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

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.

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.

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.

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.