Viral infections of the central nervous system
The project involves clinical studies of viral infections of the central nervous
system (CNS) in children and adults: mainly varicella zostervirus (VZV), herpes
simplex virus type 1 encephalitis (HSV-1) and type 2 (HSV-2) meningitis and
pediatric viral encephalitis. The studies focuse on diagnosis with quantitative
polymerase chain reaction (PCR) and intrathecal antibodies, biochemical
markers in cerebrospinal fluid (CSF), treatment and clinical outcome.
Early diagnosis and treatment are essential to diminish neurological sequelae.
CSF quantitative PCR and measurements of intrathecal antibodies are performed
for etiological diagnosis. To optimise the diagnosis of CNS varicella zoster virus
infection a new VZV serology is currently under development. Optimal
antiviral treatment lengths in different viral CNS infections are not established,
and several of the studies are of a prospective nature with different antiviral
treatment regimes.
In adults the studies include herpes simplex encephalitis, herpes simplex
meningitis and varicella zoster virus infections of the CNS. A prospective study
is ongoing on pediatric encephalitis.
Herpes simplex encephalitis – an international prospective randomised double-
blind study with oral valaciclovir treatment for 3 months, after completed iv.
treatment for 2 -3 weeks, is ongoing.
Herpes simplex meningitis- we perform a national study of valaciclovir
suppression therapy for 1 year and the patients are followed during two years.
The results are currently evaluated.
Markers in cerebrospinal fluid and serum as well as measurements of cytokines
and oxidation radicals produced by inflammatory cells are studied and correlated
to prognosis.
VZV- causes a variety of neurological symptoms including stroke in all age-
groups. A prospective study of CNS infections started 2007 and is ongoing until
2011. The natural histories of the different syndromes are studied and the study
include biochemical markers, magnetic resonance tomography and assessments
for neurological sequelae.
Pediatric viral encephalitis- Etiology and neurological sequelae are studied in a
prospective study.
Members of the viral CNS infection study group
Principal investigator, M.D Ph.D Marie Studahl
M.D Anna Persson
Ph.D Charlotta Mowitz
M.D Ph.D Susanne Woxenius
M.D Gunilla Drake
M.D PhD Thomas Linden
Professor Tomas Bergström
M.D, Ph.D Elisabeth Aurelius
M.D, Ph.D Britt-Marie Eriksson
M.D Kenny Larsson
M.D Ph.D Anders Lundqvist
M.D Katarina Lund

Studahl M, Hagberg L, Bergström T. Acute viral encephalitis i adults- a 4 year prospective study. Scand J Inf Dis 30: 215-20, 1998. Studahl M, Hagberg L, Rekabdar E, Bergström T. Hematogenously spread herpesvirus are detected as frequently as neuronally spread herpesviruses in cerebrospinal fluid by polymerase chain reaction assay. Clin Infect Dis 29: 216-7, 1999. Studahl M, Rosengren L, Günther G, Hagberg L. Difference in pathogenesis between herpes simplex virus type 1 encephalitis and tick-borne encephalitis demonstrated by means of cerebrospinal fluid markers of glial and neuronal destruction. J Neurol 247: 636-42, 2000. Studahl M. Influenza virus and CNS. J Clin Virol, 28: 25-32, 2003. Studahl M, Linde A. Chapter ”Influenza and CNS complications” in Clinical Neurovirology, J.H. Marcel-Dekker. Berger, Kentucky, USA. Studahl M. ”Infektioner orsakade av herpesgruppens virus” in Infektionsmedicin, sid.189-206, Sten Iwarson, Ragnar Norrby. Third and fourth edition. Säve förlag, 2004, 2006. Studahl M, Sköldenberg B. ”Herpes Simplex Encephalitis” in Herpes Simplex Virus Infections, Studahl M, Bergström T, Cinque P, Taylor&Francis USA, 2006. Editor book: Studahl M, Bergström T, Cinque P. Herpes Simplex Viruses, Taylor & Francis, New York, USA, 2006. Sköldenberg B, Aurelius E, Hjalmarsson A, Sabri F, Forsgren M, Andersson B, Linde A, Strannegård Ö, Studahl M, Hagberg L, Rosengren L. Incidence and pathogenesis of clinical relapse after herpes simplex encephalitis in adults. J Neurol. 2006: 253 (2): 163-70. Studahl M, Günther G, Rosengren L.Serum S-100 ß protein levels in patients with herpes simplex encephalitis and tick borne encephalitis – a marker of CNS damage during the initial stage of disease., J Neurol 256(4): 586-90, 2009. Schepis D, D'Amato M, Studahl M, Bergström T, Kärre K, Berg L Herpes simplex virus infection downmodulates NKG2D ligand expression. Scand J Immunol May;69(5):429-36, 2009. Persson A, Bergström T, Lindh M, Namvar L, Studahl M. Varicella - zoster virus CNS disease-viral load, clinical manifestations and sequels. J Clin Virol 46: 249-253, 2009.


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