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Published on: March 30, 2018
Clinical features and risk factors for Epstein-Barr virus-associated encephalitis: a retrospective cohort study
Zhu Liu1, Anjiao Peng1, Luyan Huang1
1Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, China.
Background:
Epstein-Barr virus (EBV) has been gradually recognized as an important pathogen of encephalitis, but our knowledge of EBV-associated encephalitis is still limited. The aim of this study was to describe the clinical features and explore the risk factors for EBV-associated encephalitis in a large cohort of Chinese patients.
Methods:
All patients with confirmed encephalitis in our center from June 2020 to April 2021 were enrolled. Data were extracted from the electronic medical record system and analyzed by Student's t test, Mann-Whitney U test, chi-square test, and logistic regression analyses.
Results:
This study included a total of 364 patients diagnosed with encephalitis, among which 86 cases (23.6%) had EBV detected in their cerebrospinal fluid (CSF), and 39 cases were diagnosed with EBV-associated encephalitis. The clinical characteristics of EBV-associated encephalitis differ from those caused by other herpes viruses. Compared to other herpes virus-related encephalitis, patients with EBV encephalitis exhibited significantly higher protein levels (1.310 [0.695, 1.840] vs. 0.710 [0.490, 1.700], p < 0.001), lower glucose levels (3.030 [2.585, 3.640] vs. 3.380 [2.990, 4.030], p < 0.001), and a higher incidence of meningeal involvement on MRI (11 (30.6%) vs. 3 (6.5%), p = 0.010). Additionally, univariate logistic regression analysis revealed that age (OR = 1.015, 95% CI: 1.002-1.029), HIV infection (OR = 4.285, 95% CI: 1.582-11.816), non-tumor immunosuppression (OR = 5.713, 95% CI: 1.588-22.883), and peripheral blood EBV infection (OR = 10.204, 95% CI: 4.231-26.346) were independent risk factors for CNS EBV infection.
Conclusion:
Compared to other herpes virus-associated encephalitis, EBV encephalitis is characterized by a higher degree of meningeal involvement, elevated CSF protein levels, lower glucose levels, and a reduced T-lymphocyte count in peripheral blood. These characteristics suggest that EBV encephalitis may have a distinct pathophysiology.
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