Epstein-barr virus-associated encephalitis in a case-series of more than 40 patients.

OBJECTIVE

Introduction

Epstein-Barr virus (EBV) infection can present with neurologic manifestations including encephalitis, aseptic meningitis, Guillain-Barre syndrome, and many others. Most reported cases have been in children. Little is known about EBV encephalitis in adults. The aim: To describe the clinical presentations, investigational findings, management and outcome of adult patients with EBV encephalitis.

PATIENTS AND

METHODS

Materials and methods: This report conducted a retrospective review of all cases of EBV-associated encephalitis compiled in the Kyiv's referral hospital from January 2016 to December 2017.

RESULTS

Review: Out of 226 adult patients hospitalized with acute encephalitis during the study period, 48 (21.2%) were identified as having evidence of EBV-infection: convincing EBV serology and/or positive cerebrospinal fluid (CSF) polymerase chain reaction (PCR) in patients that had no bacterial cause of encephalitis. EBV monoinfection was registered in 24 (50%) patients. Mixed herpesvirus infection with one to four viruses in addition to EBV was detected in the rest. The most common symptoms were fever, confusion, headache, focal neurological deficits, vestibulo-ataxic disorders. CSF cytosis, content of protein and glucose were close to normal. Magnetic resonance imaging (MRI) showed focal (28/58.3%) and diffuse (15/31.3%) changes of the brain parenchymal. All patients got antiviral medication: ganciclovir, valganciclovir or valaciclovir, as a rule. Outcome: 26 (54%) patients recovered without any disabling sequela, 21 (44%) patients with remaining preservations were transferred to a convalescence facility. One patient, which condition worsened against the background of the therapy, were moved to an intensive care unit. No patient died.

CONCLUSION

Conclusions

CNS infection with EBV only and as a mixed infection is common in Ukraine. Presentation of EBV-infection is non-specific, both as MR imaging, sometimes reminding of HSV-1 infection. Prognosis of the disease is favorable.