Quantitative CSF PCR in Epstein-Barr virus infections of the central nervous system

Ann Neurol. 2002 Nov;52(5):543-8. doi: 10.1002/ana.10321.


Acute Epstein-Barr virus (EBV) infection of the central nervous system (CNS) is associated with meningoencephalitis and other neurological syndromes and with CNS lymphomas (CNSLs). Diagnosis is based on serological studies and more recently on detection of EBV DNA in cerebrospinal fluid (CSF) by polymerase chain reaction (PCR). We measured EBV DNA by quantitative PCR and EBV mRNA by RT-PCR in the CSF in patients with EBV-associated neurological disorders. EBV was identified as the cause of CNS infection in 28 patients: 14 with CNSL, 10 with encephalitis, and 4 with postinfectious neurological complications. CSF analysis showed that patients with CNSL had high EBV load (mean +/- standard error of 4.8 +/- 0.2 log(10) DNA copies/ml) and low leukocyte counts (22 +/- 7 cells/microl); encephalitis was characterized by high EBV load (4.2 +/- 0.3 log(10) DNA copies/ml) and high leukocyte counts (143 +/- 62 cells/microl); and patients with postinfectious complications showed low EBV load (3.0 +/- 0.2 log(10) DNA copies/ml) with high leukocyte counts (88 +/- 57 cells/microl). Lytic cycle EBV mRNA, a marker of viral replication, was identified in 10 CSF samples from patients with CNSL and encephalitis. These studies demonstrate the utility of quantitative CSF PCR and establish the presence of lytic cycle EBV mRNA in CSF of patients with EBV-associated neurological disease.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Central Nervous System Diseases / cerebrospinal fluid*
  • Central Nervous System Diseases / virology
  • Central Nervous System Neoplasms / cerebrospinal fluid
  • Child
  • Child, Preschool
  • DNA-Binding Proteins / genetics
  • Encephalitis, Viral / cerebrospinal fluid
  • Epstein-Barr Virus Infections / cerebrospinal fluid*
  • Epstein-Barr Virus Infections / virology
  • Female
  • Herpesvirus 4, Human / genetics
  • Humans
  • Lymphoma / cerebrospinal fluid
  • Male
  • Middle Aged
  • RNA, Messenger / cerebrospinal fluid
  • RNA, Viral / cerebrospinal fluid
  • Reverse Transcriptase Polymerase Chain Reaction*
  • Trans-Activators / genetics
  • Viral Proteins*


  • BZLF1 protein, Herpesvirus 4, Human
  • DNA-Binding Proteins
  • RNA, Messenger
  • RNA, Viral
  • Trans-Activators
  • Viral Proteins