Open Access Highly Accessed Research article

Clinical characteristics of patients with Epstein Barr virus in cerebrospinal fluid

Timi Martelius1*, Maija Lappalainen2, Maarit Palomäki3 and Veli-Jukka Anttila1

Author Affiliations

1 Department of Medicine, Division of Infectious Diseases, Helsinki University Central Hospital PO Box 348, 00029 HUS, Helsinki, Finland

2 Department of Virology and Immunology, Helsinki University Central Hospital, Laboratory Services (HUSLAB), PO Box 400, 00029HUS, Helsinki, Finland

3 Department of Radiology, Helsinki University Central Hospital, PO Box 340 00029HUS, Helsinki, Finland

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BMC Infectious Diseases 2011, 11:281  doi:10.1186/1471-2334-11-281

Published: 21 October 2011

Abstract

Background

The role of Epstein-Barr (EBV) virus in central nervous system (CNS) infections is not fully resolved. It is clearly associated with lymphoproliferative disease of immunosuppressed persons, and may cause encephalitis.

Methods

We reviewed the medical records, imaging and laboratory findings of all patients EBV DNA PCR positive in cerebrospinal fluid (CSF) during 2000 to 2009 in the Helsinki University Central Hospital.

Results

We identified 32 patients with EBV DNA in CSF. 11 had history of allogeneic hematopoietic stem cell transplantation, 7 solid organ transplantation and 5 HIV/AIDS. 5 patients had no preceding immunodeficiency.

In 8 of the cases, another pathogen was identified in CSF. These were M. tuberculosis (2), T. gondii (2), Aspergillus (1), Herpes simplex virus 1 (1), C. neoformans (1) and Human herpesvirus 6 (1). Altogether in 15/32 (47%) of the cases the clinician had a strong suspicion of cause other than EBV for the patients' CNS symptoms/findings.

Of note, 7 of 11 (64%) patients with stem cell transplantation had encephalitis (univariate odds ratio 5.6; confidence Interval 1.1-27.4). Of these 6 had no other pathogen identified.

Conclusions

EBV DNA was often found together with other microbial findings in CSF of immunocompromised patients. EBV seems to be associated with encephalitis in stem cell transplant recipients.