Abstract
BackgroundThe role of Epstein-Barr (EBV) virus in central nervous system (CNS) infections is not fully resolved. It is clearly associated with lymphoproliferative disease of immunosuppressed persons, and may cause encephalitis.MethodsWe reviewed the medical records, imaging and laboratory findings of all patients EBV DNA PCR positive in cerebrospinal fluid (CSF) during 2000 to 2009 in the Helsinki University Central Hospital.ResultsWe identified 32 patients with EBV DNA in CSF. 11 had history of allogeneic hematopoietic stem cell transplantation, 7 solid organ transplantation and 5 HIV/AIDS. 5 patients had no preceding immunodeficiency.In 8 of the cases, another pathogen was identified in CSF. These were M. tuberculosis (2), T. gondii (2), Aspergillus (1), Herpes simplex virus 1 (1), C. neoformans (1) and Human herpesvirus 6 (1). Altogether in 15/32 (47%) of the cases the clinician had a strong suspicion of cause other than EBV for the patients' CNS symptoms/findings.Of note, 7 of 11 (64%) patients with stem cell transplantation had encephalitis (univariate odds ratio 5.6; confidence Interval 1.1-27.4). Of these 6 had no other pathogen identified.ConclusionsEBV DNA was often found together with other microbial findings in CSF of immunocompromised patients. EBV seems to be associated with encephalitis in stem cell transplant recipients.
Highlights
The role of Epstein-Barr (EBV) virus in central nervous system (CNS) infections is not fully resolved
EpsteinBarr virus (EBV) is associated with CNS lymphoma and encephalitis, and EBV viral load in cerebrospinal fluid (CSF) is higher than in postinfectious complications [4]
Most hospital patients with EBV DNA in CSF are immunosuppressed Of the 32 patients 26 (81%), had an immunosuppressive condition: 11 had history of allogeneic hematopoietic stem cell transplantation, 7 solid organ transplant and 5 HIV/AIDS
Summary
The role of Epstein-Barr (EBV) virus in central nervous system (CNS) infections is not fully resolved. It is clearly associated with lymphoproliferative disease of immunosuppressed persons, and may cause encephalitis. Epstein-Barr virus infects over 90% of the world population and is the causative agent of infectious mononucleosis. Central nervous system (CNS) complications of EpsteinBarr virus (EBV) infection occur in 1 to 18% of patients with infectious mononucleosis and include encephalitis, meningitis, cerebellitis, polyradiculomyelitis, transverse myelitis, cranial and peripheral neuropathies, and psychiatric abnormalities [2,3,4]. On the other hand EBV-DNA was commonly detected in CSF of HIV patients with other CNS infections or diseases [5].
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