.