Posible encefalitis por el virus de Epstein-Barr en un paciente infectado por el VIH

Cubo, P.; Abad, M. A.; Vergas, Jorge; Estrada, Vicente

doi:10.1157/13108714

Cited by 7 publications

(8 citation statements)

References 5 publications

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“…The vast majority of patients (83, 80%) were immunocompetent. Of the twenty percent of immunocompromised cases, six involved HIV-positive patients [11,16,38,44,45,100], including three cases with a CD4 count below 250/mm 3 . Nine cases were related to kidney transplant recipients [12,15,27,33,42,61,68,72,103], who were mainly treated with tacrolimus and mycophenolate mofetil (eight patients) with or without corticoids.…”

Section: Epidemiological Analysismentioning

confidence: 99%

Epstein-Barr Virus Encephalitis: A Review of Case Reports from the Last 25 Years

Peuchmaur,

Voisin,

Vaillant

et al. 2023

Microorganisms

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Although uncommon, Epstein-Barr virus-related neurological disorders represent the seventh most frequent cause of infectious encephalitis in adults. The limited number of publications on EBV encephalitis mainly document isolated clinical cases. This study aimed to summarize published data on EBV encephalitis. A systematic literature search identified 97 EBV encephalitis cases. In the selected cases, EBV-related neurological disorders manifested as lymphocytic pleocytosis in the cerebrospinal fluid (CSF) with moderate hyperproteinorachia. The EBV PCR test was positive in 87% of the CSF samples, with wide-ranging viral loads. When encephalitis occurred in the context of past EBV infections, all of the EBV PCR tests on CSF samples were positive. On the contrary, negative EBV PCR tests on CSF samples occurred only in the context of primary infections. EBV PCR was rarely carried out on blood samples, contributing minimally to the diagnosis. For the treatment of EBV encephalitis, Aciclovir was used alone in 29% of cases, and in association with other drugs in 40% of cases. Ganciclovir (30%), corticoids (52%), and immunoglobulins (15%) were mainly used in association with other drugs. Cerebral imaging was abnormal in 69% of cases, mostly in the cerebellum and basal ganglia. This work highlights that the EBV PCR test on CSF samples is currently the main laboratory diagnostic test to diagnose EBV encephalitis. This diagnostic test is useful; however, it is imperfect. New complementary diagnostic tools, approved treatments, and standardized practices could improve patient management.

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Section: Epidemiological Analysismentioning

confidence: 99%

Epstein-Barr Virus Encephalitis: A Review of Case Reports from the Last 25 Years

Peuchmaur,

Voisin,

Vaillant

et al. 2023

Microorganisms

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show abstract

“…In the context of HIV-associated immunosuppression, individuals are known to be at higher risk of CNS infections by herpes viruses, but there are few reports of EBV encephalitis [4][5][6][7][8]. Most cases of EBV encephalitis in patients with HIV infection have an insidious course, with progressive neurological impairment during weeks or even months.…”

Section: Case Descriptionmentioning

confidence: 99%

Epstein-Barr virus encephalitis presenting with brain mass lesions in a patient with human immunodeficiency virus infection

Martins,

Silva,

Ceia

et al. 2023

HIV & AIDS Review

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Epstein-Barr virus (EBV) disease of central nervous system (CNS) in human immunodeficiency virus (HIV) patients is mostly associated with primary CNS lymphoma (PCNSL). In patients who cannot undergo biopsy and have typical clinical and radiographic findings, detection of EBV deoxyribonucleic acid in CSF may provide enough evidence to start treatment for PCNSL. Here, we described a case of EBV encephalitis presenting with fever, memory, and psycho-motor deficits in a patient with HIV infection and severe immunosuppression who started antiretroviral therapy (ART) one month earlier. Brain magnetic resonance imaging showed periventricular lesions with nodular enhancing pattern and restricted diffusion, and CSF was positive for EBV. Brain biopsy revealed inflammatory lesions and lymphoid infiltrate without signs of malignancy. After three months of ART, patient improved significantly and MRI showed a marked reduction of lesions. Two years later, patient's condition remains stable. PCNSL is the leading diagnosis in HIV patients with CNS mass lesions and positive CSF for EBV. In the case described, starting treatment for PCNSL could have been considered if the patient could not undergo biopsy, or if there was no improvement under ART. However, EBV encephalitis can be a differential diagnosis in patients with compatible histopathology and clinical course.

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“…1) [144], aunque tanto el realce meníngeo del contraste como las hiperintensidades periventriculares pueden observarse en el contexto de neuroinfección por VIH [144]. En el diagnóstico por imagen de la encefalopatía por VIH son característicos la atrofia cerebral, el agrandamiento del sistema ventricular, la atrofia cortical y subcortical, la afectación de la sustancia blanca y las calcificaciones de los ganglios de la base, siendo la atrofia cerebral el hallazgo más común [140][141][144][145][146][147][148]. Tras el tratamiento antiviral y antirretroviral con lamivudina, abacavir y lopinavir/ritonavir [145,146], en la RM de control realizada se observó afectación de la sustancia blanca periventricular y atrofia cerebral de predominio temporal compatible con encefalopatía por VIH (Fig.…”

Section: Discusión Estudiounclassified

“…Tras el tratamiento antiviral y antirretroviral con lamivudina, abacavir y lopinavir/ritonavir [145,146], en la RM de control realizada se observó afectación de la sustancia blanca periventricular y atrofia cerebral de predominio temporal compatible con encefalopatía por VIH (Fig. 2) [147]. La terapia antirretroviral reduce el riesgo de encefalopatía por VIH de forma eficaz, sobre todo con fármacos con alta penetrancia en el sistema nervioso central [149].…”

Section: Discusión Estudiounclassified

“…La infección por VIH en el niño tiene una elevada morbilidad, que es mayor que en el adulto [148]. La encefalopatía por VIH es la alteración neurológica más grave, y la encefalopatía progresiva, la presentación más común en niños (30-50%), cuya clínica es la afectación del desarrollo con deterioro progresivo y déficit motor con hipertonía distal [147]. En nuestra paciente, la suma de la clínica neurológica con ataxia y alteración de la marcha, los hallazgos en las pruebas de imagen realizadas, donde se observa captación leptomeníngea, y los datos de laboratorio con PCR compatible permiten tener una alta sospecha de meningoencefalitis por VEB en el contexto de infección por VIH, aunque ello no asegura el diagnóstico de certeza [149,150].…”

Section: Discusión Estudiounclassified

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Características clínicas, etiología, tratamiento y evolución de la epilepsia refractaria en la infancia

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Posible encefalitis por el virus de Epstein-Barr en un paciente infectado por el VIH

Cited by 7 publications

References 5 publications

Epstein-Barr Virus Encephalitis: A Review of Case Reports from the Last 25 Years

Epstein-Barr Virus Encephalitis: A Review of Case Reports from the Last 25 Years

Epstein-Barr virus encephalitis presenting with brain mass lesions in a patient with human immunodeficiency virus infection

Características clínicas, etiología, tratamiento y evolución de la epilepsia refractaria en la infancia

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