Bathoorn Erik, Vlaminckx Bart J M, Schoondermark-Stolk Sung, Donders Richard, van der Meulen Marjon, Thijsen Steven F T
Department of Microbiology, Diakonessenhuis Utrecht, the Netherlands.
Scand J Infect Dis. 2011 Feb;43(2):136-44. doi: 10.3109/00365548.2010.531760. Epub 2010 Nov 11.
Several case studies have reported on neurological complications caused by a primary Epstein-Barr virus (EBV) infection. We aimed to investigate the viral loads and the clinical and inflammatory characteristics of this disease entity. We evaluated all 84 cases in which the EBV polymerase chain reaction test (PCR) was requested on cerebrospinal fluid (CSF) for the period 2003-2008. Fourteen patients with proven neuroborreliosis served as the control group. Nine patients were diagnosed with a primary EBV infection and neurological symptoms (median age 36 y; 4 male). Viral DNA copies in CSF were detected by PCR in 7 of 9 patients. The presenting symptoms were meningeal signs, epileptic insults, polyradiculomyelitis, polyradiculitis, and/or sudden cognitive disorders. All EBV cases had a pleocytosis with significantly increased mononuclear leukocytes as compared to the neuroborreliosis group (median 99% interquartile range (96-100%) versus 90% (86-97%). In cases with a primary EBV infection, viral loads ranged from 43 to 3202 copies/ml in CSF and from 61 to 15,595 copies/ml in serum. Seventy-eight percent of the cases had a positive PCR on CSF. This study provides criteria for diagnosing neurological disease during primary EBV infection. Primary EBV infections in immune competent persons can cause a broad range of neurological symptoms, with lymphocytic and monocytic inflammation both in blood and CSF.
已有多项病例研究报道了原发性爱泼斯坦-巴尔病毒（EBV）感染引起的神经系统并发症。我们旨在调查该疾病实体的病毒载量以及临床和炎症特征。我们评估了2003年至2008年期间所有84例因脑脊液（CSF）进行EBV聚合酶链反应检测（PCR）的病例。14例确诊为神经莱姆病的患者作为对照组。9例患者被诊断为原发性EBV感染并伴有神经系统症状（中位年龄36岁；男性4例）。9例患者中有7例通过PCR检测到脑脊液中的病毒DNA拷贝。出现的症状包括脑膜刺激征、癫痫发作、多神经根脊髓炎、多神经根炎和/或突发认知障碍。与神经莱姆病组相比，所有EBV病例均有细胞增多，单核白细胞显著增加（中位数99%四分位间距（96 - 100%）对90%（86 - 97%））。在原发性EBV感染病例中，脑脊液中的病毒载量为43至3202拷贝/毫升，血清中为61至15595拷贝/毫升。78%的病例脑脊液PCR呈阳性。本研究为原发性EBV感染期间的神经系统疾病诊断提供了标准。免疫功能正常者的原发性EBV感染可导致广泛的神经系统症状，血液和脑脊液中均有淋巴细胞和单核细胞炎症。
