Acute encephalitis in infectious mononucleosis

Sworn, M. J.; Urich, H.

doi:10.1002/path.1711000308

Cited by 34 publications

(3 citation statements)

References 9 publications

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“…19 The 1-to 3-week delay in onset of neurologic symptoms in those with classic infectious mononucleosis is consistent with an immunemediated process. 10 The observation that 52% of our cohort had prodromal symptoms for 7 days or more prior to the onset of neurologic illness and the findings of leptomeningeal mononuclear inflammatory infiltration, perivascular cuffing, and perivascular demyelination observed in our two fatal cases, as well as in other fatal cases, 26 is also consistent with such a process. The fact that four of five patients with central nervous system demyelination in our cohort (patients 2, 7, 16, and 19) had prodromal symptoms for 14 days or more and did not have Epstein-Barr virus detected in the cerebrospinal fluid by PCR is also suggestive of an immunemediated neurologic injury.…”

Section: Discussionsupporting

confidence: 81%

Pediatric Epstein-Barr Virus—Associated Encephalitis: 10-Year Review

et al. 2006

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Many neurologic manifestations of Epstein-Barr virus (EBV) infection have been documented, including encephalitis, aseptic meningitis, transverse myelitis, and Guillain-Barré syndrome. These manifestations can occur alone or coincidentally with the clinical picture of infectious mononucleosis. Since 1994, The Hospital for Sick Children has maintained a prospective registry of all children admitted with acute encephalitis. This report summarizes all cases of Epstein-Barr virus-associated encephalitis compiled from 1994 to 2003. Twenty-one (6%) of 216 children, median age 13 years (range 3-17 years), in the Encephalitis Registry were identified as having evidence of Epstein-Barr virus infection. This evidence consisted of convincing Epstein-Barr virus serology and/or positive cerebrospinal fluid polymerase chain reaction (PCR). One patient had symptoms of classic infectious mononucleosis; all others had a nonspecific prodrome, including fever (n = 17; 81%) and headache (n = 14; 66%). Slightly less than half (n = 10; 48%) had seizures and often had electroencephalograms showing a slow background (n = 12; 57%). Many demonstrated cerebrospinal fluid pleocytosis (n = 17; 81%), and 71% (n = 15) had abnormal magnetic resonance imaging findings. Two patients died, 2 suffered mild deficits, and 16 were neurologically normal at follow-up. Most patients with Epstein-Barr virus encephalitis do not show typical symptoms of infectious mononucleosis. Establishing a diagnosis of Epstein-Barr virus encephalitis can be difficult, and, consequently, a combination of serologic and molecular techniques should be used when investigating a child with acute encephalitis. Most children make full recoveries, but residual neurologic sequelae and even death can and do occur.

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Section: Discussionsupporting

confidence: 81%

Pediatric Epstein-Barr Virus—Associated Encephalitis: 10-Year Review

et al. 2006

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“…70 In the few cases reported, poor outcomes have occurred due to brain edema causing raised intracranial pressure. 71 In one case series of 10 patients with EBV encephalitis, four had persistent neurological morbidity; most of these were behavioral issues or developmental delay, and one was upper limb paresis. 70 Treatment modalities for EBV encephalitis are controversial.…”

Section: Key Messagesmentioning

confidence: 99%

Herpesvirus Infections of the Central Nervous System

2019

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There are over 200 herpesvirus species, of which 10 affect humans. Each of these 10 herpesviruses has a unique clinical syndrome, but common to all is their ability to cause infection and pathology in the central nervous system. In this article, we discuss the epidemiology, clinical presentation, diagnostic modalities, treatment, sequelae, and availability of vaccination of each of the following herpesviruses: herpes simplex virus 1 and 2, varicella zoster virus, human cytomegalovirus, human herpesvirus 6A, 6B, and 7, Epstein–Barr virus, human herpesvirus 8, and simian herpesvirus B.

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“…The pathological changes in the brain consist of inflammatory lesions with dense perivascular cuffing and diffuse infiltration of the parenchyma mainly with typical mononuclear cells. 4 Infectious mononucleosis is the cause of up to 5 % of all cases of acute viral encephalitis.56 It is not yet clear whether the encephalitis of infectious mononucleosis is due to direct invasion of the brain or represents a remote effect of the viral infection. The occurrence of seizures during the course of infectious mononucleosis encephalitis is uncommon, and in fact only less than 20 cases have been recorded so far in the English literature.…”

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confidence: 99%