Peripheral Neuropathies
Neuropathies associated with cytomegalovirus infection
Nov. 16, 2024
Worddefinition
At vero eos et accusamus et iusto odio dignissimos ducimus qui blanditiis praesentium voluptatum deleniti atque corrupti quos dolores et quas.
Epstein-Barr virus infections of the nervous system …
- Updated 11.11.2023
- Released 01.27.1999
- Expires For CME 11.11.2026
Epstein-Barr virus infections of the nervous system
Introduction
Overview
Epstein-Barr virus is a ubiquitous herpes virus that causes infectious mononucleosis. Neurologic complications due to acute Epstein-Barr virus infection include acute encephalitis, cerebellar ataxia, cranial nerve palsies, and Guillain-Barré syndrome. Studies also show a high prevalence of Epstein-Barr virus seropositivity among patients with multiple sclerosis.
Key points
• Epstein-Barr virus is a herpes virus that causes infectious mononucleosis. | |
• Neurologic symptoms can be seen with infectious and postinfectious complications of Epstein-Barr virus infection. | |
• The role of Epstein-Barr virus infection in multiple sclerosis is an area of intense research, but a causal relationship has not been definitively demonstrated. |
Historical note and terminology
Discovered in 1964 from lymphoma cells of the jaw, Epstein-Barr virus has since been implicated in a variety of disease processes, both benign and malignant (16). The virus was discovered by Anthony Epstein, Yvonne Barr, and colleagues upon studying lymphoma from the jaw of central African children, which was found by surgeon Denis Burkitt (08). Epstein-Barr virus was the first virus discovered that was associated with cancer (31), and years later, Epstein-Barr virus was identified as the cause of infectious mononucleosis, also known as glandular fever (20). The virus belongs to the herpesviridae family, and the origin of the word herpes comes from the Latin word herpein, which means literally to creep, move slowly. It is one of the most common viruses among humans. It is implicated in a variety of diseases such as nasopharyngeal carcinoma, hairy cell leukoplakia, Burkitt lymphoma, lymphomas in the immunocompromised, and primary CNS lymphomas. The following discussion will concentrate on neurologic manifestations of Epstein-Barr virus infection.
Clinical manifestations
Presentation and course
Young children and young adults have a predilection for symptomatic infections, with severity ranging from mild to fulminant life-threatening complications. Infectious mononucleosis due to Epstein-Barr virus is one of the most common causes of prolonged illness in adolescents and young adults in Western societies. Infection is often spread by saliva in teens and young adults, designating infectious mononucleosis as the kissing disease. After an incubation period of 4 to 7 weeks, a typical triad of fever, pharyngitis, lymphadenopathy (especially of the occipital and cervical nodes) begins. Other clinical features may include splenomegaly, mononuclear leukocytosis, and hepatocellular dysfunction rarely presenting with jaundice (38).
Epstein-Barr virus has been associated with multiple neurologic complications including acute encephalitis, meningitis, acute cerebellar ataxia, myelitis, Guillain-Barré syndrome, cranial nerve palsies, neuropsychiatric syndromes, mononeuropathies, and acute disseminated encephalomyelitis (17; 49; 02). Meningitis and encephalitis are the most common complications of acute Epstein-Barr virus infection, with encephalitis being less frequent than meningitis. The initial symptoms of meningitis are severe headache and neck stiffness. Encephalitis may present with coma, seizures, delirium, or focal neurologic deficits before infectious mononucleosis is apparent. Epstein-Barr virus encephalitis may also present with ataxia due to cerebellitis (24) and is also associated with Alice in Wonderland syndrome (AIWS), which is an encephalopathy characterized by visual hallucinations and perceptual distortions of objects and body parts, also known as metamorphopsia (28). It remains the commonest infectious cause of Alice in Wonderland syndrome, and although the pathophysiology remains controversial, local cerebral edema and ischemia similar to that shown in migraine-associated Alice in Wonderland syndrome have been postulated (42). Findings from fMRI studies show that metamorphopsia is linked to functional impairment of the occipital cortex and over activation of specific parietal regions (07).
Acute disseminated encephalomyelitis is a post-infectious immune-mediated syndrome presenting with encephalopathy and focal neurologic deficits, with lesions often seen in both the brain and spinal cord. Epstein-Barr virus may be the antecedent infection, and diagnosis is based on a reactive Epstein-Barr virus IgM serology (37). Epstein-Barr virus may cause an acute myelitis, but this is more common in immunocompromised patients through local reactivation of the virus (52). It is an inflammatory myelopathy, with lymphocytic pleocytosis and elevated protein concentration in the CSF as well as abnormal hyperintensity on MRI of cervical and thoracic spinal cord segments (46). Symptoms may include paresthesias, extremity weakness, and loss of sphincter control (35).
Epstein-Barr virus infection has also been associated with peripheral nervous system syndromes, including cranial neuropathies and polyradiculopathies (11). Hottenrott described a case of Epstein-Barr virus causing a lumbosacral radiculitis with radicular pain in an immunocompetent patient (23). Mechanisms of brachial plexus neuropathy from Epstein-Barr virus include acute virus infection, which is often associated with lymphadenopathy, and a post-infectious brachial neuritis (14).
Guillain-Barré syndrome is associated with multiple antecedent infections, the most common being Campylobacter jejuni, cytomegalovirus, Epstein-Barr virus, and Mycoplasma pneumoniae. All four of these infections associated with Guillain-Barré syndrome cause the formation of antibodies that cross-react with glycoconjugate proteins on peripheral nerves. Epstein-Barr virus, cytomegalovirus, and Mycoplasma pneumoniae can also form cold agglutinins that bind to carbohydrate antigens on glycoconjugate proteins, which is a similar mechanism to how antibodies are produced to gangliosides (26). Miller Fisher syndrome, a variant of Guillain-Barré syndrome, can be precipitated by Epstein-Barr virus infection as shown in a case report of a 14-year-old boy with bilateral cranial nerve dysfunction, limb hyporeflexia, and positive anti-GQ1b antibodies (10). The pathophysiological mechanism of Epstein-Barr virus-induced Miller Fisher syndrome is likely similar to that of the cross-reactivity theory with Epstein-Barr virus and Guillain-Barré syndrome (03).
A considerable amount of research has been carried out to investigate the association between Epstein-Barr virus and multiple sclerosis; however, a causal relationship has not been definitively demonstrated. Seropositivity for Epstein-Barr virus is as high as 100% in some study cohorts of patients with multiple sclerosis, with lower rates being found in patients without multiple sclerosis of the same age range (01). Risk of multiple sclerosis following Epstein-Barr virus infection is suggested in a longitudinal analysis of a cohort of adults with multiple sclerosis (04; 47). There are multiple hypotheses on the mechanism of the pathogenesis of Epstein-Barr virus leading to multiple sclerosis. Penders hypothesis proposes that the virus infects forbidden memory B cells that are active against host CNS epitopes and rescues them from apoptosis, thereby allowing them to act as antigen-presenting cells that activate CD4+ T cells and lead to chronic inflammation (40; 30). Other hypotheses describe a two-hit scenario that allows inflammatory cells to migrate into the CNS in the presence of Epstein-Barr virus infection (19). However, most studies conducted to investigate this subject have failed to show the presence of Epstein-Barr virus within multiple sclerosis lesions, which has led to controversy about the theories and a persistent lack of evidence of causality (29; 15; 47). The etiology and pathogenesis of multiple sclerosis is complex and heterogenous, and it has yet to be fully understood; thus, the role of Epstein-Barr virus in its pathogenesis remains unclear (05).
Although subacute sclerosing panencephalitis is classically known as a consequence of measles infection, there have been a few cases reported that include Epstein-Barr virus as a factor. Hochberg and colleagues described a case of a 13-year-old girl who died of subacute sclerosing panencephalitis during an acute mononucleosis infection (22). Brain tissue staining showed both measles and Epstein-Barr virus antigenic material. One hypothesis is that decreased cellular immunity from acute mononucleosis may be responsible for activation of latent measles virus. Epstein-Barr virus has also been implicated in nasopharyngeal cancer (51) as well as primary CNS lymphomas in immunocompetent and immunocompromised patients (34; 18).
Prognosis and complications
Epstein-Barr virus encephalitis is often self-limiting and is relatively benign compared to other herpes encephalitides (02). Rarely, the clinical course is complicated by cerebral edema, which can cause raised intracranial pressure and death. In children, it can be associated with subsequent developmental delay, and some adults show persistence of neuropsychiatric disorders after resolution of the acute illness (02). Similarly, Epstein-Barr virus myelitis is often complicated by permanent sequelae, with limited resolution of limb paresis. The prognosis of primary CNS lymphoma associated with Epstein-Barr virus among people living with HIV improves with the use of effective antiretroviral therapy. The prognosis in immunocompetent patients depends on many factors, and predictive scores such as the International Extranodal Lymphoma Study Group (IELSG) score and Memorial Sloan Kettering Cancer Center (MSKCC) prognostic score can be used to stratify patients prognoses (18). Prognostic factors generally include the age of the patient (with older age being associated with poorer outcomes) and occurrence of adverse events associated with mass effect from the tumor itself.
Compared to other viruses such as hepatitis E virus, cytomegalovirus and Epstein-Barr virus cause milder forms of Guillain-Barré syndrome with better neurologic outcomes, and full recovery is usually around six months post-onset (13).
Biological basis
Etiology and pathogenesis
Epstein-Barr virus is a human herpes virus, also known as human herpesvirus 4. The virus is unique in that it infects B lymphocytes and epithelial cells through binding to CD21 and cellular integrins, respectively. The virus can exist in a latent phase or a lytic phase, with neurologic complications occurring in both phases. The virus is spread through saliva, as well as many other bodily fluids, and viral entry is likely through the oropharynx.
The pathophysiology of neurologic complications may involve Epstein-Barr virus entering nerve tissue through infected B lymphocytes. Pathologic studies show perivascular lymphocytic infiltrates, parenchymal edema, microglial proliferation, and demyelination in the central nervous system (12). Other studies show that altered gene expression of Epstein-Barr virus-infected B lymphocytes leads to increased trafficking of these cells into the central nervous system (48). Overcoming barriers to central nervous system entry in this manner has been implicated in pathological changes that lead to diseases such as primary central nervous system lymphoma and multiple sclerosis (48; 43).
Epidemiology
Epstein-Barr virus is a ubiquitous virus, with an estimate of 95% of adults globally being seropositive (33). The ability of the virus to establish latency and reactivate after initial infection, along with mild clinical symptoms in most infected individuals, allows for the ubiquity of the virus. In developing countries, children often seroconvert by the age of 3 or 4 years (45). Primary infection occurs at younger ages in lower socioeconomic settings, whereas primary infection occurs at older ages in regions with higher socioeconomic settings (21).
Prevention
Vaccines to prevent complications like lymphoma are being developed, yet an animal model is still needed before a vaccine strategy can be implemented (36). Persons with known infectious mononucleosis are advised to avoid activities that include exchanging saliva, such as kissing or sharing utensils. To prevent the life-threatening complication of splenic rupture in those with infectious mononucleosis, contact sports are strictly prohibited during acute infection.
Differential diagnosis
Confusing conditions
The differential diagnosis for a mononucleosis-like illness other than Epstein-Barr virus includes cytomegalovirus, acute HIV, human herpesvirus 6, toxoplasmosis, and anicteric hepatitis. As for other neurologic complications, encephalitis can be caused by Epstein-Barr virus; herpes simplex virus; a number of arboviruses; and numerous other bacteria, viruses, fungi, and parasites. Cerebellar ataxia in children is often caused by a post-infectious process, including Epstein-Barr virus, Mycoplasma pneumoniae, varicella zoster virus, as well as other organisms (24).
Associated or underlying disorders
Epstein-Barr virus may be involved in the progressive neuronal degeneration observed in people living with HIV. One theory is that the presence of ongoing Epstein-Barr viral replication in the central nervous system leads to aberrant immune activity that promotes HIV-associated neuronal injury (32). This hypothesis is supported by the observation that 18% of a cohort of people living with HIV had Epstein-Barr virus DNA in cerebrospinal fluid. In addition, those with detectable Epstein-Barr virus DNA in the CSF had higher levels of HIV RNA in the cerebrospinal fluid and a rate of pleocytosis up to three times higher (32).
Diagnostic workup
Epstein-Barr infections cause a peripheral lymphocytosis with greater than 10% atypical lymphocytes. Heterophile antibodies are IgM antibodies that agglutinate sheep or horse erythrocytes; they were used diagnostically more frequently in the past as they are less specific than the current Epstein-Barr virus-specific antibody assays used today. Viral serologies are helpful in determining acute versus latent Epstein-Barr virus infection. The presence of viral capsid antigen IgM and IgG antibodies in the absence of antibodies to virus-associated nuclear antigen is evidence of a current or recent Epstein-Barr virus infection. A reactive viral capsid antigen IgG and Epstein-Barr virus-associated nuclear antigen IgG with a nonreactive viral capsid antigen IgM is indicative of a previous infection.
In meningitis and encephalitis caused by Epstein-Barr virus, there is a CSF lymphocytic pleocytosis with the protein concentration being normal or elevated and glucose levels are normal. Diagnosis is made through detection of antibodies or detection of Epstein-Barr virus DNA in CSF by polymerase chain reaction, or both findings (52). Quantitative CSF polymerase chain reaction in Epstein-Barr virus infections have shown a lower viral load in patients with postinfectious complications and a higher viral load in patients with primary encephalitis (50).
Detection of CSF Epstein-Barr virus DNA by polymerase chain reaction can also be seen in patients with primary CNS lymphoma (25). This is not always possible to establish, and negative polymerase chain reaction does not exclude primary CNS lymphoma (25). However, the predictive value of the CSF Epstein-Barr virus PCR in people living with HIV/AIDS in the correct clinical settings can be very high.
Given the high seroprevalence of Epstein-Barr virus, particularly in adults greater than 40 years of age (45), Epstein-Barr virus can sometimes be detected a false positive or can sometimes be a bystander identified during the infectious workup of certain pathologies and may not actually be the causative organism of the pathology being investigated (44; 09). Latent infection can be reactivated in the setting of activation of the immune system, and, as such, its detection has to be interpreted carefully (41).
Management
Management of Epstein-Barr viral infections includes supportive care and symptomatic treatment. Neurologic complications of acute virus infection can be treated with acyclovir (27). Acyclovir inhibits viral replication with a highly favorable therapeutic index (39). Ganciclovir also inhibits replication but has greater toxicity; however, antiviral agents are ineffective against latent infection (39). In people living with HIV, primary central nervous system lymphoma may respond to antiretroviral therapy; it may be combined with methotrexate or whole-brain radiotherapy where appropriate (06).
References
- 01
- Abrahamyan S, Eberspächer B, Hoshi MM, et al. Complete Epstein-Barr virus seropositivity in a large cohort of patients with early multiple sclerosis. J Neurol Neurosurg Psychiatry 2020;91(7):681-6. PMID 32371533
- 02
- Bharucha T, Houlihan CF, Breuer J. Herpesvirus infections of the central nervous system. Semin Neurol 2019;39(3):369-82. PMID 31378872
- 03
- Bies JJ, Hassan M, Prakash S, Porres-Aguilar M, Peralta DP. A rare association between herpes simplex virus type 1 and miller-fisher syndrome. Cureus 2023;15(4):e38163. PMID 37252484
- 04
- Bjornevik K, Cortese M, Healy BC, et al. Longitudinal analysis reveals high prevalence of Epstein-Barr virus associated with multiple sclerosis. Science 2022;375(6578):296-301. PMID 35025605
- 05
- Bjornevik K, Münz C, Cohen JI, Ascherio A. EpsteinBarr virus as a leading cause of multiple sclerosis: mechanisms and implications. Nat Rev Neurol 2023;19(3):160-71. PMID 36759741
- 06
- Brandsma D, Bromberg JEC. Primary CNS lymphoma in HIV infection. Handb Clin Neurol 2018;152:177-86. PMID 29604975
- 07
- Brumm K, Walenski M, Haist F, Robbins SL, Granet DB, Love T. Functional magnetic resonance imaging of a child with Alice in Wonderland syndrome during an episode of micropsia. J AAPOS 2010;14(4):317-22. PMID 20598927
- 08
- Burkitt D. A sarcoma involving the jaws in African children. Brit J Surg 1958;46:218-22. PMID 13628987
- 09
- Cavalcante P, Marcuzzo S, Franzi S, et al. Epstein-Barr virus in tumor-infiltrating B cells of myasthenia gravis thymoma: an innocent bystander or an autoimmunity mediator? Oncotarget 2017;8(8):95432-49. PMID 29221139
- 10
- Communal C, Filleron A, Baron-Joly S, Salet R, Tran TA. Pediatric Miller Fisher syndrome complicating an Epstein-Barr virus infection. Pediatr Neurol 2016;63:73-5. PMID 27460528
- 11
- Connelly KP, DeWitt LD. Neurologic complications of infectious mononucleosis. Pediatr Neurol 1994;10(3):181-4. PMID 8060419
- 12
- Corssmit EP, Leverstein-van Hall MA, Portegies P, Bakker P. Severe neurological complications in association with Epstein-Barr virus infection. J Neurovirol 1997;3:460-4. PMID 9475119
- 13
- De León AM, Garcia-Santibanez R, Harrison TB. Neuropathies due to infections and antimicrobial treatments. Curr Treat Options Neurol 2023;1-17. PMID 37360749
- 14
- Dodig D, Ngo M, Bailey D, Bril V. Brachial plexopathy complicating Epstein-Barr virus infection in an adult. Acta Myol 2010;29(2):357-9. PMID 21314019
- 15
- Donati D. Viral infections and multiple sclerosis. Drug Discov Today Dis Models 2020;32:27-33. PMID 32292487
- 16
- Epstein MA, Achong BG, Barr YM. Virus particles in cultured lymphoblasts from Burkitt's lymphoma. Lancet 1964;702-3. PMID 14107961
- 17
- Fujimoto H, Asaoka K, Imaizumi T, Ayabe M, Shoji H, Kaji M. Epstein-Barr virus infections of the central nervous system. Intern Med 2003;42(1):33-40. PMID 12583615
- 18
- Grommes C, DeAngelis LM. Primary CNS lymphoma. J Clin Oncol 2017;35(21):2410-8. PMID 28640701
- 19
- Guan Y, Jakimovski D, Ramanathan M, Weinstock-Guttman B, Zivadinov R. The role of Epstein-Barr virus in multiple sclerosis: from molecular pathophysiology to in vivo imaging. Neural Regen Res 2019;14(3):373-86. PMID 30539801
- 20
- Henle G, Henle W, Diehl V. Relation of Burkitt's tumor-associated herpes-type virus to infectious mononucleosis. Proc Natl Acad Sci USA 1968;59(1):94-101. PMID 5242134
- 21
- Hjalgrim H, Friborg J, Melbye M. The epidemiology of EBV and its association with malignant disease. In: Arvin A, Campadelli-Fiume G, Mocarski E, et al., editors. Human herpesviruses: biology, therapy, and immunoprophylaxis. Cambridge: Cambridge University Press, 2007:53. PMID NBK47424
- 22
- Hochberg FH, Lehrich JR, Richardson EP, Feorino P, Astrom KE. Mononucleosis-associated subacute sclerosing panencephalitis. Acta Neuropathol 1976;34:33-40. PMID 175632
- 23
- Hottenrott T, Hottenrott, Rauer S, Bäuerle J. Primary Epstein-Barr virus infection with polyradiculitis: a case report. BMC Neurology 2013;13:96. PMID 23879452
- 24
- Hussain RS, Hussain NA. Ataxia and encephalitis in a young adult with EBV mononucleosis: a case report. Case Rep Neurol Med 2013;2013:516325. PMID 23781357
- 25
- Ivers L, Kim A, Sax PE. Predictive value of polymerase chain reaction of cerebrospinal fluid for detection of Epstein-Barr virus to establish the diagnosis of HIV-related primary central nervous system lymphoma. Clin Infect Dis 2004;38(11):1629-32. PMID 15156453
- 26
- Jacobs BC, Rothbarth PH, van der Meché FG, et al. The spectrum of antecedent infections in Guillain-Barré syndrome: a case-control study. Neurology 1998;51(4):1110-5. PMID 9781538
- 27
- Jenson HB. Acute complications of Epstein-Barr infectious mononucleosis. Curr Opin Pediatr 2000;12(3):263-8. PMID 10836164
- 28
- Lanska DJ, Lanska JR. The Alice-in-Wonderland syndrome. Front Neurol Neurosci 2018;42:142-50. PMID 29151098
- 29
- Lassmann H, Niedobitek G, Aloisi F, Middeldorp JM, NeuroproMiSe EBV Working Group. EpsteinBarr virus in the multiple sclerosis brain: a controversial issuereport on a focused workshop held in the Centre for Brain Research of the Medical University of Vienna, Austria. Brain 2011;134(Pt 9):2772-86. PMID 21846731
- 30
- Laurence M, Benito-León J. EpsteinBarr virus and multiple sclerosis: updating Pender's hypothesis. Mult Scler Relat Disord 2017;16:8-14. PMID 28755684
- 31
- Lieberman PM. Epstein-Barr virus turns 50. Science 2014;343(6177):1323-5. PMID 24653027
- 32
- Lupia T, Milia MG, Atzori C, et al. Presence of Epstein-Barr virus DNA in cerebrospinal fluid is associated with greater HIV RNA and inflammation. AIDS 2020;34(3):373-80. PMID 31764071
- 33
- Luzuriaga K, Sullivan JL. Infectious mononucleosis. N Engl J Med 2010;362(21):1993-2000. PMID 20505178
- 34
- MacMahon EM, Glass JD, Hayward SD, et al. Epstein-Barr virus in AIDS-related primary central nervous system lymphoma. Lancet 1991;2:969-73. PMID 1681341
- 35
- Mazur-Melewska K, Breńska I, Jończyk-PotocznaK, et al. Neurologic complications caused by Epstein-Barr virus in pediatric patients. J Child Neurol 2016;31(6):700-8. PMID 26511720
- 36
- Münz, C. Immune control and vaccination against the Epstein-Barr virus in humanized mice. Vaccines (Basel) 2019;7(4):217. PMID 31861045
- 37
- Mohsen H, Abu Zeinah GF, Elsotouhy AH, Mohamed K. Acute disseminated encephalomyelitis following infectious mononucleosis in a toddler. BMJ Case Rep 2013;2013. PMID 23845679
- 38
- Naughton P, Healy M, Enright F, Lucey B. Infectious mononucleosis: diagnosis and clinical interpretation. Br J Biomed Sci 2021;78(3):107-16. PMID 33721513
- 39
- Pagano JS, Whitehurst CB, Andrei G. Antiviral drugs for EBV. Cancers (Basel) 2018;10(6):197. PMID 29899236
- 40
- Pender MP. Infection of autoreactive B lymphocytes with EBV, causing chronic autoimmune diseases. Trends Immunol 2003;24(11):584-8. PMID 14596882
- 41
- Pender MP. The essential role of Epstein-Barr virus in the pathogenesis of multiple sclerosis. Neuroscientist 2011;17(4):351-67. PMID 21075971
- 42
- Perez-Garcia L, Pacheco O, Delgado-Noguera L, Motezuma JPM, Sordillo EM, Paniz Mondolfi AE. Infectious causes of Alice in Wonderland syndrome. J NeuroVirol 2021;27(4):550-6. PMID 34101086
- 43
- Robinson WH, Steinman L. Epstein-Barr virus and multiple sclerosis. Science 2022;375(6578):264-5. PMID 35025606
- 44
- Sangüeza OP. Epstein-Barr virus: a serial killer or an innocent bystander? Arch Dermatol 1997;133(9):1156-7. PMID 9301594
- 45
- Sharifipour S, Rad KD. Seroprevalence of EpsteinBarr virus among children and adults in Tehran, Iran. New Microbes New Infect 2020;34:100641. PMID 32025310
- 46
- Singh JR, Ibraheem K, Jain D, Yogendra K. Myelitis: a rare presentation of Epstein Barr virus. J Assoc Physicians India 2019;67(3):93-95. PMID 31304721
- 47
- Soldan SS, Lieberman PM. EpsteinBarr virus and multiple sclerosis. Nat Rev Microbiol 2023;21(1):51-64. PMID 35931816
- 48
- Soldan SS, Su C, Lamontagne J, et al. Epigenetic plasticity enables CNS-trafficking of EBV-infected B lymphocytes. PLoS Pathog 2021;17(6):e1009618. PMID 34106998
- 49
- Tam CC, O'Brien SJ, Petersen I, Islam A, Hayward A, Rodrigues LC. Guillain-Barré syndrome and preceding infection with campylobacter, influenza and Epstein-Barr virus in the general practice research database. PloS One 2007;2(4):e344. PMID 17406668
- 50
- Weinberg A, Li S, Palmer M, Tyler K. Quantitative CSF PCR in Epstein-Barr virus infections of the central nervous system. Ann Neurol 2002;52:543-8. PMID 12402250
- 51
- Zhang J, Shu C, Song Y, Li Q, Huang J, Ma X. Epstein-Barr virus DNA level as a novel prognostic factor in nasopharyngeal carcinoma: a meta-analysis. Medicine (Baltimore) 2016;95(40):e5130. PMID 27749596
- 52
- Zhang N, Zuo Y, Jiang L, Peng Y, Huang X, Zuo L. Epstein-Barr virus and neurological diseases. Front Mol Biosci 2022;8:816098. PMID 35083281
Contributors
All contributors' financial relationships have been reviewed and mitigated to ensure that this and every other article is free from commercial bias.
Authors
-
Deanna Saylor MD MHS
Dr. Saylor of John Hopkins Hospital received an honorarium and travel support from Roche as a conference speaker.
See Profile -
Mashina Chomba MBChB MMed
Dr. Chomba of University Teaching Hospital in Lusaka, Zambia has no relevant financial relationships to disclose.
See Profile
Editor
-
Christina M Marra MD
Dr. Marra of the University of Washington School of Medicine has no relevant financial relationships to disclose.
See Profile
Former Authors
- Burk Jubelt MD, Catherine Amlie-Lefond MD, Jennifer Siriwardane MD, and Karen L Roos MD
Patient Profile
- Age range of presentation
-
- 2 to 65+ years
- Sex preponderance
-
- male=female
- Heredity
-
- none
- Population groups selectively affected
-
- none selectively affected
- Occupation groups selectively affected
-
- none selectively affected
ICD & OMIM codes
- ICD-9
-
- Epstein-Barr virus infection: 075
- Epstein-Barr virus, chronic: 780.79
- Infectious mononucleosis: 075
- Late effects of other and unspecified infectious and parasitic diseases: 139.8
- ICD-10
-
- Mononucleosis due to Epstein-Barr virus: B27.0
- Malaise and fatigue: R53
- Sequelae of other specified infectious and parasitic diseases: B94.8
This is an article preview.
Start a Free Account
to access the full version.
-
Nearly 3,000 illustrations, including video clips of neurologic disorders.
-
Every article is reviewed by our esteemed Editorial Board for accuracy and currency.
-
Full spectrum of neurology in 1,200 comprehensive articles.
-
Listen to MedLink on the go with Audio versions of each article.
Questions or Comment?
MedLink®, LLC
3525 Del Mar Heights Rd, Ste 304
San Diego, CA 92130-2122
Toll Free (U.S. + Canada): 800-452-2400
US Number: +1-619-640-4660
Support: service@medlink.com
Editor: editor@medlink.com
ISSN: 2831-9125
Also in This Category
-
-
Infectious Disorders
Genital herpes: neurologic complications
Nov. 15, 2024
-
Infectious Disorders
Zika virus: neurologic complications
Oct. 08, 2024
-
Infectious Disorders
Gram-negative bacillary meningitis
Sep. 13, 2024
-
Infectious Disorders
Pneumococcal meningitis
Sep. 03, 2024
-
Neuroimmunology
HTLV-1 associated myelopathy
Aug. 29, 2024
-
Infectious Disorders
Infective endocarditis
Aug. 27, 2024
-
Infectious Disorders
Japanese encephalitis
Aug. 27, 2024