Journal Article

Clinical significance of Epstein-Barr virus in the cerebrospinal fluid of immunocompetent patients

Cho, Jae Wook, Kim, Hyun-Woo, Kim, Jiyoung, Lee, Gha-Hyun

2021

Overview

•The clinical significance of Epstein-Barr virus (EBV) DNA in CSF of individuals with suspected CNS infection remains unclear.•EBV DNA in CSF is occasionally found in the immunocompetent population.•EBV was frequently found together with other microbes in CSF and associated with encephalitis and poor prognosis. Polymerase chain reaction (PCR)-based testing of cerebrospinal fluid (CSF) samples has greatly facilitated the diagnosis of central nervous system (CNS) infections. However, the clinical significance of Epstein-Barr virus (EBV) DNA in CSF of individuals with suspected CNS infection remains unclear. We wanted to gain a better understanding of EBV as an infectious agent in immunocompetent patients with CNS disorders. We identified cases of EBV-associated CNS infections and reviewed their clinical and laboratory characteristics. The study population was drawn from patients with EBV PCR positivity in CSF who visited Pusan National University Hospital between 2010 and 2019. Of the 780 CSF samples examined during the 10-year study period, 42 (5.4 %) were positive for EBV DNA; 9 of the patients (21.4 %) were diagnosed with non-CNS infectious diseases, such as optic neuritis, Guillain-Barré syndrome, and idiopathic intracranial hypotension, and the other 33 cases were classified as CNS infections (22 as encephalitis and 11 as meningitis). Intensive care unit admission (13/33 patients, 39.3 %) and presence of severe neurological sequelae at discharge (8/33 patients, 24.2 %) were relatively frequent. In 10 patients (30.3 %), the following pathogens were detected in CSF in addition to EBV: varicella-zoster virus (n = 3), cytomegalovirus (n = 2), herpes simplex virus 1 (n = 1), herpes simplex virus 2 (n = 1), Streptococcus pneumomiae (n = 2), and Enterococcus faecalis (n = 1). The EBV-only group (n = 23) and the co-infection group (n = 10) did not differ in age, gender, laboratory data, results of brain imaging studies, clinical manifestations, or prognosis; however, the co-infected patients had higher CSF protein levels. EBV DNA in CSF is occasionally found in the immunocompetent population; the virus was commonly associated with encephalitis and poor prognosis, and frequently found together with other microbes in CSF.

• Publisher: Elsevier B.V,Elsevier Limited
• Subject: Adult / Age / Aged / Asymptomatic / Bacterial infections / Central nervous system / Central nervous system infections / Cerebrospinal fluid / Clinical significance / Coinfection / Concurrent infection / Cytomegalovirus / Cytomegalovirus Infections - cerebrospinal fluid / Cytomegalovirus Infections - complications / Cytomegalovirus Infections - physiopathology / Deoxyribonucleic acid / DNA / DNA, Viral - cerebrospinal fluid / Encephalitis / Encephalitis, Herpes Simplex - cerebrospinal fluid / Encephalitis, Herpes Simplex - complications / Encephalitis, Herpes Simplex - physiopathology / Encephalitis, Viral - cerebrospinal fluid / Encephalitis, Viral - complications / Encephalitis, Viral - physiopathology / Enterococcus faecalis / Epstein-Barr virus / Epstein-Barr Virus Infections - cerebrospinal fluid / Epstein-Barr Virus Infections - complications / Epstein-Barr Virus Infections - physiopathology / Female / Fever / Genetic testing / Gram-Positive Bacterial Infections - cerebrospinal fluid / Gram-Positive Bacterial Infections - complications / Gram-Positive Bacterial Infections - physiopathology / Guillain-Barre syndrome / Guillain-Barre Syndrome - cerebrospinal fluid / Guillain-Barre Syndrome - complications / Guillain-Barre Syndrome - physiopathology / Herpes simplex / Herpes viruses / Herpesvirus 4, Human - genetics / Hospitals / Humans / Hypotension / Immunocompetence / Infections / Infectious diseases / Infectious Encephalitis - cerebrospinal fluid / Infectious Encephalitis - complications / Infectious Encephalitis - microbiology / Infectious Encephalitis - physiopathology / Intensive Care Units / Intracranial Hypotension - cerebrospinal fluid / Intracranial Hypotension - complications / Intracranial Hypotension - physiopathology / Laboratories / Magnetic resonance imaging / Male / Medical imaging / Medical records / Meningitis / Meningitis - cerebrospinal fluid / Meningitis - complications / Meningitis - microbiology / Meningitis - physiopathology / Meningitis, Pneumococcal - cerebrospinal fluid / Meningitis, Pneumococcal - complications / Meningitis, Pneumococcal - physiopathology / Meningitis, Viral - cerebrospinal fluid / Meningitis, Viral - complications / Meningitis, Viral - physiopathology / Middle Aged / Mononucleosis / Neuritis / Neuroimaging / Neurological complications / Neurology / Neurosurgery / Optic neuritis / Optic Neuritis - cerebrospinal fluid / Optic Neuritis - complications / Optic Neuritis - physiopathology / Patients / Polymerase chain reaction / Population studies / Prognosis / Proteins / Software / Streptococcal Infections - cerebrospinal fluid / Streptococcal Infections - complications / Streptococcal Infections - physiopathology / Streptococcus infections / Streptococcus pneumoniae / Varicella / Varicella Zoster Virus Infection - cerebrospinal fluid / Varicella Zoster Virus Infection - complications / Varicella Zoster Virus Infection - physiopathology