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July 1985

Infectious Origin and Epstein-Barr Virus

Author Affiliations

Department of Medicine (Neurology) and Microbiology The Pennsylvania State College of Medicine Hershey, PA 17033

Arch Neurol. 1985;42(7):626. doi:10.1001/archneur.1985.04060070012003

To the Editor.  —Feinberg et al1 presented an interesting case of neurologic illness following Epstein-Barr virus (EBV) infection, but I believe that their suppositions of direct EBV infection of the nervous system were overstated. Elevated antibody levels to EBV in cerebrospinal fluid (CSF) three weeks after the onset of illness were taken to indicate nervous system infection. The CSF antibody levels, which were half of the serum levels, were not believed by the authors to be the result of the relatively slight amount of blood-brain barrier disruption that was present, indicated by the total CSF protein level of 71 mg/dL. However, this protein value was almost twice the admission value of 38 mg/dL. The evidence of ongoing blood-brain barrier disruption and the lack of increase of the CSF IgG level argue more strongly toward a peripheral rather than a central origin of antibody synthesis.The authors speculated that EBV