Clinical characteristics of 73 children with Epstein-Barr virus encephalitis

Abstract

Objective To summarize the clinical features of Epstein-Barr virus encephalitis(EBE), and to discuss the factors that could result in poor prognosis. Methods Seventy-three cases of EBE admitted to Beijing children′s Hospital, Capital Medical University from July 2006 to June 2016 were collected.The clinical features, laboratory tests and imaging results were analyzed, and the follow-up check-up by phone was conducted. Results EBE could occur at any time of the year, and more cases occurred in winter/spring than in summer/autumn.Ratio of male to female patients was 1.5∶1.0, and more cases occurred among the older children with their average age of 5 years and 6 months old.Specific types were: meningoencephalitis 56 cases(75.7%), demyelination 16 cases(21.9%), and acute cerebellar ataxia 1 case(1.4%). EBE included 24 cases (32.9%) of meningoencephalitis, 22 cases (30.1%) of encephalitis, 10 cases (14.0%) of meninges, 2 cases (2.7%) combined with myelitis, and 1 case (1.4%) combined with ophthalmoneuromyelitis.Only 2 cases were found with typical symptoms of infectious mononucleosis, 1 case was diagnosed as chronic Epstein-barr virus(EBV) infection, and 1 case was diagnosed as hemophagocytic histiocytosis.Clinical symptoms were: 70 cases (95.9%) of fever, 37 cases (50.7%) of convulsion, 34 cases (46.6%) of altered state of consciousness, 24 cases (32.9%) of vomit, and 21 cases (28.8%) of headache, which were found to be the primary symptoms, together with other symptoms, including 12 cases (16.4%) of hepatomegaly, 10 cases (13.7%) of rash, and 11 cases (15.0%) of other symptoms.There were 42 cases (57.5%) of central nervous system(CNS)infection positive and neck stiffness, 32 cases (43.8%) of Babinski′s sign positive, 10 cases (13.7%) of decreased muscle strength, 11 cases (15.1%) of atonia, 5 cases (6.8%) of hypermyotonia, 5 cases (6.8%) of coats disease positive, and 2 cases (2.7%) with Brudzinski signs.Twenty-two patients (30.1%) did not have CNS positive symptoms.There were 48 cases (45.8%) of magnetic resonance imaging (MRI) result showing abnormalities, with common symptoms including 9 cases (12.7%) of cytotoxic edema, 8 cases (11.3%) of demyelination, and 4 cases (5.6%) with encephalanalosis symptoms.Affected organs included 14 cases (19.7%) of frontal lobe, 11 cases (15.5%) of parietal lobe, 11 cases (15.5%) of temporal lobe, 8 cases (11.3%) of thalamus, 7 cases (9.9%) of basal ganglia, 6 cases (8.5%) of occipital, and 5 cases (7.0%) of corpus callosum etc.Follow-up check-up was conducted on 52 cases, with 21 cases lost contact, and 44 cases (84.6%) with good prognosis, 8 cases (15.4%) with poor prognosis and 3 death cases (5.8%). Serologic examinations found 20 cases (29.9%) of primary EBV infection [EBV-capsid antigen(CA)-IgM+ and core antigen(NA)-IgG-], 47 cases (70.1%) of existed EBV infection being activated (EBV-CA-IgM+ and NA-IgG+ ), and there was no statistically significant difference in terms of clinical characteristics and prognosis.Convulsion occurs more frequently in group of poor prognosis(P=0.03) after comparing the aspects of main clinical features, stage of EBV infection, underlying diseases and combined with other infections etc(P>0.001). Conclusions EBE can occur at various stage of EB infection.EBE can occur in various forms at clinic.CNS symptoms of meningoencephalitis, encephalitis, meninges, demyelination, and cerebellar ataxia etc.Patients’ brain parenchyma can be affected extensively, and most of the patients experienced good prognosis, the virus can cause lethal infection; while patients with symptoms of convulsion may experience poor prognosis. Key words: Epstein-Barr virus; Encephalitis; Child