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Human Herpesvirus 6


Presentation

  • The patient presented to the emergency department soon thereafter with worsening eruption, fever, rigors, facial edema, and lymphadenopathy. Methylprednisolone was initiated.[ncbi.nlm.nih.gov]
  • Fever was present in all the patients. Meningeal compromise, seizures and encephalitis were present in some of the patients. Polymerase chain reaction (PCR) of cerebrospinal fluid (CSF) specimens was positive for HHV-6 in all the patients.[ncbi.nlm.nih.gov]
  • We report the case of a previously healthy woman who presented with a skin rash, mild upper respiratory symptoms, and abdominal pain and succumbed to fulminant hepatic failure attributed to infection with HHV-6B.[ncbi.nlm.nih.gov]
  • The present case report links, for the first time, myocarditis with a human herpesvirus 6 subtype A infection and the appearance of apical ballooning.[ncbi.nlm.nih.gov]
  • Furthermore, other exanthematous infections such as rubella, human parvovirus B19, human herpesvirus 6 (HHV-6) and HHV-7 present with clinical symptoms and IgM antibody levels similar to those in measles.[ncbi.nlm.nih.gov]
Movement Disorder
  • We report two previously healthy young boys with human herpesvirus 6-associated encephalitis who developed a progressive, and ultimately fatal, encephalopathy with refractory movement disorder concurrent with acquisition of acute human herpesvirus 6 infection[ncbi.nlm.nih.gov]
Constitutional Symptom
  • Lymphadenopathy, haematological abnormalities and constitutional symptoms are among the non-specific manifestations seen in drug rash with eosinophilia and systemic symptoms (DRESS), an uncommon but potentially fatal cutaneous adverse drug reaction.[ncbi.nlm.nih.gov]
Mild Clinical Course
  • Human herpesvirus (HHV)-6 infection is common after organ transplantation; however, most cases are associated with a mild clinical course.[ncbi.nlm.nih.gov]
Urticaria
  • Reactivation of latent herpesviridae has not been studied systematically in chronic idiopathic/spontaneous urticaria (CIU).[ncbi.nlm.nih.gov]
Visual Hallucination
  • Two patients with confusion accompanied by seizures, memory changes, or specific visual hallucinations and HHV6 detectable by polymerase chain reaction (PCR) in cerebrospinal fluid had improvement in viral load with ganciclovir or foscarnet treatment.[ncbi.nlm.nih.gov]
Febrile Convulsions
  • Twenty-two HHV-6 encephalitis patients at the time of primary infection, 6 febrile convulsion (FC) patients caused by HHV-6 infection, and 14 FC patients without HHV-6 infection (non HHV-6 FC) were enrolled.[ncbi.nlm.nih.gov]
  • In summary, we have identified three infants with febrile convulsions associated with primary HHV-7 infection.[adc.bmj.com]
  • convulsions Reactivation of latent HHV6 is common after liver transplantation, possibly induced and facilitated by allograft rejection and immunosuppressive therapy ( World J Gastroenterol 2009;15:2561 ) High intrahepatic HHV6 virus loads are associated[pathologyoutlines.com]
  • convulsions and several months after the occurrence of exanthem subitum. 48 It was suggested that HHV-6 may invade the brain during acute HHV-6 infection, establish a latent CNS infection, and cause recurrent febrile convulsions, if reactivated.[pediatrics.aappublications.org]
Cranial Neuropathy
  • Neurologic examination revealed cranial neuropathies, cerebellar dysfunction, and extremity weakness. Magnetic resonance imaging abnormalities located in the cerebellum, basal ganglia/thalamus, and cerebral hemispheres were detected in 2 patients.[ncbi.nlm.nih.gov]

Workup

  • This article describes the clinical presentation, diagnostic workup, and neurologic outcome of 3 immunocompetent pediatric patients diagnosed with human herpesvirus 6 (HHV6) rhombencephalitis.[ncbi.nlm.nih.gov]
  • In emergency department, patient underwent septic workup, including lumbar puncture (adhesive bandage), with normal cerebrospinal fluid analysis results.[emedicine.medscape.com]
  • Laboratory diagnosis is rarely required in patients who are immunocompetent; most often, HHV-6 infection is diagnosed on the basis of its clinical features (see DDx and Workup). No specific treatment for HHV-6 infection has been established.[emedicine.medscape.com]
  • The height of the fever, as well as the spectrum of accompanying clinical signs not usually associated with roseola, such as otitis and diarrhea, resulted in a varied, often time-consuming, and expensive workup in the emergency department.[nejm.org]
Hyponatremia
  • Severe hyponatremia is a critical electrolyte abnormality in allogeneic stem cell transplantation (allo-SCT) recipients and 50% of cases of severe hyponatremia are caused by the syndrome of inappropriate secretion of antidiuretic hormone (SIADH).[ncbi.nlm.nih.gov]
  • We retrospectively evaluated the clinical significance of hyponatremia in cases of HHV-6 encephalitis/myelitis.[ncbi.nlm.nih.gov]

Treatment

  • Here we review representative cases of both conditions to highlight specific and relevant neurologic features that prompted effective diagnosis and treatment.[ncbi.nlm.nih.gov]
  • Anti-HHV-6 treatment improved the patient's vision, but immune restoration seems to remain essential for long-term recovery.[ncbi.nlm.nih.gov]
  • To date, the prevalence, species distribution, and treatment responses of ciHHV-6 are unknown for cardiac patients.[ncbi.nlm.nih.gov]
  • Systemic corticosteroid treatment of those with DHS testing positive for HHV6 has been speculated to prolong the duration of disease.[ncbi.nlm.nih.gov]
  • […] the clinical response to this treatment ( Figure 1.E ).[doi.org]

Prognosis

  • Despite the poor prognosis, no validated treatments or preventative measures have been established. Establishment of preventative strategies represents an important challenge.[ncbi.nlm.nih.gov]
  • The demonstration of HHV-6 reactivation is a useful marker of diagnosis as well as prognosis in DIHS.[ncbi.nlm.nih.gov]
  • The long-term clinical complications and prognosis, however, remain unclear.[ncbi.nlm.nih.gov]
  • Prognosis may be improved by early initiation of antiviral therapy. KEYWORDS: Cord blood transplantation; Human herpesvirus-6; Myelitis; Pain; Pre-engraftment immune reaction[ncbi.nlm.nih.gov]
  • Considering that the prognosis of this type of epileptic encephalopathy is devastating, elucidation of the mechanisms responsible for the development of epileptic encephalopathy and development of a new strategy for its management are urgently needed.[jstage.jst.go.jp]

Etiology

  • HHV-6A has not been etiologically linked to any human disease, but such an association will probably be found soon.[doi.org]
  • The etiological diagnosis is possible only by examining the blood and cerebrospinal fluid, when the patient shows no skin rash.[ncbi.nlm.nih.gov]
  • Human herpesvirus-6 (HHV-6) is the main etiologic agent of exanthema subitum in young children. Central nervous system (CNS) infections in children due to HHV-6 have been described on many occasions.[ncbi.nlm.nih.gov]
  • Extensive work-ups for underlying etiologies included serologic evaluation for underlying chronic liver diseases, toxicology screening, inborn errors of metabolism, and infectious diseases.[ncbi.nlm.nih.gov]

Epidemiology

  • We describe the epidemiological, clinical and outcome findings of five patients with diagnosis of HIV/AIDS and central nervous system involvement (CNS) due to HHV-6. Fever was present in all the patients.[ncbi.nlm.nih.gov]
  • The two subtypes share certain biological properties and a high level of sequence homology, but differ dramatically in their epidemiology.[ncbi.nlm.nih.gov]
  • Paolo Lusso, HHV-6 and HIV-1 Infection, Human Herpesvirus-6, Second Edition - General Virology, Epidemiology and Clinical Pathology, 10.1016/S0168-7069(06)12021-2, (263-277), (2006).[doi.org]
  • Little is known about the epidemiology or clinical implications of HHV-6A. The clinical manifestations, diagnosis, and treatment of HHV-6 infection in adults will be presented here.[uptodate.com]
  • The epidemiology and disease association for HHV-6A remain ill-defined. Specific anti-HHV-6 drugs do not exist and classic antiherpes drugs have secondary effects that are often problematic for transplant patients.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • SUMMARY: Understanding the pathophysiology of HHV-6B encephalitis remains incomplete, especially regarding young children. Clinical trials of antiviral therapy are warranted for treatment and prevention of HHV-6B encephalitis after transplantation.[ncbi.nlm.nih.gov]
  • There are still numerous pending questions about HHV-6 which should stimulate future research works on the pathophysiology, diagnosis, and therapy of this remarkable human virus. Copyright 2015, American Society for Microbiology. All Rights Reserved.[ncbi.nlm.nih.gov]
  • There are still numerous pending questions about HHV-6 which should stimulate future research works on the pathophysiology, diagnosis, and therapy of this remarkable human virus. Copyright 2015, American Society for Microbiology.[cmr.asm.org]
  • Effective strategies to prevent and treat AD remain elusive despite major efforts to understand its basic biology and clinical pathophysiology. Significant investments in therapeutic ...[annualreviews.org]
  • Useful For Suggests clinical disorders or settings where the test may be helpful As an adjunct in the rapid diagnosis of human herpesvirus-6 infection in plasma specimens Clinical Information Discusses physiology, pathophysiology, and general clinical[mayomedicallaboratories.com]

Prevention

  • Despite the poor prognosis, no validated treatments or preventative measures have been established. Establishment of preventative strategies represents an important challenge.[ncbi.nlm.nih.gov]
  • Clinical trials of antiviral therapy are warranted for treatment and prevention of HHV-6B encephalitis after transplantation.[ncbi.nlm.nih.gov]
  • This finding supports the need for further investigation into the possible relationship between human herpesvirus-6 and SJS, which may illuminate the pathogenesis of SJS and bring us closer to achieving enhanced prevention and treatment of this rare disease[ncbi.nlm.nih.gov]
  • Reeves, Centers for Disease Control and Prevention, Mail Stop A-15, 1600 Clifton Rd., Atlanta, GA 30333 ( wcr1@cdc.gov ). Search for other works by this author on: William C.[doi.org]
  • Pretransplantation screening of donors and recipients may further prevent the misdiagnosis of CIHHV-6.[ncbi.nlm.nih.gov]

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