INTRODUCTION Polymerase chain reaction (PCR)-based testing of cerebrospinal fluid (CSF) samples has greatly facilitated the diagnosis of central nervous system (CNS) infections. However, the clinical significance of Epstein-Barr virus (EBV) DNA in CSF of individuals with suspected CNS infection remains unclear. We wanted to gain a better understanding of EBV as an infectious agent in immunocompetent patients with CNS disorders. METHODS We identified cases of EBV-associated CNS infections and reviewed their clinical and laboratory characteristics. The study population was drawn from patients with EBV PCR positivity in CSF who visited Pusan National University Hospital between 2010 and 2019. RESULTS Of the 780 CSF samples examined during the 10-year study period, 42 (5.4 %) were positive for EBV DNA; 9 of the patients (21.4 %) were diagnosed with non-CNS infectious diseases, such as optic neuritis, Guillain-Barré syndrome, and idiopathic intracranial hypotension, and the other 33 cases were classified as CNS infections (22 as encephalitis and 11 as meningitis). Intensive care unit admission (13/33 patients, 39.3 %) and presence of severe neurological sequelae at discharge (8/33 patients, 24.2 %) were relatively frequent. In 10 patients (30.3 %), the following pathogens were detected in CSF in addition to EBV: varicella-zoster virus (n = 3), cytomegalovirus (n = 2), herpes simplex virus 1 (n = 1), herpes simplex virus 2 (n = 1), Streptococcus pneumomiae (n = 2), and Enterococcus faecalis (n = 1). The EBV-only group (n = 23) and the co-infection group (n = 10) did not differ in age, gender, laboratory data, results of brain imaging studies, clinical manifestations, or prognosis; however, the co-infected patients had higher CSF protein levels. CONCLUSION EBV DNA in CSF is occasionally found in the immunocompetent population; the virus was commonly associated with encephalitis and poor prognosis, and frequently found together with other microbes in CSF.

中文翻译：

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免疫功能正常患者脑脊液中EB病毒的临床意义

引言 基于聚合酶链反应 (PCR) 的脑脊液 (CSF) 样本检测极大地促进了中枢神经系统 (CNS) 感染的诊断。然而，疑似 CNS 感染个体脑脊液中 Epstein-Barr 病毒 (EBV) DNA 的临床意义仍不清楚。我们希望更好地了解 EBV 作为具有免疫功能的 CNS 疾病患者的感染因子。方法 我们确定了与 EBV 相关的中枢神经系统感染病例，并回顾了他们的临床和实验室特征。研究人群来自 2010 年至 2019 年访问釜山国立大学医院的 CSF 中 EBV PCR 阳性的患者。结果 在 10 年研究期间检查的 780 份 CSF 样本中，42 份 (5.4%) 为 EBV DNA 阳性；9 名患者 (21. 4%）被诊断为非中枢神经系统感染性疾病，如视神经炎、格林-巴利综合征、特发性低颅压等，其余33例为中枢神经系统感染（22例为脑炎，11例为脑膜炎）。重症监护病房入院（13/33 患者，39.3 %）和出院时出现严重神经系统后遗症（8/33 患者，24.2 %）相对频繁。在 10 名患者 (30.3 %) 中，除 EBV 外，在 CSF 中检测到以下病原体：水痘带状疱疹病毒 (n = 3)、巨细胞病毒 (n = 2)、单纯疱疹病毒 1 (n = 1)、单纯疱疹病毒2 (n = 1)、肺炎链球菌 (n = 2) 和粪肠球菌 (n = 1)。仅 EBV 组 (n = 23) 和合并感染组 (n = 10) 在年龄、性别、实验室数据、脑成像研究结果、临床表现、或预后；然而，合并感染的患者脑脊液蛋白水平较高。结论 脑脊液中的 EBV DNA 偶尔会在免疫功能正常的人群中发现。该病毒通常与脑炎和预后不良有关，并且经常与脑脊液中的其他微生物一起发现。