Subacute Enterovirus-Associated Encephalitis in a Young Adult Coinfected With Borrelia Burgdorferi

Dyachenko, Pavel; Kurhanska, Victoriia A; Dyachenko, Anatoly G; Smiianova, Olha Ivanivna

doi:10.36740/wlek202005140

Cited by 6 publications

(7 citation statements)

References 14 publications

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“…[3] EBV DNA can exist outside the host chromosome or be incorporated into the host cell genome. [4] Second, EBV not only releases toxins directly into the nervous system through the immune-mediated effect of CD8 + T lymphocytes, but also produces antigen-antibody complexes that can cause brain cell damage. EBV is the causative agent of infectious mononucleosis and has also been linked to a variety of diseases, such as childhood lymphoma and nasopharyngeal carcinoma.…”

Section: Discussionmentioning

confidence: 99%

A case of EBV encephalomyelitis with positive anti-GFAP-IgG antibody with recurrent fever and dysuresia as the main symptoms: Case report and retrospective analysis

et al. 2022

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Rationale: Due to neuronal destruction caused by Epstein-Barr virus (EBV) infection, exposure to neuronal surface antigens may lead to an imbalance in immune tolerance, which in turn triggers an autoimmune response. In addition, due to the involvement of nonspecific B-cell activation or molecular mimicry, EBV and Glial Fibrillary Acidic Protein (GFAP) receptors may have common epitopes. Viral infection triggers activation of B-cell and cross-reaction with viral antibodies, resulting in autoimmune encephalomyelitis. The clinical presentation may be complex or even atypical. A small number of patients may develop autoimmune reactions. Patient concerns: Most patients with EBV encephalomyelitis have a good prognosis, with the disease generally having a short course, few complications, and a good prognosis. In most patients, after treatment, their neurological function basically recovers within a few weeks or months. Diagnosis interventions: The patient had fever and headache. His 3 tests for cerebral spinal fluid (CSF) are consistent with the features of viral encephalomyelitis. Pathogenic examination of CSF confirmed EBV, and imaging suggested brain and spinal cord involvement. After antiviral treatment, the patient’s symptoms relieved. The diagnosis of EBV encephalomyelitis was considered. However, the patient’s temperature continued to increase. He was transferred to a superior hospital and was given GFAP-Ab in CSF, which was strongly positive. The patient was given immunoglobulin and antiviral therapy. This supports the diagnosis of GFAP-IgG antibody positive with EBV encephalomyelitis. Outcomes: After treatment with antiviral drugs and immunoglobulins, the patient’s symptoms improved and he was able to function. Lessons: EBV encephalomyelitis is a rare clinical disease. Therefore, more attention should be paid to the early diagnosis and treatment of similar patients to avoid misdiagnosis. CSF tests, genetic tests, and imaging tests can confirm the diagnosis.

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Section: Discussionmentioning

confidence: 99%

A case of EBV encephalomyelitis with positive anti-GFAP-IgG antibody with recurrent fever and dysuresia as the main symptoms: Case report and retrospective analysis

et al. 2022

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“…2). Dyachenko et al 19 reported that 48 (21.2%) of 226 patients with acute encephalitis had evidence of EBV infection, including 24 (50%) with EBV monoinfection. CSF cytosis, protein and glucose content of these patients were close to normal, and MRI showed nonspecific focal (58.3%) and diffuse (31.3%) changes in the brain parenchymal.…”

Section: Discussionmentioning

confidence: 99%

Chronic Active Epstein-Barr Virus Infection With Central Nervous System Involvement in Children: A Clinical Study of 22 Cases

Zhao

Wei

et al. 2022

Pediatric Infectious Disease Journal

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Objective:To analyze the clinical features, treatment, and prognosis of chronic active Epstein-Barr virus infection (CAEBV) with central nervous system (CNS) involvement in children. Methods: Patients with CAEBV admitted to Beijing Children's Hospital, Capital Medical University, were enrolled in this study from January 2017 to December 2020. They were divided into a CNS group and a non-CNS group based on the presence of CNS involvement. Results: Twenty-two patients developed CNS disease, accounting for 23.9% (22/92) of CAEBV patients in the same period. Of these, only 2 of 22 patients presented initially with neurologic symptoms in the CNS group, and they all improved after treatment. Cerebrospinal fluid (CSF) examination demonstrated normal protein concentration and cell number in all patients with CNS involvement. Only 7 patients were positive for CSF EBV-DNA. Twenty-one patients had neuroimaging abnormalities, such as white matter signal abnormalities, encephalography or calcification. In the CNS group, 7 (31.8%) patients died, including 5 who died of active hemophagocytic lymphohistiocytosis, 1 died of unrelated causes, and 1 died of respiratory failure caused by pulmonary lymphoproliferative disease progression after transplantation. The 3-year overall survival was lower in the CNS group than in the non-CNS group (63.6% ± 11.9% versus 86.9% ± 4.1%, P = 0.027).Hemophagocytic lymphohistiocytosis (HLH) is an independent risk factor for CNS involvement in patients with CAEBV (OR = 2.946, 95% CI: 1.042-8.335, P = 0.042). Compared with the non-CNS group, blood EBV-DNA loads and CD4+/CD8+ ratio of T lymphocytes in the CNS group were higher (P < 0.001), while fibrinogen levels and natural killer (NK)-cell activity were lower (P = 0.047). Children with CAEBV were more likely to develop CNS diseases with low NK-cell activity (NK-cell activity < 14.00%, P = 0.023) or high alanine aminotransferase (ALT) levels (ALT levels > 40 U/L, P = 0.032). Conclusion: CAEBV with CNS involvement has nonspecific clinical manifestations, laboratory data, neuroimaging but has a worse prognosis. Blood fibrinogen levels and NK-cell activity in CAEBV children with CNS involvement are lower than in those without CNS involvement. In contrast, blood EBV-DNA loads and CD4+/CD8+ ratio of T lymphocytes are higher. Children with CAEBV who presented with HLH, NK-cell activity <14.00%, serum ALT >40 U/L and high-blood EBV-DNA loads are prone to develop CNS diseases.

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“…However, the prognosis is generally good in the pediatric clientele and disabling sequela are uncommon. 54,55 The diagnosis is based on EBV DNA in cerebrospinal fluid (CSF) and serum by PCR. The CSF of patients with EBV meningitis/encephalitis typically shows pleocytosis, slightly increased protein levels, and atypical lymphocytes.…”

Section: Neurologic Disorders Associated With Lytic Ebv Infection Ebv...mentioning

confidence: 99%

“…However, the prognosis is generally good in the pediatric clientele and disabling sequela are uncommon. 54 , 55 …”

Section: Ebv-mediated Cns Pathologymentioning

confidence: 99%

Treatment Options for Epstein-Barr Virus-Related Disorders of the Central Nervous System

Andersen¹,

Ernberg²,

Hedström³

2023

IDR

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Epstein-Barr virus (EBV), a causative agent for several types of lymphomas and mucosal cancers, is a human lymphotropic herpesvirus with the capacity to establish lifelong latent infection. More than 90% of the human population worldwide is infected. The primary infection is usually asymptomatic in childhood, whereas infectious mononucleosis (IM) is common when the infection occurs in adolescence. Primary EBV infection, with or without IM, or reactivation of latent infection in immunocompromised individuals have been associated with a wide range of neurologic conditions, such as encephalitis, meningitis, acute disseminated encephalomyelitis, and cerebellitis. EBV is also involved in malignant lymphomas in the brain. An increasing number of reports on EBV-related disorders of the central nervous system (CNS) including the convincing association with multiple sclerosis (MS) have put in focus EBV-related conditions beyond its established link to malignancies. In this review, we present the clinical manifestations of EBVrelated CNS-disorders, put them in the context of known EBV biology and focus on available treatment options and future therapeutic approaches.

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Subacute Enterovirus-Associated Encephalitis in a Young Adult Coinfected With Borrelia Burgdorferi

Cited by 6 publications

References 14 publications

A case of EBV encephalomyelitis with positive anti-GFAP-IgG antibody with recurrent fever and dysuresia as the main symptoms: Case report and retrospective analysis

A case of EBV encephalomyelitis with positive anti-GFAP-IgG antibody with recurrent fever and dysuresia as the main symptoms: Case report and retrospective analysis

Chronic Active Epstein-Barr Virus Infection With Central Nervous System Involvement in Children: A Clinical Study of 22 Cases

Treatment Options for Epstein-Barr Virus-Related Disorders of the Central Nervous System

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