Clinical characteristics of patients with Epstein Barr virus in cerebrospinal fluid

Abstract

Background: 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.

Methods: We 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.

Results: We 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.

Conclusions: EBV 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.

Figure 1

Clinical manifestations of patients with EBV DNA in CSF. Y-axis: number of patients. HIV = HIV infection, HSCT = stem cell transplantation, SOT = solid organ transplantation. "Brain abscess" also includes fungal lesions.

Figure 2

Number of leukocytes in CSF (× 10⁶ cells/liter) Leukocyte number in cerebrospinal fluids with EBV only or with other pathogens (difference not significant). Box plots show the median, interquartile range, error bars and outliers.