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Peuchmaur M, Voisin J, Vaillant M, Truffot A, Lupo J, Morand P, Le Maréchal M, Germi R. Epstein-Barr Virus Encephalitis: A Review of Case Reports from the Last 25 Years. Microorganisms 2023; 11:2825. [PMID: 38137968 PMCID: PMC10745555 DOI: 10.3390/microorganisms11122825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/10/2023] [Accepted: 11/16/2023] [Indexed: 12/24/2023] Open
Abstract
Although uncommon, Epstein-Barr virus-related neurological disorders represent the seventh most frequent cause of infectious encephalitis in adults. The limited number of publications on EBV encephalitis mainly document isolated clinical cases. This study aimed to summarize published data on EBV encephalitis. A systematic literature search identified 97 EBV encephalitis cases. In the selected cases, EBV-related neurological disorders manifested as lymphocytic pleocytosis in the cerebrospinal fluid (CSF) with moderate hyperproteinorachia. The EBV PCR test was positive in 87% of the CSF samples, with wide-ranging viral loads. When encephalitis occurred in the context of past EBV infections, all of the EBV PCR tests on CSF samples were positive. On the contrary, negative EBV PCR tests on CSF samples occurred only in the context of primary infections. EBV PCR was rarely carried out on blood samples, contributing minimally to the diagnosis. For the treatment of EBV encephalitis, Aciclovir was used alone in 29% of cases, and in association with other drugs in 40% of cases. Ganciclovir (30%), corticoids (52%), and immunoglobulins (15%) were mainly used in association with other drugs. Cerebral imaging was abnormal in 69% of cases, mostly in the cerebellum and basal ganglia. This work highlights that the EBV PCR test on CSF samples is currently the main laboratory diagnostic test to diagnose EBV encephalitis. This diagnostic test is useful; however, it is imperfect. New complementary diagnostic tools, approved treatments, and standardized practices could improve patient management.
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Affiliation(s)
| | - Joris Voisin
- University Grenoble Alpes, CNRS, CEA, IRIG IBS, 38000 Grenoble, France; (J.V.); (A.T.); (J.L.); (P.M.)
| | - Mathieu Vaillant
- University Grenoble Alpes, Service de Neurologie, CHU Grenoble Alpes, 38000 Grenoble, France;
| | - Aurélie Truffot
- University Grenoble Alpes, CNRS, CEA, IRIG IBS, 38000 Grenoble, France; (J.V.); (A.T.); (J.L.); (P.M.)
| | - Julien Lupo
- University Grenoble Alpes, CNRS, CEA, IRIG IBS, 38000 Grenoble, France; (J.V.); (A.T.); (J.L.); (P.M.)
| | - Patrice Morand
- University Grenoble Alpes, CNRS, CEA, IRIG IBS, 38000 Grenoble, France; (J.V.); (A.T.); (J.L.); (P.M.)
| | - Marion Le Maréchal
- University Grenoble Alpes, Inserm, CHU Grenoble Alpes, GIN, 38000 Grenoble, France;
| | - Raphaele Germi
- University Grenoble Alpes, CNRS, CEA, IRIG IBS, 38000 Grenoble, France; (J.V.); (A.T.); (J.L.); (P.M.)
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Pandey N, Chawala A, Kandhi S, Dhallu M, Chilimuri S. Epstein-Barr Virus Encephalitis Presenting As Acute Disseminated Encephalomyelitis: A Challenging Diagnostic Dilemma. Cureus 2023; 15:e48277. [PMID: 38058351 PMCID: PMC10695853 DOI: 10.7759/cureus.48277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 12/08/2023] Open
Abstract
Epstein-Barr virus (EBV) is a common human herpesvirus associated with a wide range of clinical manifestations, primarily affecting the lymphoid system. However, central nervous system (CNS) involvement, although rare, can occur and present a diagnostic challenge, particularly in immunocompetent individuals. We present a case of a 28-year-old healthy female who initially presented with a flu-like illness, her symptoms rapidly progressed, leading to neurological deficits, and altered mental status. The patient's diagnostic workup, including a viral panel and various antibodies, failed to provide a conclusive diagnosis. However, lumbar puncture revealed significant abnormalities in cerebrospinal fluid (CSF), including elevated white blood cell count and elevated CSF protein. Neuroimaging studies demonstrated non-specific findings in subcortical white matter, pontomedullary junction, and extended spinal cord lesion. Tragically, the patient's condition rapidly worsened, with diffuse cerebral edema observed on repeat imaging, leading to the patient's demise even after conventional treatment. CSF analysis, performed at an apex lab, unexpectedly returned positive for EBV PCR, indicating a diagnosis of EBV encephalitis or EBV-associated acute disseminated encephalomyelitis (ADEM). This case highlights the challenges encountered in diagnosing EBV-associated CNS manifestations, especially in immunocompetent individuals, where these presentations are exceedingly rare. The atypical clinical course, negative initial laboratory investigations, and absence of specific radiological findings further complicated the diagnostic process. Early recognition and consideration of infectious etiologies, including EBV, in patients presenting with unexplained encephalitis or ADEM-like symptoms, are essential for timely intervention and optimal patient outcomes.
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Affiliation(s)
| | - Arpan Chawala
- Internal Medicine, BronxCare Health System, Bronx, USA
| | - Sameer Kandhi
- Internal Medicine, BronxCare Health System, Bronx, USA
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Epstein-Barr virus-related encephalitis in a young woman: A case report. J Infect Chemother 2020; 26:741-744. [DOI: 10.1016/j.jiac.2020.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/30/2020] [Accepted: 02/10/2020] [Indexed: 11/24/2022]
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Engelmann I, Alidjinou EK, Lazrek M, Pouillaude JM, Ogiez J, Rose F, Duhamel A, Dewilde A, Hober D. Comparison of two commercial quantitative PCR assays for EBV DNA detection and their correlation with the first WHO International Standard for EBV. J Med Microbiol 2018; 67:529-536. [DOI: 10.1099/jmm.0.000702] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Ilka Engelmann
- Université de Lille, Faculté de Médecine, CHU Lille, Laboratoire de Virologie EA3610, F-59000 Lille, France
| | - Enagnon Kazali Alidjinou
- Université de Lille, Faculté de Médecine, CHU Lille, Laboratoire de Virologie EA3610, F-59000 Lille, France
| | - Mouna Lazrek
- Université de Lille, Faculté de Médecine, CHU Lille, Laboratoire de Virologie EA3610, F-59000 Lille, France
| | - Jean-Marie Pouillaude
- Université de Lille, Faculté de Médecine, CHU Lille, Laboratoire de Virologie EA3610, F-59000 Lille, France
| | - Judith Ogiez
- Université de Lille, Faculté de Médecine, CHU Lille, Laboratoire de Virologie EA3610, F-59000 Lille, France
| | - François Rose
- Université de Lille, Faculté de Médecine, CHU Lille, Laboratoire de Virologie EA3610, F-59000 Lille, France
| | - Alain Duhamel
- Université de Lille, CHU Lille, EA 2694 - Santé publique : épidémiologie et qualité des soins, F-59000 Lille, France
| | - Anny Dewilde
- Université de Lille, Faculté de Médecine, CHU Lille, Laboratoire de Virologie EA3610, F-59000 Lille, France
| | - Didier Hober
- Université de Lille, Faculté de Médecine, CHU Lille, Laboratoire de Virologie EA3610, F-59000 Lille, France
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Bertrand A, Leclercq D, Martinez-Almoyna L, Girard N, Stahl JP, De-Broucker T. MR imaging of adult acute infectious encephalitis. Med Mal Infect 2017; 47:195-205. [PMID: 28268128 DOI: 10.1016/j.medmal.2017.01.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/11/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Imaging is a key tool for the diagnosis of acute encephalitis. Brain CT scan must be urgently performed to rule out a brain lesion with mass effect that would contraindicate lumbar puncture. Brain MRI is less accessible than CT scan, but can provide crucial information with patients presenting with acute encephalitis. METHOD We performed a literature review on PubMed on April 1, 2015 with the search terms "MRI" and "encephalitis". RESULTS We first described the various brain MRI abnormalities associated with each pathogen of acute encephalitis (HSV, VZV, other viral agents targeting immunocompromised patients or travelers; tuberculosis, listeriosis, other less frequent bacterial agents). Then, we identified specific patterns of brain MRI abnomalies that may suggest a particular pathogen. Limbic encephalitis is highly suggestive of HSV; it also occurs less frequently in encephalitis due to HHV6, syphillis, Whipple's disease and HIV primary infection. Rhombencephalitis is suggestive of tuberculosis and listeriosis. Acute ischemic lesions can occur in patients presenting with severe bacterial encephalitis, tuberculosis, VZV encephalitis, syphilis, and fungal infections. CONCLUSION Brain MRI plays a crucial role in the diagnosis of acute encephalitis. It detects brain signal changes that reinforce the clinical suspicion of encephalitis, especially when the causative agent is not identified by lumbar puncture; it can suggest a particular pathogen based on the pattern of brain abnormalities and it rules out important differential diagnosis (vascular, tumoral or inflammatory causes).
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Affiliation(s)
- A Bertrand
- Service de neuroradiologie diagnostique et fonctionnelle, groupe hospitalier Pitié-Salpêtrière, 47-83 boulevard de l'hôpital, 75651 Paris cedex 13, France; Sorbonne universités, UPMC université Paris 06, Inserm, CNRS, institut du cerveau et la moelle (ICM), Inria Paris, Aramis project-team, 75013 Paris, France
| | - D Leclercq
- Service de neuroradiologie diagnostique et fonctionnelle, groupe hospitalier Pitié-Salpêtrière, 47-83 boulevard de l'hôpital, 75651 Paris cedex 13, France
| | | | - N Girard
- Service de neuroradiologie, CHU La-Timone, AP-HM, 13015 Marseille, France
| | - J-P Stahl
- Service d'infectiologie, CHU de Grenoble, « European study Group for the Infections of the Brain (ESGIB) », 38043 Grenoble, France.
| | - T De-Broucker
- Service de neurologie, CH Saint-Denis, BP 279, 93205, France
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Bazzino Rubio F, Gonzalez Betlza M, Gonzalez Rabelino G, Bello Pedrosa O. Optic neuritis following Epstein-Barr virus encephalitis in immunocompetent children: A case report. NEUROLOGÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.nrleng.2015.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Bazzino Rubio F, Gonzalez Betlza M, Gonzalez Rabelino G, Bello Pedrosa O. Optic neuritis following Epstein-Barr virus encephalitis in immunocompetent children: A case report. Neurologia 2015; 32:129-131. [PMID: 26073488 DOI: 10.1016/j.nrl.2015.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 03/25/2015] [Accepted: 03/26/2015] [Indexed: 11/28/2022] Open
Affiliation(s)
- F Bazzino Rubio
- Pediatría, Sanatorio Americano, Infectología Pediátrica, Facultad de Medicina UDELAR, Montevideo, Uruguay.
| | | | | | - O Bello Pedrosa
- Pediatría, Intesivismo, Neonatología, Emergencias, Consultoría Sociedad Médico Quirúrgica de Salto, Uruguay
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Liu Y, Duan C, Zhang C, Yang X, Zhao Y, Dong R, Zhou J, Gai Z. Evaluation of a viral microarray based on simultaneous extraction and amplification of viral nucleotide acid for detecting human herpesviruses and enteroviruses. PLoS One 2015; 10:e0117626. [PMID: 25774509 PMCID: PMC4361642 DOI: 10.1371/journal.pone.0117626] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 12/29/2014] [Indexed: 12/17/2022] Open
Abstract
In this study, a viral microarray based assay was developed to detect the human herpesviruses and enteroviruses associated with central nervous system infections, including herpes simplex virus type 1, type 2 (HSV1 and HSV2), Epstein-Barr virus (EBV), cytomegalovirus (CMV), enterovirus 71 (EV71), coxsackievirus A 16 (CA16) and B 5(CB5). The DNA polymerase gene of human herpesviruses and 5’-untranslated region of enteroviruses were selected as the targets to design primers and probes. Human herpesviruses DNA and enteroviruses RNA were extracted simultaneously by using a guanidinium thiocyanate acid buffer, and were subsequently amplified through a biotinylated asymmetry multiplex RT-PCR with the specific primer of enteroviruses. In total, 90 blood samples and 49 cerebrospinal fluids samples with suspected systemic or neurological virus infections were investigated. Out of 139 samples, 66 were identified as positive. The specificities of this multiplex RT-PCR microarray assay were over 96% but the sensitivities were various from 100% for HSV1, HSV2, EV71 and CB5, 95.83% for CMV, 80% for EBV to 71.43% for CA16 in comparison with reference standards of TaqMan qPCR/qRT-PCR. The high Kappa values (>0.90) from HSV1, HSV2, CMV, EV71 and CB5 were obtained, indicating almost perfect agreement in term of the 5 viruses detection. But lower Kappa values for EBV (0.63) and CA16 (0.74) displayed a moderate to substantial agreement. This study provides an innovation of simultaneous extraction, amplification, hybridization and detection of DNA viruses and RNA viruses with simplicity and specificity, and demonstrates a potential clinical utility for a variety of viruses’ detection.
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Affiliation(s)
- Yi Liu
- Pediatric Research Institute, Qilu Children’s Hospital of Shandong University, Ji’nan, China
| | - Chunhong Duan
- Department of Pediatrics, Qilu Children’s Hospital of Shandong University, Ji’nan, China
| | - Chunxiu Zhang
- Shanghai Biochip National Engineering Research Center, Shanghai, China
| | - Xiaomeng Yang
- Pediatric Research Institute, Qilu Children’s Hospital of Shandong University, Ji’nan, China
| | - Yan Zhao
- Clinical Central Laboratory, Maternal and Children's Health Care Institute of Jinan, Jinan, China
| | - Rui Dong
- Pediatric Research Institute, Qilu Children’s Hospital of Shandong University, Ji’nan, China
| | - Jiajing Zhou
- Shanghai Biochip National Engineering Research Center, Shanghai, China
| | - Zhongtao Gai
- Pediatric Research Institute, Qilu Children’s Hospital of Shandong University, Ji’nan, China
- Department of Pediatrics, Qilu Children’s Hospital of Shandong University, Ji’nan, China
- * E-mail:
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