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Pediatric Epstein-Barr Virus—Associated Encephalitis: 10-Year Review

Division of Neurology, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada

Ari Bitnun, MD

Division of Infectious Diseases, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada, Department of Pediatrics, Division of Microbiology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada

Elizabeth Lee Ford Jones, MD

Division of Infectious Diseases, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada, Department of Pediatrics, Division of Microbiology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada

Susan Richardson, MD

Division of Microbiology, Department of Laboratory Medicine, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada

Raymond Tellier, MD

Division of Microbiology, Department of Laboratory Medicine, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada

Martin Petric, MD

Division of Microbiology, Department of Laboratory Medicine, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada

Helen Heurter, RN

Division of Infectious Diseases, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada, Department of Pediatrics, Division of Microbiology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada

Daune MacGregor, MD

Division of Neurology, , Department of PediatricsThe Hospital for Sick Children and University of Toronto, Toronto, ON, Canada, daune.macgregor{at}sickkids.ca

Many neurologic manifestations of Epstein-Barr virus (EBV) infection have been documented, including encephalitis, aseptic meningitis, transverse myelitis, and Guillain-Barré syndrome. These manifestations can occur alone or coincidentally with the clinical picture of infectious mononucleosis. Since 1994, The Hospital for Sick Children has maintained a prospective registry of all children admitted with acute encephalitis. This report summarizes all cases of Epstein-Barr virus—associated encephalitis compiled from 1994 to 2003. Twenty-one (6%) of 216 children, median age 13 years (range 3—17 years), in the Encephalitis Registry were identified as having evidence of Epstein-Barr virus infection. This evidence consisted of convincing Epstein-Barr virus serology and/or positive cerebrospinal fluid polymerase chain reaction (PCR). One patient had symptoms of classic infectious mononucleosis; all others had a nonspecific prodrome, including fever ( n = 17; 81%) and headache (n = 14; 66%). Slightly less than half (n = 10; 48%) had seizures and often had electroencephalograms showing a slow background (n = 12; 57%). Many demonstrated cerebrospinal fluid pleocytosis (n = 17; 81%), and 71% (n = 15) had abnormal magnetic resonance imaging findings. Two patients died, 2 suffered mild deficits, and 16 were neurologically normal at follow-up. Most patients with Epstein-Barr virus encephalitis do not show typical symptoms of infectious mononucleosis. Establishing a diagnosis of Epstein-Barr virus encephalitis can be difficult, and, consequently, a combination of serologic and molecular techniques should be used when investigating a child with acute encephalitis. Most children make full recoveries, but residual neurologic sequelae and even death can and do occur. (J Child Neurol2006;21:384—391; DOI 10.2310/7010.2006.00114).

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