Fulminant Epstein Barr virus encephalitis

Mathew, Aji; Parvez, Yusuf

doi:10.1007/s13312-013-0101-5

Cited by 9 publications

(4 citation statements)

References 5 publications

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“…Pathological finding can be seen in acute condition of viral encephalitis, there are infiltration of mononuclear inflammatory cells in the meningens surrounding the wall of vessels [8]. Clinical presentation of EBV meningoencephalitis includes fever, headaches, altered consciousness, meningeal signs, fever, seizure and bizarre behavior [5,10,11]. These symptoms was seen in our patient.…”

Section: Discussionsupporting

confidence: 57%

Meningoencephalitis Caused by Epstein-barr Virus in Adult with Lung Tuberculosis

Widayanti¹,

Tjoa²,

Tasia³

et al. 2017

JNSK

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Epstein-Barr virus (EBV) infections usually cause mild symptoms and resolves spontaneously, however the virus may cause severe complications such as neurological diseases, malignant diseases and myocarditis. Determining a diagnosis requires molecular, serological and imaging procedures. The therapeutic modalities for EBV-related severe organ damage including central nervous system manifestations are still uncertain. We report a 31-year-old man with lung tuberculosis with EBV meningoencephalitis presenting with prolonged fever and altered consciousness. Cranial imaging was consistent with meningoencephalitis characteristics. The diagnosis was made by EBV-DNA amplification in cerebrospinal fluid samples. In this case report, we aim to describe a meningoencephalitis caused by EBV in adult with underlying other organ infection.have antibodies to the virus [1,2]. Central nervous system (CNS) involvement in primary EBV infection in adults is rare, with less than 8% of cases found. EBV was found as a causative agent in 2 to 5% of viral encephalitis and meningitis cases [3].Involvement of EBV in CNS includes encephalitis, meningitis, cerebellitis, myelitis, plexitis and acute disseminated encephalomyelitis [2,[4][5][6]. This case report aims to describe a patient with lung tuberculosis showing symptoms and signs of meningoencephalitis caused by EBV. Case ReportA 31-year-old man was admitted to the emergency room with a history of unconsciousness since the day before admission. He previously had 6 days of fluctuating fever and headache. The patient had some behavioral changes since six days before admission such as deliriousness, incoherence and anxiousness. There were involuntary movements in both his hands. He was diagnosed with miliary type lung tuberculosis (TB) 3 months ago. He was given a regimen of antituberculosis drugs which he consumed for only two months before stopping for one month.On admission, he was sopor (Glasgow Coma Scale E2M5V2) and his vital signs recorded were blood pressure 110/70 mmHg, heart rate 70x/minute, respiratory rate 32x/minute, and temperature 37oC. There was crackles in right lung examination. In the neurologic examination there was nuchal rigidity, positive Kernig sign, hemiparesis in right extremities, and positive Babinski sign.Initial investigations including hematologic, liver function, renal function and random plasma glucose did not show any abnormalities, except for a decrease in serum sodium 123 mmol/L. Anti-HIV test was negative, with normal CD4 count, CD 8 count and CD4:CD8 ratio. Serology test for syphilis were normal. Blood culture was negative for bacteria.The chest X-ray revealed no abnormality at this admission. Contrast-enhanced CT scan conducted on admission was consistent with meningoencephalitis characteristics and hydrocephalus sign was noted. He was diagnosed with TB meningoencephalitis and lung tuberculosis with history incompliance to TB therapy. He was treated with ceftriaxone, the same antituberculosis drug regimen and dexamethasone therapy with tapering...

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Section: Discussionsupporting

confidence: 57%

Meningoencephalitis Caused by Epstein-barr Virus in Adult with Lung Tuberculosis

Widayanti¹,

Tjoa²,

Tasia³

et al. 2017

JNSK

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“…Coxsackievirus B5 (CB5) has been reported to be responsible for recent outbreak in our province [ 5 ]. In addition, infections of CNS can also be caused by human cytomegalovirus (CMV) [ 6 , 7 ], Esterin-Barr virus (EBV), and other pathogens [ 8 , 9 ]. Early diagnosis and treatment are crucial to prevent further disease deterioration.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a Viral Microarray Based on Simultaneous Extraction and Amplification of Viral Nucleotide Acid for Detecting Human Herpesviruses and Enteroviruses

et al. 2015

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In this study, a viral microarray based assay was developed to detect the human herpesviruses and enteroviruses associated with central nervous system infections, including herpes simplex virus type 1, type 2 (HSV1 and HSV2), Epstein-Barr virus (EBV), cytomegalovirus (CMV), enterovirus 71 (EV71), coxsackievirus A 16 (CA16) and B 5(CB5). The DNA polymerase gene of human herpesviruses and 5’-untranslated region of enteroviruses were selected as the targets to design primers and probes. Human herpesviruses DNA and enteroviruses RNA were extracted simultaneously by using a guanidinium thiocyanate acid buffer, and were subsequently amplified through a biotinylated asymmetry multiplex RT-PCR with the specific primer of enteroviruses. In total, 90 blood samples and 49 cerebrospinal fluids samples with suspected systemic or neurological virus infections were investigated. Out of 139 samples, 66 were identified as positive. The specificities of this multiplex RT-PCR microarray assay were over 96% but the sensitivities were various from 100% for HSV1, HSV2, EV71 and CB5, 95.83% for CMV, 80% for EBV to 71.43% for CA16 in comparison with reference standards of TaqMan qPCR/qRT-PCR. The high Kappa values (>0.90) from HSV1, HSV2, CMV, EV71 and CB5 were obtained, indicating almost perfect agreement in term of the 5 viruses detection. But lower Kappa values for EBV (0.63) and CA16 (0.74) displayed a moderate to substantial agreement. This study provides an innovation of simultaneous extraction, amplification, hybridization and detection of DNA viruses and RNA viruses with simplicity and specificity, and demonstrates a potential clinical utility for a variety of viruses’ detection.

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“…1 Mathew et al described two cases of EBV encephalitis: one with drowsiness, wide-based gait and nystagmus but with no seizures or focal neurological signs, 3 and another case presented with tonic-clonic seizures leading to status epilepticus. 3 Clinicians should be aware that EBV encephalitis can present with highly variable clinical features that may overlap other pathologies 2 and should be considered in the differential of acute encephalitis. 1 Recommended investigations of suspected encephalitis should include an LP, blood cultures, serology and neuroimaging.…”

Section: Key Pointsmentioning

confidence: 99%