Epstein–Barr Virus and Cytomegalovirus Infections

Epstein–Barr virus and cytomegalovirus are members of the human herpesviruses that have an extremely high seroprevalence in all populations studied. The initial infection is usually asymptomatic, or causes a febrile illness, but can rarely manifest itself neurologically. These viruses are increasingly important in the modern era of immunosuppression, whether due to AIDS or in the transplant or cancer chemotherapy population, and their reactivation gives rise to a wide spectrum of neurological diseases. The pathogenesis of these infections is not completely understood, but certainly multifaceted. In CMV lytic infection damages systemic tissues directly, whereas EBV involves an activated and distorted immune system. These diseases are treatable, but need to be recognized early in their course so that antiviral intervention can be effected promptly. The choice of therapeutic strategy can be counterintuitive: while CMV infections are conventionally managed with antiviral medications, EBV infections may demand a neoplastic treatment paradigm as an addition to (or alternative to) antiviral treatment.