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Acute manifestations and neurologic sequelae of Epstein-Barr virus encephalitis in children
J B Domachowske1, C K Cunningham, D L Cummings
1Department of Pediatrics, State University of New York, Health Science Center at Syracuse, USA. jdomach@helix.nih.gov
Insights
Epstein-Barr virus (EBV) encephalitis in children can present without typical infectious mononucleosis symptoms. This study found that a significant number of pediatric patients develop persistent neurologic issues following EBV encephalitis.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neurovirology
Background:
- Epstein-Barr virus (EBV) infection can cause various neurologic complications, including encephalitis.
- EBV encephalitis in children is often considered self-limited with minimal long-term effects.
Purpose of the Study:
- To characterize the clinical and laboratory findings of EBV encephalitis in pediatric patients.
- To determine the extent of neurologic sequelae following EBV encephalitis in children.
Main Methods:
- Retrospective chart review of patients under 18 diagnosed with encephalitis or meningoencephalitis between 1982 and 1992.
- Analysis of clinical presentation, laboratory findings, neuroimaging, EEG, and long-term neurologic outcomes.
Main Results:
- Diverse acute neurologic manifestations were observed, including behavioral changes, seizures, and focal deficits.
- Classic infectious mononucleosis signs were infrequent; abnormal EEGs were common (64%).
- Forty percent of patients experienced persistent neurologic abnormalities, such as global impairment and motor deficits.
Conclusions:
- Epstein-Barr virus encephalitis in children may lack typical infectious mononucleosis symptoms.
- A substantial proportion of pediatric patients with EBV encephalitis develop significant neurologic sequelae.
Background:
Complications of Epstein-Barr virus (EBV) infection are diverse and include a number of neurologic manifestations such as meningitis, meningoencephalitis, cerebellitis, cranial neuritis and others. In general encephalitis caused by EBV in pediatric patients has been considered a self-limited illness with few or no sequelae.
Methods:
Charts were reviewed from all patients < 18 years of age admitted to or discharged from the State University of New York Health Science Center at Syracuse between 1982 and 1992 with a diagnosis of encephalitis or meningo-encephalitis. Eleven cases of EBV encephalitis diagnosed during a 10-year period were reviewed to characterize the clinical and laboratory findings in the acute setting and the extent of neurologic sequelae on follow-up.
Results:
Acute neurologic manifestations were diverse and included combative behavior (55%), seizures (36%), headache (36%) and evidence of focal involvement (27%). Classic findings of infectious mononucleosis were noted infrequently; 18% each had pharyngitis, adenopathy, positive heterophile antibody tests or atypical lymphocytosis. Two patients (18%) had abnormal neuroimaging studies, one in the acute stage and the other at the time of follow-up. Seven patients (64%) had abnormal electroencephalograms (EEGs) in the acute setting; of these three had persistent abnormalities on follow-up. Forty percent developed persistent neurologic abnormalities including global impairment, perseverative autistic-like behavior and persistent left upper extremity paresis.
Conclusions:
Classic signs, symptoms and laboratory findings in infectious mononucleosis may be absent in Epstein-Barr virus encephalitis. Neurologic sequelae occur in a substantial number of patients.