Epstein–Barr virus infections of the nervous system

Epstein–Barr virus (EBV) is a human herpesvirus that is highly prevalent in all human populations studied. The initial infection is either asymptomatic or a self-limited febrile illness, but occasionally may be more severe and cause neurologic and systemic disease. After resolution of the initial illness, the virus persists in a “latent” asymptomatic form, kept in check by the immune system. In the modern era of immune modulation and suppression (cancer chemotherapy, transplants, monoclonal antibody therapy, acquired immunodeficiency syndrome (AIDS)), EBV can become “reactivated,” and result in a number of illnesses, some affecting the nervous system. The systemic and neurologic effects of EBV can be difficult to diagnose and manage. In part, this is due to the unusual mix of pathogenetic mechanisms of EBV, which infects and immortalizes B lymphocytes. Immune insufficiency can unleash a lymphoproliferative state. Treatment of EBV disease may require consideration of a neoplastic treatment paradigm, in addition to regular antiviral medications.