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Akolbire DA, Akolbire D, Delapenha R. A Case Report of a Rapidly Progressive Epstein-Barr Virus Encephalitis Infection in an Adult With HIV on Highly Active Antiretroviral Therapy. Cureus 2024; 16:e52392. [PMID: 38361681 PMCID: PMC10869129 DOI: 10.7759/cureus.52392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/17/2024] Open
Abstract
Epstein-Barr virus (EBV) encephalitis is a rare complication of EBV infection, with most cases described in children. Although some cases of EBV encephalitis have been reported in adults, they have occurred in the presence of other central nervous system infections, superimposed on an underlying neurocognitive disorder, or in immunocompromised states. We present herein a rare case of rapidly progressive EBV encephalitis in an adult male with HIV infection on highly active antiretroviral therapy (HAART) with no pre-existing neurocognitive symptoms. A 52-year-old African American man with HIV infection on HAART presented with acute altered mental status and weakness. On admission, he had normal muscle tone and reflexes, with no signs of meningism. Head CT without contrast showed no acute intracranial pathology. Blood and urine cultures were negative. CSF analysis was suggestive of a viral infection. Viral studies were positive only for EBV DNA by PCR in CSF. The patient received IV acyclovir for two weeks, followed by four weeks of oral valacyclovir with full recovery. Clinicians should consider a diagnosis of EBV encephalitis in HIV-positive patients on HAART who present with acute altered mental status. Treatment with antiviral therapy should be considered in patients with EBV encephalitis.
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Affiliation(s)
| | - Doris Akolbire
- Internal Medicine, Howard University Hospital, Washington, USA
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2
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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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Del Giudice E, Mondì F, Bazzanella GR, Marcellino A, Martucci V, Pontrelli G, Sanseviero M, Pavone P, Bloise S, Martellucci S, Carraro A, Ventriglia F, Lichtner M, Lubrano R. Post-Infectious Acute Cerebellar Ataxia Treatment, a Case Report and Review of Literature. CHILDREN 2023; 10:children10040668. [PMID: 37189917 DOI: 10.3390/children10040668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/13/2023] [Accepted: 03/22/2023] [Indexed: 04/03/2023]
Abstract
Background: infectious mononucleosis is very common during childhood and neurological manifestations are extremely rare. However, when they occur, an appropriate treatment must be undertaken to reduce morbidity and mortality as well as to ensure appropriate management. Methods: we describe the clinical and neurological records of a female patient with post-EBV acute cerebellar ataxia, whose symptoms rapidly resolved with intravenous immunoglobulin therapy. Afterwards, we compared our results with published data. Results: we reported the case of an adolescent female with a 5-day history of sudden asthenia, vomiting, dizziness, and dehydration, with a positive monospot test and hypertransaminasemia. In the following days, she developed acute ataxia, drowsiness, vertigo, and nystagmus with a positive EBV IgM titer, confirming acute infectious mononucleosis. The patient was clinically diagnosed with EBV-associated acute cerebellitis. A brain MRI showed no acute changes and a CT scan showed hepatosplenomegaly. She started therapy with acyclovir and dexamethasone. After a few days, because of her condition’s deterioration, she received intravenous immunoglobulin and demonstrated a good clinical response. Conclusions: although there are no consensus guidelines for the treatment of post-infectious acute cerebellar ataxia, early intervention with intravenous immunoglobulin might prevent adverse outcomes, especially in cases that do not respond to high-dose steroid therapy.
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Kong F, Zeng XX. Case report and literature review: A hiccup patient developed encephalitis and duodenal perforation. Antivir Ther 2023; 28:13596535231161488. [PMID: 36861651 DOI: 10.1177/13596535231161488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Brainstem encephalitis is rare and this study aims to report the clinical course, imaging features, and therapeutic response of hiccup patient with gastric ulcer who developed brainstem encephalitis with Epstein-Barr virus (EBV) detected in cerebrospinal fluid and then subsequently followed by development of duodenal perforation. Data of a gastric ulcer patient who suffered from hiccups, with brainstem encephalitis detected and then subsequently suffered from duodenal perforation were collected retrospectively and analyzed. A literature search was conducted on Epstein-Barr virus associated encephalitis using keywords like "Epstein-Barr virus encephalitis" and "brainstem encephalitis," "hiccup." The etiology of EBV-related brainstem encephalitis in this case report is not clear. However, from the initial hiccup to the presentation of both brainstem encephalitis and duodenal perforation during the course of hospitalizations builds up an uncommon case.
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Affiliation(s)
- Fanfeng Kong
- Intensive Care Unit, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Xiao Xue Zeng
- Department of Health Management, Centre of General Practice, The Seventh Affiliated Hospital, Southern Medical University, Foshan, China
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Rios J, Félix C, Proença P, Malaia L, Nzwalo H. Ischemic Stroke and Subarachnoid Hemorrhage following Epstein-Barr Virus Infection. J Neurosci Rural Pract 2020; 11:680-681. [PMID: 33144820 PMCID: PMC7595775 DOI: 10.1055/s-0040-1717827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Jonathan Rios
- Department of Physical Medicine and Rehabilitation, Algarve Hospital University Center-Faro, Portugal, Rua Leão Penedo, Faro, Portugal
| | - Catarina Félix
- Department of Neurology, Algarve Hospital University Center-Faro, Portugal, Rua Leão Penedo, Faro, Portugal
| | - Paula Proença
- Infectious Disease Department, Algarve Hospital University Center-Faro, Portugal, Rua Leão Penedo, Faro, Portugal
| | - Luís Malaia
- Department of Physical Medicine and Rehabilitation, Algarve Hospital University Center-Faro, Portugal, Rua Leão Penedo, Faro, Portugal
| | - Hipólito Nzwalo
- Department of Biomedical Sciences and Medicine, University of Algarve-Edifício 7-Ala Nascente- 3°andar Campus de Gambelas Faro, Portugal
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Kamel MH, Yin W, Zavaro C, Francis JM, Chitalia VC. Hyperthrombotic Milieu in COVID-19 Patients. Cells 2020; 9:E2392. [PMID: 33142844 PMCID: PMC7694011 DOI: 10.3390/cells9112392] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/23/2020] [Accepted: 10/25/2020] [Indexed: 02/06/2023] Open
Abstract
COVID-19 infection has protean systemic manifestations. Experience from previous coronavirus outbreaks, including the current SARS-CoV-2, has shown an augmented risk of thrombosis of both macrovasculature and microvasculature. The former involves both arterial and venous beds manifesting as stroke, acute coronary syndrome and venous thromboembolic events. The microvascular thrombosis is an underappreciated complication of SARS-CoV-2 infection with profound implications on the development of multisystem organ failure. The telltale signs of perpetual on-going coagulation and fibrinolytic cascades underscore the presence of diffuse endothelial damage in the patients with COVID-19. These parameters serve as strong predictors of mortality. While summarizing the alterations of various components of thrombosis in patients with COVID-19, this review points to the emerging evidence that implicates the prominent role of the extrinsic coagulation cascade in COVID-19-related coagulopathy. These mechanisms are triggered by widespread endothelial cell damage (endotheliopathy), the dominant driver of macro- and micro-vascular thrombosis in these patients. We also summarize other mediators of thrombosis, clinically relevant nuances such as the occurrence of thromboembolic events despite thromboprophylaxis (breakthrough thrombosis), current understanding of systemic anticoagulation therapy and its risk-benefit ratio. We conclude by emphasizing a need to probe COVID-19-specific mechanisms of thrombosis to develop better risk markers and safer therapeutic targets.
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Affiliation(s)
- Mohamed Hassan Kamel
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA; (M.H.K.); (W.Y.); (C.Z.); (J.M.F.)
| | - Wenqing Yin
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA; (M.H.K.); (W.Y.); (C.Z.); (J.M.F.)
| | - Chris Zavaro
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA; (M.H.K.); (W.Y.); (C.Z.); (J.M.F.)
| | - Jean M. Francis
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA; (M.H.K.); (W.Y.); (C.Z.); (J.M.F.)
| | - Vipul C. Chitalia
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA; (M.H.K.); (W.Y.); (C.Z.); (J.M.F.)
- Veterans Affairs Boston Healthcare System, Boston, MA 02132, USA
- Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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Maiese A, La Russa R, Passaro G, Santoro P, De Matteis A, Fineschi V. Fatal Epstein-Barr virus infection in an immunocompetent host: a postmortem diagnosis. Forensic Sci Med Pathol 2020; 16:714-717. [PMID: 32394206 DOI: 10.1007/s12024-020-00254-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2020] [Indexed: 11/25/2022]
Abstract
Meningoencephalitis is the most common neurological complication related to Epstein-Barr virus (EBV), and in immunocompetent adults, it is most commonly self-limited. We describe a case of fatal EBV infection characterized by meningoencephalitis, foci of myocarditis and interstitial nephritis in an immunocompetent 74-year-old man. The postmortem diagnosis was made based on the presence of EBV DNA in the cerebrospinal fluid and by immunohistochemical assay that showed spots of intracellular positivity to anti-EBV antibody in brain tissue.
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Affiliation(s)
- Aniello Maiese
- Section of Legal Medicine, Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Raffaele La Russa
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161, Rome, Italy
| | - Giovanna Passaro
- Fondazione Policlinico Universitario A. Gemelli IRCCS Research Hospital, Rome, Italy
| | - Paola Santoro
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161, Rome, Italy
| | - Alessandra De Matteis
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161, Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161, Rome, Italy.
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Beneficial and Detrimental Effects of Regulatory T Cells in Neurotropic Virus Infections. Int J Mol Sci 2020; 21:ijms21051705. [PMID: 32131483 PMCID: PMC7084400 DOI: 10.3390/ijms21051705] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 02/07/2023] Open
Abstract
Neurotropic viruses infect the central nervous system (CNS) and cause acute or chronic neurologic disabilities. Regulatory T cells (Treg) play a critical role for immune homeostasis, but may inhibit pathogen-specific immunity in infectious disorders. The present review summarizes the current knowledge about Treg in human CNS infections and their animal models. Besides dampening pathogen-induced immunopathology, Treg have the ability to facilitate protective responses by supporting effector T cell trafficking to the infection site and the development of resident memory T cells. Moreover, Treg can reduce virus replication by inducing apoptosis of infected macrophages and attenuate neurotoxic astrogliosis and pro-inflammatory microglial responses. By contrast, detrimental effects of Treg are caused by suppression of antiviral immunity, allowing for virus persistence and latency. Opposing disease outcomes following Treg manipulation in different models might be attributed to differences in technique and timing of intervention, infection route, genetic background, and the host’s age. In addition, mouse models of virus-induced demyelination revealed that Treg are able to reduce autoimmunity and immune-mediated CNS damage in a disease phase-dependent manner. Understanding the unique properties of Treg and their complex interplay with effector cells represents a prerequisite for the development of new therapeutic approaches in neurotropic virus infections.
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Epstein-Barr virus hemorrhagic meningoencephalitis: case report and review of the literature. J Neurovirol 2016; 22:695-698. [DOI: 10.1007/s13365-016-0430-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 02/19/2016] [Indexed: 11/25/2022]
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