Epstein-Barr virus in suspected intracranial infection: a multicenter, retrospective study.

OBJECTIVES

The clinical relevance of Epstein-Barr virus (EBV) detection in cerebrospinal fluid (CSF) using metagenomic next-generation sequencing (mNGS) in patients with suspected intracranial infections has not been fully clarified. This study aimed to assess the clinical features, imaging characteristics, and outcomes in EBV-positive patients.

METHODS

We retrospectively enrolled patients with suspected intracranial infection who underwent commercial mNGS of CSF samples between December 2019 and October 2023 across 13 hospitals in four cities. Clinical data were collected, and multivariable logistic regression was performed to assess the association between EBV positivity and unfavorable outcomes.

RESULTS

Among 507 patients, 51 (10.1%) were EBV-positive in CSF. EBV-positive cases showed higher CSF mononuclear cell proportions (83.8% vs. 32.8%, P < 0.001), lower chloride levels (123.0 vs. 126.1 mmol/l, P = 0.019), and more frequent herpesvirus co-detection (21.6% vs. 8.6%, P = 0.007). Imaging abnormalities did not differ significantly. After adjustment, multivariable logistic regression showed that EBV was not an independent risk factor for clinical outcomes (OR 1.005, 95% CI 0.516-1.972, P = 0.988).

CONCLUSIONS

EBV was detected in 10.1% of patients in CSF samples from patients with suspected intracranial infections. EBV positivity correlated with a lymphocytic CSF profile and co-detection of other herpesviruses but was not independently associated with unfavorable outcomes.