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Inoue J, Weber D, Fernandes JF, Adegnika AA, Agnandji ST, Lell B, Kremsner PG, Grobusch MP, Mordmüller B, Held J. HHV-6 infections in hospitalized young children of Gabon. Infection 2023; 51:1759-1765. [PMID: 37501013 PMCID: PMC10665219 DOI: 10.1007/s15010-023-02077-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/15/2023] [Indexed: 07/29/2023]
Abstract
PURPOSE Fever is a common cause for hospitalization among the pediatric population. The spectrum of causative agents is diverse. Human herpesvirus 6 (HHV-6) is a ubiquitous virus that often causes hospitalization of children in western countries. Previously, we investigated the cause of fever of 600 febrile hospitalized children in Gabon, and in 91 cases the causative pathogen was not determined. In this study, we assessed HHV-6 infection as potential cause of hospitalization in this group. METHODS Blood samples were assessed for HHV-6 using real-time quantitative PCR. Three groups were investigated: (1) group of interest: 91 hospitalized children with febrile illness without a diagnosed causing pathogen; (2) hospitalized control: 91 age-matched children hospitalized with febrile illness with a potentially disease-causing pathogen identified; both groups were recruited at the Albert Schweitzer Hospital in Lambaréné, Gabon and (3) healthy control: 91 healthy children from the same area. RESULTS Samples from 273 children were assessed. Age range was two months to 14 years, median (IQR) age was 36 (12-71) months; 52% were female. HHV-6 was detected in 64% (58/91), 41% (37/91), and 26% (24/91) of the samples from groups 1, 2, and 3, respectively; with statistically significant odds of being infected with HHV-6 in group 1 (OR = 4.62, 95% CI [2.46, 8.90]). Only HHV-6B was detected. CONCLUSIONS Although tropical diseases account for a large proportion of children's hospitalizations, considering common childhood diseases such as HHV-6 when diagnosing febrile illnesses in pediatric populations in tropical countries is of importance.
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Affiliation(s)
- Juliana Inoue
- Institute of Tropical Medicine, Eberhard Karls University Tübingen, Tübingen, Germany
| | - David Weber
- Institute of Tropical Medicine, Eberhard Karls University Tübingen, Tübingen, Germany
| | - José Francisco Fernandes
- Institute of Tropical Medicine, Eberhard Karls University Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
- German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Infection & Immunity, Amsterdam Public Health, Amsterdam University Medical Centres, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Ayola Akim Adegnika
- Institute of Tropical Medicine, Eberhard Karls University Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
- German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany
| | - Selidji Todagbe Agnandji
- Institute of Tropical Medicine, Eberhard Karls University Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
- German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany
| | - Bertrand Lell
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Peter G Kremsner
- Institute of Tropical Medicine, Eberhard Karls University Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
- German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany
| | - Martin Peter Grobusch
- Institute of Tropical Medicine, Eberhard Karls University Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Infection & Immunity, Amsterdam Public Health, Amsterdam University Medical Centres, Location University of Amsterdam, Amsterdam, The Netherlands
- Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Masanga Medical Research Unit, Masanga, Sierra Leone
| | - Benjamin Mordmüller
- Institute of Tropical Medicine, Eberhard Karls University Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jana Held
- Institute of Tropical Medicine, Eberhard Karls University Tübingen, Tübingen, Germany.
- German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany.
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2
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Messacar K, Palmer C, Gregoire L, Elliott A, Ackley E, Perraillon MC, Tyler KL, Dominguez SR. Clinical and Financial Impact of a Diagnostic Stewardship Program for Children with Suspected Central Nervous System Infection. J Pediatr 2022; 244:161-168.e1. [PMID: 35150729 PMCID: PMC9807012 DOI: 10.1016/j.jpeds.2022.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/05/2022] [Accepted: 02/04/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To investigate the optimal implementation and clinical and financial impacts of the FilmArray Meningitis Encephalitis Panel (MEP) multiplex polymerase chain reaction testing of cerebrospinal fluid (CSF) in children with suspected central nervous system infection. STUDY DESIGN A pre-post quasiexperimental cohort study to investigate the impact of implementing MEP using a rapid CSF diagnostic stewardship program was conducted at Children's Hospital Colorado (CHCO). MEP was implemented with electronic medical record indication selection to guide testing to children meeting approved use criteria: infants <2 months, immunocompromised, encephalitis, and ≥5 white blood cells/μL of CSF. Positive results were communicated with antimicrobial stewardship real-time decision support. All cases with CSF obtained by lumbar puncture sent to the CHCO microbiology laboratory meeting any of the 4 aforementioned criteria were included with preimplementation controls (2015-2016) compared with postimplementation cases (2017-2018). Primary outcome was time-to-optimal antimicrobials compared using log-rank test with Kaplan-Meier analysis. RESULTS Time-to-optimal antimicrobials decreased from 28 hours among 1124 preimplementation controls to 18 hours (P < .0001) among 1127 postimplementation cases (72% with MEP testing conducted). Postimplementation, time-to-positive CSF results was faster (4.8 vs 9.6 hours, P < .0001), intravenous antimicrobial duration was shorter (24 vs 36 hours, P = .004), with infectious neurologic diagnoses more frequently identified (15% vs 10%, P = .03). There were no differences in time-to-effective antimicrobials, hospital admissions, antimicrobial starts, or length of stay. Costs of microbiologic testing increased, but total hospital costs were unchanged. CONCLUSIONS Implementation of MEP with a rapid central nervous system diagnostic stewardship program improved antimicrobial use with faster results shortening empiric therapy. Routine MEP testing for high-yield indications enables antimicrobial optimization with unchanged overall costs.
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Affiliation(s)
- Kevin Messacar
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; Children's Hospital Colorado, Aurora, CO.
| | - Claire Palmer
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | | | | | | | | | - Kenneth L Tyler
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO
| | - Samuel R Dominguez
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; Children's Hospital Colorado, Aurora, CO
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3
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Zhu Y, Xu M, Ding C, Peng Z, Wang W, Sun B, Cheng J, Chen C, Chen W, Wei H, Hu Z. Metagenomic Next-Generation Sequencing vs. Traditional Microbiological Tests for Diagnosing Varicella-Zoster Virus Central Nervous System Infection. Front Public Health 2022; 9:738412. [PMID: 35127608 PMCID: PMC8814106 DOI: 10.3389/fpubh.2021.738412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/03/2021] [Indexed: 11/27/2022] Open
Abstract
Background Unbiased metagenomic next-generation sequencing (mNGS) detects pathogens in a target-independent manner. It is not well-understood whether mNGS has comparable sensitivity to target-dependent nucleic acid test for pathogen identification. Methods This study included 31 patients with chickenpox and neurological symptoms for screening of possible varicella-zoster virus (VZV) central nervous system (CNS) infection. Microbiological diagnosing of VZV cerebrospinal fluid (CSF) infection was performed on stored CSF samples using mNGS, quantitative and qualitative VZV-specific PCR assays, and VZV IgM antibodies test. Results The median age was 30.0 [interquartile range (IQR), 24.3–33.3] years. 51.6% of the patients were men. About 80.6% of the patients had normal CSF white blood cell counts (≤ 5 × 106/L). VZV IgM antibodies presented in 16.1% of the CSF samples, and nucleic acids were detectable in 16.1 and 9.7% using two different VZV-specific real-time PCR protocols. Intriguingly, maximal identification of VZV elements was achieved by CSF mNGS (p = 0.001 and p = 007; compared with qualitative PCR and VZV IgM antibody test, respectively), with sequence reads of VZV being reported in 51.6% (16/31) of the CSF samples. All VZV PCR positive samples were positive when analyzed by mNGS. Of note, human betaherpesvirus 6A with clinical significance was unexpectedly detected in one CSF sample. Conclusions Our study suggests that CSF mNGS may have higher sensitivity for VZV detection than CSF VZV PCR and antibody tests, and has the advantage of identifying unexpected pathogens.
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Affiliation(s)
- Yunqi Zhu
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Miaomiao Xu
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Chengyuan Ding
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Zhihang Peng
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Weixiao Wang
- Department of Clinical Research Center, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Binghu Sun
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jian Cheng
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Chen Chen
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Wei Chen
- Department of Clinical Research Center, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Hongxia Wei
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
- Hongxia Wei
| | - Zhiliang Hu
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- *Correspondence: Zhiliang Hu
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Descamps V, Gautheret‐Dejean A, Pelletier A, Bonnafous P, Deschamps L, Prusty BK. Chronic persistent HHV-6B infection after sulfasalazine-induced DRESS with demonstration of HHV-6 encoded small noncoding RNAs (sncRNAs) in Crohn's-like colitis: Case report. Clin Case Rep 2021; 9:841-844. [PMID: 33598255 PMCID: PMC7869345 DOI: 10.1002/ccr3.3680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/08/2020] [Accepted: 09/20/2020] [Indexed: 12/18/2022] Open
Abstract
A sulfasalazine-induced DRESS (Drug Reactivation with Eosinophilia and Systemic Symptoms) was complicated by a Crohn's-like colitis. We demonstrated HHV-6 reactivation with presence of HHV-6 DNA and small noncoding RNA in colonic lesions. This observation confirms the major role of HHV-6 reactivation in DRESS manifestations and the importance of looking for HHV-6 reactivation in DRESS.
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Affiliation(s)
- Vincent Descamps
- Department of DermatologyBichat HospitalAPHP ParisParis 7 UniversityParisFrance
| | | | - Anne‐Laure Pelletier
- Department of GastroenterologyBichat HospitalAPHP ParisParis 7 UniversityParisFrance
| | | | - Lydia Deschamps
- Department of PathologyBichat HospitalAPHP ParisParis 7 UniversityParisFrance
| | - Bhupesh K. Prusty
- Institute for Virology and ImmunobiologyUniversity of WuerzburgWuerzburgGermany
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5
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Petit V, Bonnafous P, Fages V, Gautheret-Dejean A, Engelmann I, Baras A, Hober D, Gérard R, Gibier JB, Leteurtre E, Glowacki F, Moulonguet F, Decaestecker A, Provôt F, Chamley P, Faure E, Prusty BK, Maanaoui M, Hazzan M. Donor-to-recipient transmission and reactivation in a kidney transplant recipient of an inherited chromosomally integrated HHV-6A: Evidence and outcomes. Am J Transplant 2020; 20:3667-3672. [PMID: 32428994 DOI: 10.1111/ajt.16067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/04/2020] [Accepted: 05/07/2020] [Indexed: 01/25/2023]
Abstract
Human herpesvirus (HHV)-6A can be inherited and chromosomally integrated (iciHHV-6A), and donor-to-recipient transmission has been reported in solid organ transplant. However, when HHV-6A reactivation happens after transplant, the source of HHV-6A is often not evident and its pathogenicity remains unclear. Here, we present an exhaustive case of donor-to-recipient transmission and reactivation of iciHHV-6A through kidney transplant. The absence of HHV-6A genome from the nails of the recipient excluded a recipient-related iciHHV-6A. Viral loads > 7 log10 copies/106 cells in donor blood samples and similarities of U38, U39, U69, and U100 viral genes between donor, recipient, and previously published iciHHV-6A strains are proof of donor-related transmission. Detection of noncoding HHV-6 snc-RNA14 using fluorescence in situ hybridization analysis and immunofluorescence staining of HHV-6A gp82/gp105 late proteins on kidney biopsies showed evidence of reactivation in the transplanted kidney. Because HHV-6A reactivation can be life threatening in immunocompromised patients, we provide several tools to help during the complete screening and diagnosis.
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Affiliation(s)
- Vivien Petit
- Service de Néphrologie, CHU Lille, Lille, France
| | - Pascale Bonnafous
- Sorbonne Department, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), THERAVIR Team, Paris, France
| | - Victor Fages
- Service de Néphrologie, CHU Lille, Lille, France
| | - Agnès Gautheret-Dejean
- Service de Virologie, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Paris, France.,Faculté de Pharmacie de Paris, Laboratoire de Microbiologie, Université de Paris, UMR-S 1139 (3PHM), Paris, France
| | - Ilka Engelmann
- Laboratoire de Virologie ULR3610, University of Lille, CHU Lille, Lille, France
| | - Agathe Baras
- Laboratoire de Virologie ULR3610, University of Lille, CHU Lille, Lille, France
| | - Didier Hober
- Laboratoire de Virologie ULR3610, University of Lille, CHU Lille, Lille, France
| | - Romain Gérard
- Gastroenterology Department, University of Lille, CHU Lille, Lille, France
| | - Jean-Baptiste Gibier
- Centre de Biologie Pathologie, Institute of Pathology, CHU Lille, Lille, France.,University of Lille, INSERM UMR1172, Lille, France
| | - Emmanuelle Leteurtre
- Centre de Biologie Pathologie, Institute of Pathology, CHU Lille, Lille, France.,University of Lille, INSERM UMR1172, Lille, France
| | - François Glowacki
- Service de Néphrologie, CHU Lille, Lille, France.,UnivErsity of Lille, Lille, France
| | | | | | | | - Paul Chamley
- Service de Néphrologie, CHU Lille, Lille, France
| | - Emmanuel Faure
- Service de Maladies Infectieuses, CHU Lille, Lille, France.,U1019-UMR9017-CIIL-Centre d'Infection et d'Immunité de Lille, CHU Lille, UnivErsity of Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France
| | - Bhupesh K Prusty
- Institut für Virologie und Immunobiologie, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Mehdi Maanaoui
- Service de Néphrologie, CHU Lille, Lille, France.,University of Lille, INSERM U1190, Translational Research for Diabetes, Lille, France
| | - Marc Hazzan
- Service de Néphrologie, CHU Lille, Lille, France
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Miyani B, McCall C, Xagoraraki I. High abundance of human herpesvirus 8 in wastewater from a large urban area. J Appl Microbiol 2020; 130:1402-1411. [PMID: 33058412 DOI: 10.1111/jam.14895] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/18/2020] [Accepted: 10/07/2020] [Indexed: 11/28/2022]
Abstract
AIMS This study assesses the diversity and abundance of Human Herpesviruses (HHVs) in the influent of an urban wastewater treatment plant using shotgun sequencing, metagenomic analysis and qPCR. METHODS AND RESULTS Influent wastewater samples were collected from the three interceptors that serve the City of Detroit and Wayne, Macomb and Oakland counties between November 2017 to February 2018. The samples were subjected to a series of processes to concentrate viruses which were further sequenced and amplified using qPCR. All nine types of HHV were detected in wastewater. Human Herpesvirus 8 (HHV-8), known as Kaposi's sarcoma herpesvirus, which is only prevalent in 5-10% of USA population, was found to be the most abundant followed by HHV-3 or Varicella-zoster virus. CONCLUSIONS The high abundance of HHV-8 in the Detroit metropolitan area may be attributed to the HIV-AIDS outbreak that was ongoing in Detroit during the sampling period. SIGNIFICANCE AND IMPACT OF THE STUDY The approach described in this paper can be used to establish a baseline of viruses secreted by the community as a whole. Sudden changes in the baseline would identify changes in community health and immunity.
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Affiliation(s)
- B Miyani
- Department of Civil and Environmental Engineering, Michigan State University, East Lansing, MI, USA
| | - C McCall
- Department of Civil and Environmental Engineering, Michigan State University, East Lansing, MI, USA
| | - I Xagoraraki
- Department of Civil and Environmental Engineering, Michigan State University, East Lansing, MI, USA
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McCall C, Wu H, Miyani B, Xagoraraki I. Identification of multiple potential viral diseases in a large urban center using wastewater surveillance. WATER RESEARCH 2020; 184:116160. [PMID: 32738707 PMCID: PMC7342010 DOI: 10.1016/j.watres.2020.116160] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/27/2020] [Accepted: 07/05/2020] [Indexed: 05/08/2023]
Abstract
Viruses are linked to a multitude of human illnesses and can disseminate widely in urbanized environments causing global adverse impacts on communities and healthcare infrastructures. Wastewater-based epidemiology was employed using metagenomics and quantitative polymerase chain reaction (qPCR) assays to identify enteric and non-enteric viruses collected from a large urban area for potential public health monitoring and outbreak analysis. Untreated wastewater samples were collected from November 2017 to February 2018 (n = 54) to evaluate the diversity of human viral pathogens in collected samples. Viruses were classified into virus types based on primary transmission routes and reviewed against viral associated diseases reported in the catchment area. Metagenomics detected the presence of viral pathogens that cause clinically significant diseases reported within the study area during the sampling year. Detected viruses belong to the Adenoviridae, Astroviridae, Caliciviridae, Coronaviridae, Flaviviridae, Hepeviridae, Herpesviridae, Matonaviridae, Papillomaviridae, Parvoviridae, Picornaviridae, Poxviridae, Retroviridae, and Togaviridae families. Furthermore, concentrations of adenovirus, norovirus GII, sapovirus, hepatitis A virus, human herpesvirus 6, and human herpesvirus 8 were measured in wastewater samples and compared to metagenomic findings to confirm detected viral genus. Hepatitis A virus obtained the greatest average viral load (1.86 × 107 genome copies/L) in wastewater samples compared to other viruses quantified using qPCR with a 100% detection rate in metagenomic samples. Average concentration of sapovirus (1.36 × 106 genome copies/L) was significantly greater than norovirus GII (2.94 × 104 genome copies/L) indicating a higher burden within the study area. Findings obtained from this study aid in evaluating the utility of wastewater-based epidemiology for identification and routine monitoring of various viruses in large communities. This methodology has the potential to improve public health responses to large scale outbreaks and viral pandemics.
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Affiliation(s)
- Camille McCall
- Department of Civil and Environmental Engineering, Michigan State University, East Lansing, MI, 48823, USA
| | - Huiyun Wu
- Department of Civil and Environmental Engineering, Michigan State University, East Lansing, MI, 48823, USA
| | - Brijen Miyani
- Department of Civil and Environmental Engineering, Michigan State University, East Lansing, MI, 48823, USA
| | - Irene Xagoraraki
- Department of Civil and Environmental Engineering, Michigan State University, East Lansing, MI, 48823, USA.
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Development of a multiplex one-step real-time RT-PCR assay for the simultaneous detection of eight viruses associated with febrile rash illnesses. BIOSAFETY AND HEALTH 2020. [DOI: 10.1016/j.bsheal.2020.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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9
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Viral Loads in Ocular Fluids of Acute Retinal Necrosis Eyes Infected by Varicella-Zoster Virus Treated with Intravenous Acyclovir Treatment. J Clin Med 2020; 9:jcm9041204. [PMID: 32331430 PMCID: PMC7230916 DOI: 10.3390/jcm9041204] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 11/20/2022] Open
Abstract
Acute retinal necrosis (ARN) is a rare viral endophthalmitis, and human herpesvirus is the principal pathogen. Early diagnosis and treatment are critical to avoid visual impairment by ARN, and pars plana vitrectomy (PPV) is required in advanced cases. In this study, we evaluated the transition of viral load in ocular fluids of ARN eyes with varicella-zoster virus (VZV) after intravenous acyclovir treatment. Fourteen eyes of 13 patients were analyzed retrospectively. All patients received intravenous acyclovir treatment, and eventually, all eyes underwent PPV. A polymerase chain reaction (PCR) test showed a 100% detection rate in all aqueous humor samples collected before the treatment (Pre-AH), as well as aqueous humor (Post-AH) and vitreous fluid samples (VF), collected during PPV conducted after the treatment. Within eight days or less of acyclovir treatment, viral loads both in AH and VF did not decrease significantly. Furthermore, the viral load of Pre-AH had a strong correlation with that of VH. These data suggest that in ARN eyes with VZV infection, the AH sample for the PCR test was reliable to confirm the pathogen. We propose that short-term treatment of intravenous acyclovir may be insufficient for reducing intraocular viral load, and the Pre-AH sample could be a predictor of viral activity in the eyes after acyclovir treatment.
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Abstract
OBJECTIVES Reactivation viremia is associated with adverse clinical outcomes and immune dysfunction in adults with sepsis. We determined the incidence of viremia and its association with clinical outcomes and immune paralysis phenotype in children with severe sepsis. DESIGN Prospective cohort study. SETTING Single academic PICU from September 2016 to March 2018. PATIENTS Fifty-nine patients 2-17 years old treated for severe sepsis. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We performed real-time polymerase chain reaction assays on whole blood specimens to determine the incidence of cytomegalovirus. Cytomegalovirus was detected in three patients (5%). All patients with cytomegalovirus viremia were seropositive, with an incidence of 13% in this subset. We additionally performed Epstein-Barr virus and human herpesvirus-6 polymerase chain reaction assays on last available specimens and detected Epstein-Barr virus in 4% and human herpesvirus-6 in 30% of the study population. Overall, viremia was not associated with clinical outcomes or immune function in univariable analyses. However, viremia was associated with lower odds of complicated course (defined as death within 28 d or ≥ 2 organ dysfunctions at 7 d) after controlling for age, Pediatric Risk of Mortality III score, and blood transfusion (adjusted odds ratio, 0.08; 95% CI, 0.01-0.84; p = 0.04). CONCLUSIONS Children with severe sepsis had low rates of detectable viremia, which limited analyses of its association with clinical outcomes or immune paralysis phenotype. Given the rare occurrence of cytomegalovirus viremia, in particular, our study does not support a role for viremia as a biomarker of illness severity or as a modifiable risk factor of clinical outcomes for most patients. Future studies on the role of viremia in pediatric sepsis will need to consider the challenges posed by low rates of viremia in this population.
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Yang CH, Sahoo MK, Fitzpatrick M, Lau AH, Pinsky BA, Martinez OM. Evaluating for Human Herpesvirus 6 in the Liver Explants of Children With Liver Failure of Unknown Etiology. J Infect Dis 2020; 220:361-369. [PMID: 30418598 DOI: 10.1093/infdis/jiy644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 11/05/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Liver failure of unknown etiology (LFUE) has a transplant-free survival rate <25%. Human herpesvirus 6 (HHV-6) may be associated with LFUE, but studies are limited by small sample size. METHODS We identified all children who underwent liver transplant for LFUE at a single quaternary children's hospital; 51/65 cases could be age matched with controls (children who underwent liver transplant for metabolic liver disease). Quantitative polymerase chain reaction for HHV-6 was performed on DNA from formalin-fixed paraffin-embedded liver explant tissue. RESULTS HHV-6 was detected in 34/51 cases (66.7%) and 19/51 controls (37.3%) (P = .005). Average HHV-6 viral load was 213207 copies/106 cells in positive cases (range: 7293-1102030) and 38115 copies/106 cells in positive controls (range: 1382-122375) (P = .0008). HHV-6 was present significantly more often in cases compared to controls in patients younger than 6 years. In particular, in patients younger than 3 years, HHV-6 was present in 13/27 cases (48.1%) and 2/27 controls (7.4%) (P = .0009). CONCLUSIONS HHV-6 was detected in liver explants significantly more often and in higher quantities in children transplanted for LFUE compared to controls, suggesting HHV-6 should be evaluated in young children who present with LFUE.
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Affiliation(s)
- Christine H Yang
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | | | | | | | - Benjamin A Pinsky
- Department of Pathology.,Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, California
| | - Olivia M Martinez
- Department of Surgery, Division of Abdominal Transplantation and Stanford Immunology, Stanford University Medical Center, California
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Human herpesvirus 6A active infection in patients with autoimmune Hashimoto's thyroiditis. Braz J Infect Dis 2019; 23:435-440. [PMID: 31751524 PMCID: PMC9428182 DOI: 10.1016/j.bjid.2019.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/25/2019] [Accepted: 10/17/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Hypothyroidism due to Hashimoto's thyroiditis (HT) is the commonest autoimmune endocrine illness in which antibodies against thyroid organ result in inflammation. The disease has a complex etiology that involves genetic and environmental influences. Viral infections may be involved in triggering of the disease as their molecular mimicry enhance autoimmune responses. Human herpesvirus-6 (HHV-6) is recognized for its contribution to some autoimmune diseases. OBJECTIVE In the current study, the prevalence of HHV-6 active infection in patients with HT and with non-autoimmune thyroid disorders were compared with patients with euthyroidism. In addition, a correlation between presence of HHV-6 infections and HT was investigated. METHODS A total of 151 patients with clinically and laboratory confirmed HT, 59 patients with non-autoimmune thyroid disorders, and 32 patients with normal thyroid function were included in the study. For further confirmation of HT disease, all the precipitants were tested for anti-thyroid peroxidase (TPO), and anti-thyroglobulin (TG) antibodies. For detection of both HHV-6 types A and B, nested PCR and restriction enzyme digestion were used. HHV-6 DNA positive samples were further investigated by DNA sequencing analysis. RESULTS HHV-6A DNA was found in serum sample of 57 out of 151 patients (38%) with HT, which was significantly more often than in patients with non-autoimmune thyroid disorders (p=0.001). However, HHV-6 DNA was not detected in serum samples of euthyroid subjects. CONCLUSIONS The results support a possible role for active HHV-6A infection, demonstrated by the presence of HHV-6 DNA in sera, in the development of HT.
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Bonnafous P, Phan TL, Himes R, Eldin K, Gautheret-Dejean A, Prusty BK, Agut H, Munoz FM. Evaluation of liver failure in a pediatric transplant recipient of a liver allograft with inherited chromosomally integrated HHV-6B. J Med Virol 2019; 92:241-250. [PMID: 31579937 DOI: 10.1002/jmv.25600] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 09/25/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Active infections of human herpesvirus 6B (HHV-6B) are frequent in immunocompromised recipients after transplantation. Nevertheless, they need to be distinguished from latent inherited chromosomally integrated genomes (iciHHV-6) present in about 1% of the population to avoid unnecessary administration of toxic antivirals. METHODS A 5-year-old child presented with acute liver allograft rejection associated with HHV-6 DNA in plasma, which led to an unfavorable outcome. We investigated the possibility of HHV-6 infection derived from an iciHHV-6 present in the donor's liver using molecular and histopathology studies in various tissues, including quantification of HHV-6 DNA, genotyping, sequencing for antiviral resistance genes, relative quantification of viral transcripts, and detection of gB and gH viral proteins. RESULTS The presence of iciHHV-6B was evidenced in the donor with signs of reactivation in the gallbladder and transplanted liver (detection of HHV-6B mRNA and late proteins). This localized expression could have played a role in liver rejection. Low viral loads in the recipient's plasma, with identical partial U39 sequences, were in favor of viral DNA released from the transplanted liver rather than a systemic infection. CONCLUSIONS Determination of iciHHV-6 status before transplantation should be considered to guide clinical decisions, such as antiviral prophylaxis, viral load monitoring, and antiviral therapy.
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Affiliation(s)
- Pascale Bonnafous
- Sorbonne Department, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), THERAVIR team, Paris, France
| | - Tuan L Phan
- Department of Microbiology and Immunology, Tulane University School of Medicine, New Orleans, Louisiana
- HHV-6 Foundation, Santa Barbara, California
| | - Ryan Himes
- Departments of Pediatrics, Molecular Virology and Microbiology, Hepatology, and Pathology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Karen Eldin
- Departments of Pediatrics, Molecular Virology and Microbiology, Hepatology, and Pathology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Agnès Gautheret-Dejean
- AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Service de Virologie, Paris, France
- Department Paris Descartes, Institute de Pharmacie de Paris, UMR-S 1139 (3PHM), Paris, France
| | | | - Henri Agut
- AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Service de Virologie, Paris, France
| | - Flor M Munoz
- Departments of Pediatrics, Molecular Virology and Microbiology, Hepatology, and Pathology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
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Savassi-Ribas F, Gomes Dos Santos de Almeida S, Baez CF, Magalhães de Souza L, Wagner TCS, Matuck TA, Monteiro de Carvalho DDB, Marandino Guimarães MAA, Varella RB. Impact assessment and investigation of factors associated with herpesviruses viremia in the first year of renal transplantation. J Med Virol 2019; 92:107-112. [PMID: 31463932 DOI: 10.1002/jmv.25580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/26/2019] [Indexed: 12/16/2022]
Abstract
The increased risk for opportunistic infections after a renal transplant requires monitoring of viral infections to avoid future complications. Our goal was to investigate the impact and factors associated with Epstein-Barr virus (EBV), human cytomegalovirus (HCMV) and human herpesvirus type 6 (HHV-6) viremia in renal transplant recipients. Whole blood samples were collected monthly from 82 patients during the first semester and then quarterly up to 1 year after transplantation. EBV, HCMV, and HHV-6 were detected and quantified by TaqMan real-time polymerase chain reaction. The results showed that EBV and HCMV viremia were detected in 32 patients (39% each), while HHV-6 viremia in only 3 patients (3.7%). EBV was significantly associated with age (P = .050), thymoglobuline induction (P = .019), mTOR inhibitor-based therapy (P = .003), and female gender (P = .044). HCMV was significantly associated with basiliximab induction (P = .015), mycophenolate mofetil (MMF)-based therapy (P = .003) and allograft acute rejection (P = .033). Moreover, HCMV-disease was correlated with MMF-based therapy (P = .021) and female gender (P = .003). In conclusion, EBV and HCMV viremia were associated with different immunosuppressive induction and maintenance strategies. Additionally, higher HCMV viremia (> 10 4 copies/mL) was related to acute allograft rejection.
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Affiliation(s)
- Flavia Savassi-Ribas
- Department of Microbiology and Parasitology, Biomedical Institute, Fluminense Federal University, Niteroi, Brazil
| | | | - Camila Freze Baez
- Department of Preventive Medicine, University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leandro Magalhães de Souza
- Department of Preventive Medicine, University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tereza Cristina Simão Wagner
- Service of Renal Transplantation, Rio de Janeiro State Center of transplantation, São Francisco na Providência de Deus Hospital, Rio de Janeiro, Brazil
| | - Tereza Azevedo Matuck
- Service of Renal Transplantation, Rio de Janeiro State Center of transplantation, São Francisco na Providência de Deus Hospital, Rio de Janeiro, Brazil
| | - Deise De Boni Monteiro de Carvalho
- Service of Renal Transplantation, Rio de Janeiro State Center of transplantation, São Francisco na Providência de Deus Hospital, Rio de Janeiro, Brazil
| | | | - Rafael Brandão Varella
- Department of Microbiology and Parasitology, Biomedical Institute, Fluminense Federal University, Niteroi, Brazil
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McGuire JL, Tuite NV, Swami SK, Avery RA. Assessment of Diagnostic Yield of Nonculture Infection Testing on Cerebrospinal Fluid in Immune-Competent Children. JAMA Netw Open 2019; 2:e197307. [PMID: 31322691 PMCID: PMC6646983 DOI: 10.1001/jamanetworkopen.2019.7307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Nonculture infection tests of cerebrospinal fluid (CSF) samples using polymerase chain reaction and antigen or antibody assays are frequently ordered on lumbar puncture specimens concurrently with routine CSF cell counts, but the value of CSF infection testing in otherwise healthy children is unknown. OBJECTIVE To determine the value of nonculture CSF infection testing in immune-competent children with normal CSF cell counts. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study reviewed screening and diagnostic tests in the electronic medical record system of a large academic tertiary care children's hospital. Records of children aged 0.5 to 18.9 years (n = 4083) who underwent lumbar puncture (n = 4811 procedures) in an inpatient or outpatient facility of Children's Hospital of Philadelphia between July 1, 2007, and December 31, 2016, were reviewed. Those with indwelling CSF shunts or catheters; those with active or past oncologic, immunologic, or rheumatologic conditions; or those taking immune-suppressing medications were excluded from analysis. This study was conducted from July 20, 2017, to March 13, 2019. MAIN OUTCOMES AND MEASURES Outcome variables included frequency of nonculture CSF infection testing and frequency of positive results in the entire cohort, and among those with normal cell counts. Normal cell counts were defined as CSF white blood cell counts lower than 5 cells/μL and CSF red blood cell counts lower than 500 cells/μL. RESULTS In total, 4811 lumbar puncture procedures were performed on 4083 unique children, with a median (range) age of 7.4 (0.5-18.9) years, 2537 boys (52.7%), and 3331 (69.2%) with normal CSF cell counts. At least 1 nonculture CSF infection test was performed on 1270 lumbar puncture specimens with normal cell counts (38.1%; 95% CI, 36%-40%), and more tests were performed in the summer months. Only 18 (1.4%; 95% CI, 0.9%-2.2%) of 1270 lumbar puncture specimens with normal cell counts had at least 1 nonculture infection test with a positive result; 2 of these 18 children required clinical intervention for their positive results, but each also had other clear clinical signs of infection. CONCLUSIONS AND RELEVANCE Nonculture CSF infection testing appeared to be common in immune-competent children with normal CSF cell counts, but positive results were uncommon and were not independently associated with clinical care; delaying the decision to send nonculture infection tests until CSF cell counts are available could reduce unnecessary diagnostic testing and medical costs, which may improve value-based care.
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Affiliation(s)
- Jennifer L. McGuire
- Division of Neurology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Department of Neurology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Nichole V. Tuite
- Division of Neurology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sanjeev K. Swami
- Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Division of Infectious Disease, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Robert A. Avery
- Department of Neurology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Division of Ophthalmology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Ophthalmology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Kobayashi N, Nishiyama T, Yamauchi T, Shimada K, Suka M, Kondo K, Yanagisawa H. Attenuation of human herpesvirus 6B reactivation by aging. J Med Virol 2019; 91:1335-1341. [DOI: 10.1002/jmv.25434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/26/2019] [Accepted: 02/15/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Nobuyuki Kobayashi
- Department of VirologyThe Jikei University School of MedicineTokyo Japan
| | - Toshiko Nishiyama
- Department of Public Health and Environmental MedicineThe Jikei University School of MedicineTokyo Japan
- Department of Internal MedicineOtemachi Sakura Clinic in ToyosuTokyo Japan
| | - Takashi Yamauchi
- Department of Public Health and Environmental MedicineThe Jikei University School of MedicineTokyo Japan
| | - Kazuya Shimada
- Department of VirologyThe Jikei University School of MedicineTokyo Japan
| | - Machi Suka
- Department of Public Health and Environmental MedicineThe Jikei University School of MedicineTokyo Japan
| | - Kazuhiro Kondo
- Department of VirologyThe Jikei University School of MedicineTokyo Japan
| | - Hiroyuki Yanagisawa
- Department of Public Health and Environmental MedicineThe Jikei University School of MedicineTokyo Japan
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Abstract
BACKGROUND Although febrile neutropenia (FN) is one of the most common adverse events produced by chemotherapy, its microbiological etiology is determined for only 15% to 30% of cases. OBJECTIVES We investigated the rate of viremia with common DNA viruses in patients with FN. STUDY DESIGN From June 2012 to April 2014, 72 blood samples from 24 patients receiving chemotherapy, who experienced FN episodes, were examined for the presence of herpes viruses and other DNA viruses. We used real-time polymerase chain reaction assays to detect herpes simplex virus type 1 and 2, varicella zoster virus, Epstein-Barr virus, cytomegalovirus, human herpes virus types 6 and 7, BK virus and human parvovirus B19 (B19). RESULTS Viruses were identified in 14 of 72 samples (19.4%). The detected etiological agents were BK virus (5 episodes), human herpes virus type 6 (4 episodes), B19 (4 episodes), Epstein-Barr virus (2 episodes), and cytomegalovirus (1 episode). CONCLUSIONS Our results indicate that viral infections are common causes in patients with FN. Therefore, viruses may be responsible for FN in a large proportion of patients in whom a causative microorganism could not be identified, and this viral etiology may explain their poor response to antibiotic therapy.
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18
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Clinical significance of cancer-related fatigue in multiple myeloma patients. Int J Hematol 2018; 108:580-587. [DOI: 10.1007/s12185-018-2516-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 08/04/2018] [Accepted: 08/06/2018] [Indexed: 01/29/2023]
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Abstract
Human roseoloviruses include three different species, human herpesviruses 6A, 6B, and 7 (HHV-6A, HHV-6B, HHV-7), genetically related to human cytomegalovirus. They exhibit a wide cell tropism in vivo and, like other herpesviruses, induce a lifelong latent infection in humans. In about 1% of the general population, HHV-6 DNA is covalently integrated into the subtelomeric region of cell chromosomes (ciHHV-6). Many active infections, corresponding to primary infections, reactivations, or exogenous reinfections, are asymptomatic. They also may cause serious diseases, particularly in immunocompromised individuals, including hematopoietic stem-cell transplant (HSCT) and solid-organ transplant recipients, and acquired immunodeficiency syndrome (AIDS) patients. This opportunistic pathogenic role is formally established for HHV-6 infection and less clear for HHV-7. It mainly concerns the central-nervous system, bone marrow, lungs, gastrointestinal tract, skin, and liver. As the best example, HHV-6 causes both exanthema subitum, a benign disease associated with primary infection, and severe encephalitis associated with virus reactivations in HSCT recipients. Diagnosis using serologic and direct antigen-detection methods currently exhibits limitations. The most prominent technique is the quantification of viral DNA in blood, other body fluids, and organs by means of real-time polymerase-chain reaction (PCR). The antiviral compounds ganciclovir, foscarnet, and cidofovir are effective against active infections, but there is currently no consensus regarding the indications of treatment or specifics of drug administration. Numerous questions about HHV-6A, HHV-6B, HHV-7 are still pending, concerning in particular clinical impact and therapeutic options in immunocompromised patients.
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20
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Impact of stem cell graft on early viral infections and immune reconstitution after allogeneic transplantation in adults. J Clin Virol 2017; 93:30-36. [PMID: 28601677 DOI: 10.1016/j.jcv.2017.05.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 05/05/2017] [Accepted: 05/28/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Viral infections are well-known complications after allogeneic stem cell transplant (allo-SCT). OBJECTIVES We compared prospectively incidences of DNAemia and active infections (AI) for five opportunistic viruses (Human Herpesvirus 6 (HHV-6), Epstein-Barr virus (EBV), BK polyomavirus (BKPyV), Cytomegalovirus (CMV) and Adenovirus (ADV)) and kinetics of immune reconstitution (IR) in adults receiving either double umbilical cord blood (dUCB group) or unrelated peripheral blood stem cell (uPBSC group) allo-SCT after a reduced-intensity conditioning (RIC) regimen. STUDY DESIGN Whole blood samples were collected at transplant, every 15days during the first 3 months and at 4, 5 and 6 months post-transplant. RESULTS Sixty-five patients were enrolled (uPBSC n=34; dUCB n=31). Incidences of HHV-6 and BKPyV DNAemia were significantly higher for dUCB (97% vs 23.5% and 58% vs 32%, respectively) while EBV DNAemia was more frequently detected in uPBSC (71% vs 26%). The incidence of CMV DNAemia was similar between both groups. ADV AI developed only in dUCB. HHV-6 AI were also higher in dUCB (84% vs 21%). In multivariate analysis, dUCB graft was the only independent factor associated with HHV-6 DNAemia (OR: 19.0; 95%CI: 5.2-69.1; p<0.0001) while EBV DNAemia were significantly associated with uPBSC (OR: 29.9; 95%CI: 5.68-158; p <0.0001). dUCB graft was also the only factor associated with HHV-6 AI. Finally, higher counts and faster recoveries of B lymphocytes (p<0.0001) and monocytes (p=0.0007) were observed in the dUCB group. CONCLUSION We demonstrate a strong correlation between sources of graft and patterns of viral DNAemia and AI and IR after RIC allo-SCT.
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21
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Yip CCY, Sridhar S, Cheng AKW, Fung AMY, Cheng VCC, Chan KH, Yuen KY. Comparative evaluation of a laboratory developed real-time PCR assay and the RealStar ® HHV-6 PCR Kit for quantitative detection of human herpesvirus 6. J Virol Methods 2017; 246:112-116. [PMID: 28476346 DOI: 10.1016/j.jviromet.2017.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/29/2017] [Accepted: 05/02/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND HHV-6 reactivation in immunocompromised patients is common and may be associated with serious morbidity and mortality; therefore, early detection and initiation of therapy might be of benefit. Real-time PCR assays allow for early identification of HHV-6 reactivation to assist in providing a timely response. Thus, we compared the performance of an in-house developed HHV-6 quantitative PCR assay with a commercially available kit, the RealStar® HHV-6 PCR Kit. METHOD The analytical sensitivity, analytical specificity, linearity, precision and accuracy of the in-house developed HHV-6 qPCR assay were evaluated. The diagnostic performance of the in-house HHV-6 qPCR assay was compared with the RealStar® HHV-6 PCR Kit, using 72 clinical specimens and 17 proficiency testing samples. RESULTS Linear regression analysis of the quantitative results showed a dynamic range from 2 to 10 log10 copies/ml and a coefficient of determination (R2) of 0.999 for the in-house assay. A dilution series demonstrated a limit of detection and a limit of quantification of 1.7 log10 and 2 log10 copies/ml, respectively. The precision of the assay was highly reproducible among runs with coefficients of variance (CV) ranging from 0.27% to 4.37%. A comparison of 27 matched samples showed an excellent correlation between the quantitative viral loads measured by the in-house HHV-6 qPCR assay and the RealStar® HHV-6 PCR Kit (R2=0.926; P<0.0001), with an average bias of -0.24 log10 copies/ml. CONCLUSIONS The in-house developed HHV-6 qPCR method is a sensitive and reliable assay with lower cost for the detection and quantification of HHV-6 DNA when compared to the RealStar® HHV-6 PCR Kit.
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Affiliation(s)
- Cyril C Y Yip
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region
| | - Siddharth Sridhar
- Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Andrew K W Cheng
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region
| | - Ami M Y Fung
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region
| | - Vincent C C Cheng
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region
| | - Kwok-Hung Chan
- Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Kwok-Yung Yuen
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region; Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region; State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong Special Administrative Region; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong Special Administrative Region; Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong Special Administrative Region; The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The University of Hong Kong, Hong Kong Special Administrative Region.
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22
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Nefzi F, Lambert C, Gautheret-Dejean A, Fisson S, Khebizi Q, Khelif A, Agut H, Aouni M. Cytokine and cellular responses to human herpesvirus-6B in patients with B-acute lymphoblastic leukemia. Microbiol Immunol 2017; 60:770-777. [PMID: 27862208 DOI: 10.1111/1348-0421.12452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/26/2016] [Accepted: 11/06/2016] [Indexed: 01/21/2023]
Abstract
Primary infection with human herpesvirus-6 (HHV-6), is followed by its lifelong persistence in the host. Most T-cell responses to HHV-6 have been characterized using peripheral blood from healthy adults; however, the role of HHV-6 infection in immune modulation has not been elucidated for some diseases. Therefore, in this study the immune response to HHV-6 infection in patients with B-acute lymphoblastic leukemia (B-ALL) was analyzed. HHV-6 load was quantified in blood samples taken at the time of diagnosis of leukemia and on remission. The same concentrations of anti- and pro-inflammatory cytokines (IL-4, IL-1, IL-6, IL-8, IL-12p70, IL-17a, TNF-α and IFN-γ) were detected in plasma samples from 20 patients with and 20 without detectable HHV-6 virus loads in blood. Characterization of T-cell responses to HHV-6 showed low specific T-cells frequencies of 2.08% and 1.46% in patients with and without detectable viral loads, respectively. IFN-γ-producing T cells were detected in 0.03%-0.23% and in 0%-0.2% of CD4+T cells, respectively. Strong production of IL-6 was detected in medium supernatants of challenged T-cells whatever the HHV-6 status of the patients (973.51 ± 210.06 versus 825.70 ± 210.81 pg/mL). However, concentrations of TNF-α and IFN-γ were low. Thus, no association between plasma concentrations of cytokines and detection of HHV-6 in blood was identified, suggesting that HHV-6 is not strongly associated with development of B-ALL. The low viral loads detected may correspond with latently infected cells. Alternatively, HHV-6B specific immune responses may be below the detection threshold of the assays used.
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Affiliation(s)
- Faten Nefzi
- Laboratory of Transmissible Diseases and Biological Active Substances, LR99ES27, Faculty of Pharmacy, University of Monastir, Street Avicenne 5000, Monastir, Tunisia
| | - Claude Lambert
- Immunology Laboratory, Georges Friedel Laboratory (CNRS UMR5307); University Hospital of Saint-Étienne, 44 Rue Pointe Cadet, 42100 Saint-Étienne, France
| | - Agnès Gautheret-Dejean
- Sorbonne University, Pierre and Marie Curie University, Center for Immunology and Infectious Diseases of Paris (UMRS CR7), Persistent Viral Infections Team, 4 Jussieu Place, 75005, Paris, France.,Public Assistance-Hospitals of Paris, University Hospitals Pitié Salpêtrière-Charles Foix, Virology Service, 3 Avenue Victoria, 75004 Paris, France
| | - Sylvain Fisson
- INSERM U951, University of Evry Val d'Essonne, UMR_S951, Genethon, F-91002 Evry, France
| | - Quentin Khebizi
- INSERM U951, University of Evry Val d'Essonne, UMR_S951, Genethon, F-91002 Evry, France
| | - Abderrahim Khelif
- Department of Clinical Hematology, Farhat Hached Hospital, Sousse, Tunisia
| | - Henri Agut
- Sorbonne University, Pierre and Marie Curie University, Center for Immunology and Infectious Diseases of Paris (UMRS CR7), Persistent Viral Infections Team, 4 Jussieu Place, 75005, Paris, France.,Public Assistance-Hospitals of Paris, University Hospitals Pitié Salpêtrière-Charles Foix, Virology Service, 3 Avenue Victoria, 75004 Paris, France
| | - Mahjoub Aouni
- Laboratory of Transmissible Diseases and Biological Active Substances, LR99ES27, Faculty of Pharmacy, University of Monastir, Street Avicenne 5000, Monastir, Tunisia
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Graf EH, Farquharson MV, Cárdenas AM. Comparative evaluation of the FilmArray meningitis/encephalitis molecular panel in a pediatric population. Diagn Microbiol Infect Dis 2016; 87:92-94. [PMID: 27771208 DOI: 10.1016/j.diagmicrobio.2016.09.022] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 08/29/2016] [Accepted: 09/28/2016] [Indexed: 11/16/2022]
Abstract
We compared an FDA cleared molecular meningitis/encephalitis panel to lab developed viral PCRs and bacterial culture. Of the 67 viral PCR or bacterial culture-positive samples, 92.5% were positive for the same target by the panel. Of the 66 negative samples tested, no targets were detected by the panel, for an agreement of 96.2%.
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Affiliation(s)
- Erin H Graf
- University of Pennsylvania, Department of Pathology and Laboratory Medicine, 3400 Spruce Street, Philadelphia, PA 19104; Children's Hospital of Philadelphia, Infectious Disease Diagnostics Laboratory, 3401 Civic Center Boulevard, Philadelphia, PA 19104
| | - Maria Victoria Farquharson
- Children's Hospital of Philadelphia, Infectious Disease Diagnostics Laboratory, 3401 Civic Center Boulevard, Philadelphia, PA 19104
| | - Ana María Cárdenas
- University of Pennsylvania, Department of Pathology and Laboratory Medicine, 3400 Spruce Street, Philadelphia, PA 19104; Children's Hospital of Philadelphia, Infectious Disease Diagnostics Laboratory, 3401 Civic Center Boulevard, Philadelphia, PA 19104.
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Caregiver burden and fatigue in caregivers of people with dementia: Measuring human herpesvirus (HHV)-6 and -7 DNA levels in saliva. Arch Gerontol Geriatr 2016; 66:42-8. [DOI: 10.1016/j.archger.2016.04.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 04/25/2016] [Accepted: 04/26/2016] [Indexed: 11/22/2022]
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Aoki R, Kobayashi N, Suzuki G, Kuratsune H, Shimada K, Oka N, Takahashi M, Yamadera W, Iwashita M, Tokuno S, Nibuya M, Tanichi M, Mukai Y, Mitani K, Kondo K, Ito H, Nakayama K. Human herpesvirus 6 and 7 are biomarkers for fatigue, which distinguish between physiological fatigue and pathological fatigue. Biochem Biophys Res Commun 2016; 478:424-430. [PMID: 27396623 DOI: 10.1016/j.bbrc.2016.07.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 07/02/2016] [Indexed: 11/16/2022]
Abstract
Fatigue reduces productivity and is a risk factor for lifestyle diseases and mental disorders. Everyone experiences physiological fatigue and recovers with rest. Pathological fatigue, however, greatly reduces quality of life and requires therapeutic interventions. It is therefore necessary to distinguish between the two but there has been no biomarker for this. We report on the measurement of salivary human herpesvirus (HHV-) 6 and HHV-7 as biomarkers for quantifying physiological fatigue. They increased with military training and work and rapidly decreased with rest. Our results suggested that macrophage activation and differentiation were necessary for virus reactivation. However, HHV-6 and HHV-7 did not increase in obstructive sleep apnea syndrome (OSAS), chronic fatigue syndrome (CFS) and major depressive disorder (MDD), which are thought to cause pathological fatigue. Thus, HHV-6 and HHV-7 would be useful biomarkers for distinguishing between physiological and pathological fatigue. Our findings suggest a fundamentally new approach to evaluating fatigue and preventing fatigue-related diseases.
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Affiliation(s)
- Ryo Aoki
- Department of Psychiatry, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan.
| | - Nobuyuki Kobayashi
- Department of Virology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Go Suzuki
- Flight Crew Operations and Technology Unit, Japan Aerospace Exploration Agency Houston Office, 18050 Saturn Lane, Suite 310, Houston, TX 77058, USA
| | - Hirohiko Kuratsune
- Clinical Center for Fatigue Science, Osaka City University Graduate School of Medicine, Osaka, Japan; Department of Health Science, Faculty of Health Science for Welfare, Kansai University of Welfare Sciences, Osaka, Japan
| | - Kazuya Shimada
- Department of Virology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Naomi Oka
- Department of Virology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Mayumi Takahashi
- Department of Virology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Wataru Yamadera
- Department of Psychiatry, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Masayuki Iwashita
- Department of Psychiatry, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Shinichi Tokuno
- Department of Defense Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Masashi Nibuya
- Department of Psychiatry, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Masaaki Tanichi
- Department of Psychiatry, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Yasuo Mukai
- Military Medicine Research Unit, Test and Evaluation Command, Japan Ground Self Defense Force, Setagaya, Tokyo, Japan
| | - Keiji Mitani
- Department of Internal Medicine, Japan Self-Defense Force Central Hospital, Setagaya, Tokyo, Japan
| | - Kazuhiro Kondo
- Department of Virology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Hiroshi Ito
- Department of Psychiatry, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Kazuhiko Nakayama
- Department of Psychiatry, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
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Charnot-Katsikas A, Baewer D, Cook L, David MZ. Fulminant hepatic failure attributed to infection with human herpesvirus 6 (HHV-6) in an immunocompetent woman: A case report and review of the literature. J Clin Virol 2015; 75:27-32. [PMID: 26745830 DOI: 10.1016/j.jcv.2015.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 11/13/2015] [Accepted: 12/10/2015] [Indexed: 12/18/2022]
Abstract
Mild disease due to human herpesvirus-6 (HHV-6) has been reported in healthy children. Severe disease due to this virus can occur in immunocompromised patients but is rarely reported in previously healthy adults. 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. HHV-6 may be more commonly associated with fulminant hepatitis in immunocompetent patients than previously thought and should be considered in the differential diagnosis of patients presenting with skin rash, upper respiratory symptoms, and unexplained hepatitis.
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Affiliation(s)
- Angella Charnot-Katsikas
- Department of Pathology, The University of Chicago Medicine, 5841 S. Maryland Ave., TW003-d, Chicago, IL 60637, USA.
| | - David Baewer
- Coppe Healthcare Solutions, W229 N1870 Westwood Dr., Waukesha, WI 53186, USA.
| | - Linda Cook
- Department of Laboratory Medicine, University of Washington Medical Center, Box 357110 1959 NE Pacific Street, NW120, Seattle, WA 98195-7110, USA.
| | - Michael Z David
- Department of Medicine, The University of Chicago Medicine, 5841 S. Maryland Ave., Chicago, IL 60637, USA.
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27
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Quintela A, Escuret V, Roux S, Bonnafous P, Gilis L, Barraco F, Labussière-Wallet H, Duscastelle-Leprêtre S, Nicolini FE, Thomas X, Chidiac C, Ferry T, Frobert E, Morisset S, Poitevin-Later F, Monneret G, Michallet M, Ader F. HHV-6 infection after allogeneic hematopoietic stem cell transplantation: From chromosomal integration to viral co-infections and T-cell reconstitution patterns. J Infect 2015; 72:214-22. [PMID: 26518057 DOI: 10.1016/j.jinf.2015.09.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 08/29/2015] [Accepted: 09/29/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Human herpes virus 6 (HHV-6) can reactivate after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and may be associated with significant clinical manifestations. METHODS Case control study of HHV-6 infections after allo-HSCT. Chromosomal integration (ciHHV-6) for viral loads ≥ 5.5-log10 copies/mL was investigated. Viral co-infections, T-cell recovery, risk factors and outcome were compared in HHV-6- and non-HHV-6-infected patients. Antiviral treatment strategies were reviewed. RESULTS Among 366 adult allo-HSCT recipients, 75 HHV-6 infections occurred. Three (4%) recipients were ciHHV-6. HHV-6 infections were associated with CMV (p = 0.05; sdHR 1.73, CI 0.99-3.02) and/or BKV infections (p < 0.0001; sdHR 4.63, CI 2.04-10.53) but not EBV reactivation (p = 0.34). A slower CD8+ T-cells recovery was observed until 6 months after allo-HSCT in the HHV-6-infected group (p < 0.001), independently of acute and/or chronic graft-versus-host disease. The overall probability of survival after allo-HSCT was diminished for active HHV-6-infected patients (p = 0.0326). Cord blood unit recipients had a higher risk of developing HHV-6 infection compared to bone marrow recipients (p = 0.0007; sdHR 3.82, CI 1.76-8.27). Anti-HHV-6 treatment achieved complete response in only 2/3 of the cases. CONCLUSIONS In this series of allo-HSCT recipients, 4% were ciHHV-6, active HHV-6 infection was likely associated with CMV and BKV co-reactivations, delayed CD8+ T-cell recovery and poorer outcome.
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Affiliation(s)
- Adrien Quintela
- Hematology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Vanessa Escuret
- Virology Laboratory, Laboratoire de Virologie Est, Hospices Civils de Lyon, F-69677 Bron, France
| | - Sandrine Roux
- Infectious Diseases Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004 Lyon, France
| | - Pascale Bonnafous
- Sorbonne Universités, UPMC, CIMI-Paris UMRS CR7, Inserm U1135, PVI Team, Paris, France
| | - Lila Gilis
- Hematology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Fiorenza Barraco
- Hematology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Hélène Labussière-Wallet
- Hematology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | | | - Franck-Emmanuel Nicolini
- Hematology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Xavier Thomas
- Hematology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Christian Chidiac
- Infectious Diseases Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004 Lyon, France
| | - Tristan Ferry
- Infectious Diseases Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004 Lyon, France; Inserm U1111 CIRI, Claude Bernard Lyon I University, Lyon, France
| | - Emilie Frobert
- Virology Laboratory, Laboratoire de Virologie Est, Hospices Civils de Lyon, F-69677 Bron, France
| | - Stéphane Morisset
- Hematology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Françoise Poitevin-Later
- Cellular Immunology Laboratory, Hôpital E. Herriot, Hospices Civils de Lyon, F-69003 Lyon, France
| | - Guillaume Monneret
- Cellular Immunology Laboratory, Hôpital E. Herriot, Hospices Civils de Lyon, F-69003 Lyon, France
| | - Mauricette Michallet
- Hematology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Florence Ader
- Infectious Diseases Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004 Lyon, France; Inserm U1111 CIRI, Claude Bernard Lyon I University, Lyon, France.
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28
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Sadighi Z, Sabin ND, Hayden R, Stewart E, Pillai A. Diagnostic Clues to Human Herpesvirus 6 Encephalitis and Wernicke Encephalopathy After Pediatric Hematopoietic Cell Transplantation. J Child Neurol 2015; 30:1307-14. [PMID: 25564483 PMCID: PMC4692275 DOI: 10.1177/0883073814560628] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 10/27/2014] [Indexed: 11/17/2022]
Abstract
Human herpesvirus 6 (HHV6) encephalitis and Wernicke encephalopathy are treatable yet frequently undiagnosed causes of encephalopathy in pediatric recipients of allogeneic and autologous hematopoietic cell transplantation. Here we review representative cases of both conditions to highlight specific and relevant neurologic features that prompted effective diagnosis and treatment. 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. Two patients had confusion, ataxia, or ocular changes and low serum thiamine levels, which resolved with parenteral thiamine. In all cases, definitive diagnosis and treatment were facilitated by a high index of suspicion and search for specific pathognomonic neurologic deficits accompanying the confusional state. It is critical to clinically differentiate these 2 conditions from other common neurologic syndromes occurring after transplant, allowing potentially improved patient outcomes by prompt diagnosis and effective treatment.
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Affiliation(s)
- Zsila Sadighi
- Department of Neurology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Noah D Sabin
- St Jude Children's Research Hospital, Memphis, TN, USA
| | | | | | - Asha Pillai
- Department of Bone Marrow Transplantation and Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN, USA
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29
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Ueda MYH, Alvarenga PG, Real JM, Moreira EDS, Watanabe A, Passos-Castilho AM, Vescovi M, Novis Y, Rocha V, Seber A, Oliveira JSR, Rodrigues CA, Granato CFH. Optimisation of a quantitative polymerase chain reaction-based strategy for the detection and quantification of human herpesvirus 6 DNA in patients undergoing allogeneic haematopoietic stem cell transplantation. Mem Inst Oswaldo Cruz 2015; 110:461-7. [PMID: 26038958 PMCID: PMC4501408 DOI: 10.1590/0074-02760150004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 05/07/2015] [Indexed: 12/19/2022] Open
Abstract
Human herpesvirus 6 (HHV-6) may cause severe complications after haematopoietic stem
cell transplantation (HSCT). Monitoring this virus and providing precise, rapid and
early diagnosis of related clinical diseases, constitute essential measures to
improve outcomes. A prospective survey on the incidence and clinical features of
HHV-6 infections after HSCT has not yet been conducted in Brazilian patients and the
impact of this infection on HSCT outcome remains unclear. A rapid test based on
real-time quantitative polymerase chain reaction (qPCR) has been optimised to screen
and quantify clinical samples for HHV-6. The detection step was based on reaction
with TaqMan® hydrolysis probes. A set of previously described primers and
probes have been tested to evaluate efficiency, sensitivity and reproducibility. The
target efficiency range was 91.4% with linearity ranging from 10-106
copies/reaction and a limit of detection of five copies/reaction or 250 copies/mL of
plasma. The qPCR assay developed in the present study was simple, rapid and
sensitive, allowing the detection of a wide range of HHV-6 loads. In conclusion, this
test may be useful as a practical tool to help elucidate the clinical relevance of
HHV-6 infection and reactivation in different scenarios and to determine the need for
surveillance.
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Affiliation(s)
| | | | - Juliana M Real
- Centro de Oncologia, Instituto de Ensino e Pesquisa, Hospital Sírio Libanês, São Paulo, SP, Brasil
| | | | | | | | | | - Yana Novis
- Centro de Oncologia, Instituto de Ensino e Pesquisa, Hospital Sírio Libanês, São Paulo, SP, Brasil
| | - Vanderson Rocha
- Centro de Oncologia, Instituto de Ensino e Pesquisa, Hospital Sírio Libanês, São Paulo, SP, Brasil
| | - Adriana Seber
- Instituto de Oncologia Pediátrica, São Paulo, SP, Brasil
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30
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Agut H, Bonnafous P, Gautheret-Dejean A. Laboratory and clinical aspects of human herpesvirus 6 infections. Clin Microbiol Rev 2015; 28:313-35. [PMID: 25762531 PMCID: PMC4402955 DOI: 10.1128/cmr.00122-14] [Citation(s) in RCA: 182] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Human herpesvirus 6 (HHV-6) is a widespread betaherpesvirus which is genetically related to human cytomegalovirus (HCMV) and now encompasses two different species: HHV-6A and HHV-6B. HHV-6 exhibits a wide cell tropism in vivo and, like other herpesviruses, induces a lifelong latent infection in humans. As a noticeable difference with respect to other human herpesviruses, genomic HHV-6 DNA is covalently integrated into the subtelomeric region of cell chromosomes (ciHHV-6) in about 1% of the general population. Although it is infrequent, this may be a confounding factor for the diagnosis of active viral infection. The diagnosis of HHV-6 infection is performed by both serologic and direct methods. The most prominent technique is the quantification of viral DNA in blood, other body fluids, and organs by means of real-time PCR. Many active HHV-6 infections, corresponding to primary infections, reactivations, or exogenous reinfections, are asymptomatic. However, the virus may be the cause of serious diseases, particularly in immunocompromised individuals. As emblematic examples of HHV-6 pathogenicity, exanthema subitum, a benign disease of infancy, is associated with primary infection, whereas further virus reactivations can induce severe encephalitis cases, particularly in hematopoietic stem cell transplant recipients. Generally speaking, the formal demonstration of the causative role of HHV-6 in many acute and chronic human diseases is difficult due to the ubiquitous nature of the virus, chronicity of infection, existence of two distinct species, and limitations of current investigational tools. The antiviral compounds ganciclovir, foscarnet, and cidofovir are effective against active HHV-6 infections, but the indications for treatment, as well as the conditions of drug administration, are not formally approved to date. 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.
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Affiliation(s)
- Henri Agut
- Sorbonne Universités, UPMC, CIMI-Paris UMRS CR7, PVI Team, Paris, France INSERM, CIMI-Paris U1135, PVI Team, Paris, France AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Service de Virologie, Paris, France
| | - Pascale Bonnafous
- Sorbonne Universités, UPMC, CIMI-Paris UMRS CR7, PVI Team, Paris, France INSERM, CIMI-Paris U1135, PVI Team, Paris, France
| | - Agnès Gautheret-Dejean
- Sorbonne Universités, UPMC, CIMI-Paris UMRS CR7, PVI Team, Paris, France INSERM, CIMI-Paris U1135, PVI Team, Paris, France AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Service de Virologie, Paris, France Université René Descartes, Faculté de Pharmacie, Laboratoire de Microbiologie UPRES EA 4065, Paris, France
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31
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Dytrych P, Krol P, Kotrova M, Kuzilkova D, Hubacek P, Krol L, Katra R, Hrusak O, Kabelka Z, Dolezalova P, Kalina T, Fronkova E. Polyclonal, newly derived T cells with low expression of inhibitory molecule PD-1 in tonsils define the phenotype of lymphocytes in children with Periodic Fever, Aphtous Stomatitis, Pharyngitis and Adenitis (PFAPA) syndrome. Mol Immunol 2015; 65:139-47. [PMID: 25656804 DOI: 10.1016/j.molimm.2015.01.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 12/15/2014] [Accepted: 01/08/2015] [Indexed: 01/30/2023]
Abstract
PURPOSE PFAPA syndrome is a benign, recurrent inflammatory disease of childhood. Tonsillectomy is one of the therapeutic options with a yet unexplained biological mechanism. We tested whether specific lymphocyte subsets recruited from blood to human tonsils participate in PFAPA pathogenesis. METHODS Paired tonsils/peripheral blood (PB) samples were investigated (a) from children with PFAPA that successfully resolved after tonsillectomy (n=10) (b) from children with obstructive sleep apnoea syndrome as controls (n=10). The lymphocyte profiles were analysed using 8-colour flow cytometry, immunoglobulin (IGH) and T-cell receptor (TCR) gene rearrangements via PCR and next generation sequencing; a TREC/KREC analysis was performed using qPCR. RESULTS The PFAPA tonsils in the asymptomatic phase had a lower percentage of B-lymphocytes than controls; T-lymphocyte counts were significantly higher in PB. The percentages of cytotoxic CD8pos T-lymphocytes were approximately 2-fold higher in PFAPA tonsils; the transitional B cells and naïve stages of both the CD4pos and CD8pos T-lymphocytes with a low expression of PD-1 molecule and high numbers of TREC were also increased. With the exception of elevated plasmablasts, no other differences were significant in PB. The expression levels of CXCL10, CXCL9 and CCL19 genes were significantly higher in PFAPA tonsils. The IGH/TCR pattern showed no clonal/oligoclonal expansion. DNA from the Epstein-Barr virus, Human Herpervirus-6 or adenovirus was detected in 7 of 10 PFAPA tonsils but also in 7 of 9 controls. CONCLUSIONS Our findings suggest that the uninhibited, polyclonal response of newly derived lymphocytes participate in the pathogenesis of PFAPA. Because most of the observed changes were restricted to tonsils and were not present in PB, they partly explain the therapeutic success of tonsillectomy in PFAPA syndrome.
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MESH Headings
- Adenoviridae/genetics
- Adenoviridae/isolation & purification
- B-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/immunology
- Chemokine CCL19/biosynthesis
- Chemokine CXCL10/biosynthesis
- Chemokine CXCL9/biosynthesis
- Child
- Child, Preschool
- Female
- Fever of Unknown Origin/complications
- Fever of Unknown Origin/immunology
- Fever of Unknown Origin/surgery
- Herpesvirus 4, Human/genetics
- Herpesvirus 4, Human/isolation & purification
- Herpesvirus 6, Human/genetics
- Herpesvirus 6, Human/isolation & purification
- Humans
- Infant
- Lymphadenitis/complications
- Lymphadenitis/immunology
- Lymphadenitis/surgery
- Lymphocyte Count
- Male
- Palatine Tonsil/cytology
- Palatine Tonsil/immunology
- Palatine Tonsil/surgery
- Pharyngitis/complications
- Pharyngitis/immunology
- Pharyngitis/surgery
- Programmed Cell Death 1 Receptor/biosynthesis
- Receptors, Antigen, T-Cell/genetics
- Sleep Apnea, Obstructive/immunology
- Sleep Apnea, Obstructive/surgery
- Stomatitis, Aphthous/complications
- Stomatitis, Aphthous/immunology
- Stomatitis, Aphthous/surgery
- T-Lymphocyte Subsets/immunology
- Tonsillectomy
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Affiliation(s)
- Petra Dytrych
- Department of ENT, Charles University, 2nd Faculty of Medicine, Charles University Prague and University Hospital Motol, Czech Republic
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32
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Messacar K, Breazeale G, Wei Q, Robinson CC, Dominguez SR. Epidemiology and clinical characteristics of infants with human parechovirus or human herpes virus-6 detected in cerebrospinal fluid tested for enterovirus or herpes simplex virus. J Med Virol 2015; 87:829-35. [PMID: 25650069 DOI: 10.1002/jmv.24119] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2014] [Indexed: 11/06/2022]
Abstract
Human parechovirus (HPeV) and human herpes virus-6 (HHV-6) are acquired commonly in infancy and associated with central nervous system infection. The prevalence of HPeV and HHV-6 in the cerebrospinal fluid (CSF) of infants tested for enterovirus (EV) and herpes-simplex virus (HSV) is unknown. All stored CSF samples from EV or HSV testing in infants less than 6 months of age at Children's Hospital Colorado between January 1, 2010 and December 31, 2011 were tested for HPeV, HHV-6, EV, and HSV by PCR. Clinical characteristics and epidemiological data were collected using retrospective electronic chart review. Of 239 infants tested, 29 cases of EV (12.1%), 7 cases of HPeV (2.9%), 5 cases of HHV-6 (2.1%), and 5 cases of HSV (2.1%) were identified with no bacterial co-infections. HPeV cases occurred between July and October in infants with median age of 24 days. Infants with HPeV had a median maximum temperature of 39 °C, median fever duration of 3 days and median peripheral white blood cell count of 5.2 × 10(3)/μL. HHV-6 cases occurred in infants with median age of 61 days without seasonality. Five percent of infants less than 6 months of age undergoing testing for EV or HSV have HPeV or HHV-6 in the CSF. Targeting testing of HPeV towards febrile infants less than 2 months of age with leukopenia in the late summer to early fall, and HHV-6 towards older infants may increase diagnostic yield. The clinical and fiscal impact of testing infants for HPeV and HHV-6 needs to be determined.
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Affiliation(s)
- Kevin Messacar
- Department of Pediatrics, Section of Hospital Medicine and Infectious Diseases, Aurora, Colorado; Department of Pathology and Laboratory Medicine, Aurora, Colorado
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33
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Prevalence of herpesviruses at onset of idiopathic nephrotic syndrome. Pediatr Nephrol 2014; 29:2325-31. [PMID: 24899237 DOI: 10.1007/s00467-014-2860-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 04/15/2014] [Accepted: 05/14/2014] [Indexed: 01/15/2023]
Abstract
BACKGROUND Idiopathic nephrotic syndrome (INS) is likely a primary immune disorder, but viruses might also be involved in the mechanisms of the disease. Here, we investigate the link between herpesvirus infection and the first manifestation of INS in children. METHODS A prospective, multicentre, and population-based case-control study called NEPHROVIR included 164 patients, aged 6 months to 15 years old, newly diagnosed with INS, and 233 controls matched for gender, age, and period of sample. The analysis was done on 124 patients and 196 controls. Epstein-Barr virus (EBV), cytomegalovirus (CMV), human herpesvirus-6 (HHV-6), and human herpesvirus-7 (HHV-7) DNA prevalence at diagnosis were assessed from whole peripheral blood samples, as well as EBV and CMV viral load and seroprevalence. RESULTS EBV DNA was significantly more prevalent in cases than in controls (50.8 vs 29.1 %; OR = 2.6; p = 0.0002), with no difference in viral load. A significant difference was also found for CMV (11.3 vs 3.6 %; p = 0.02) and HHV-7 (83 vs 72 %; p = 0.02) DNA prevalence between cases and controls. There were significantly more EBV and CMV recent infections or reactivations based on VCA-IgM and CMV IgM in cases than controls, while there were no differences in IgG seroprevalence. CONCLUSION The prevalence of positive EBV DNA detection and recent infection or reactivation is higher in children at onset of INS compared to a population matched for age, gender, and time of sampling.
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34
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Mészáros B, Sápy T, Gergely L, Csoma E. Prevalence of human herpesvirus 6A and 6B during pregnancy. Acta Microbiol Immunol Hung 2014; 61:309-16. [PMID: 25102917 DOI: 10.1556/amicr.61.2014.3.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The aim of the present study was to assess the frequency of human herpesvirus 6A (HHV-6A) and human herpesvirus 6B (HHV-6B) infection during pregnancy. 100-100 blood samples were collected from pregnant and non-pregnant women, then nucleic acid was isolated from both plasma and leukocytes fraction. Nested and real-time PCR were used to detect and differentiate HHV-6A and HHV-6B DNA and to determine viral loads. Reverse transcription PCR (RT-PCR) for HHV-6 U79/80 mRNA was performed in order to reveal active HHV-6 replication.HHV-6A and HHV-6B active infections were not detected in blood samples neither from pregnant nor from non-pregnant women. Frequency of HHV-6B and HHV-6A latency did not show difference between the studied groups (15% vs. 16%). HHV-6B latency was dominant in both studied groups (14/15 and 15/16). Beside these results, in leukocyte samples of one pregnant and three non-pregnant women high HHV-6A viral loads (1.28 × 10⁵ - 5.07 × 10⁵ GEq / 1.5 × 10⁶ leukocytes) were detected, and viral DNA was also found in plasma samples. Although RT-PCR did not confirm virus replication, but chromosomal integration was also not proved unequivocally, the number of 0.08-0.33 HHV-6 copy / 1 leukocyte refers more to postnatal infection.
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Affiliation(s)
- Beáta Mészáros
- 1 University of Debrecen Department of Medical Microbiology Debrecen Hungary
| | - Tamás Sápy
- 2 University of Debrecen Department of Obstetrics and Gynaecology Debrecen Hungary
| | - Lajos Gergely
- 1 University of Debrecen Department of Medical Microbiology Debrecen Hungary
| | - Eszter Csoma
- 1 University of Debrecen Department of Medical Microbiology Debrecen Hungary
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Nefzi F, Ben Salem NA, Khelif A, Feki S, Aouni M, Gautheret-Dejean A. Quantitative analysis of human herpesvirus-6 and human cytomegalovirus in blood and saliva from patients with acute leukemia. J Med Virol 2014; 87:451-60. [PMID: 25163462 DOI: 10.1002/jmv.24059] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2014] [Indexed: 01/24/2023]
Abstract
Human herpesvirus-6 (HHV-6) and human cytomegalovirus (HCMV) DNAs were quantified by real-time PCR assays in blood and saliva obtained from 50 patients with acute leukemia at the time of diagnosis (50 of each matrix), aplasia (65 of each matrix), remission (55 of each matrix), and relapse (20 of each matrix) to evaluate which biological matrix was more suitable to identify a viral reactivation, search for a possible link between HHV-6 and HCMV reactivations, and evaluate the relations between viral loads and count of different leukocyte types in blood. The median HHV-6 loads were 136; 219; 226, and 75 copies/million cells in blood at diagnosis, aplasia, remission and relapse, respectively. The HCMV loads were 193 and 317 copies/million cells in blood at diagnosis and remission. In the saliva samples, the HHV-6 loads were 22,165; 15,238; 30,214, and 17,454 copies/million cells at diagnosis, aplasia, remission, and relapse, respectively. The HCMV loads were 8,991; 1,461; 2,980, and 4,283 copies/million cells at diagnosis, aplasia, remission, and relapse, respectively. The HHV-6 load in the blood was correlated to the counts of polymorphonuclear leukocytes (R(2) = 0.5; P < 0.0001) and lymphocytes (R(2) = 0.4; P = 0.001) and was not correlated to the monocyte counts (R(2) = 0.07; P = 0.7). Saliva appears to be a more sensitive biological matrix than whole blood in the detection of HHV-6 or HCMV reactivations. The HHV-6 and HCMV reactivations were linked only in saliva.
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Affiliation(s)
- Faten Nefzi
- Laboratory of Infectious Diseases and Biological Agents, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
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Godet AN, Soignon G, Koubi H, Bonnafous P, Agut H, Poirot C, Gautheret-Dejean A. Presence of HHV-6 genome in spermatozoa in a context of couples with low fertility: what type of infection? Andrologia 2014; 47:531-5. [PMID: 24846813 DOI: 10.1111/and.12299] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2014] [Indexed: 01/11/2023] Open
Abstract
Human herpesvirus-6 (HHV-6) is a betaherpesvirus whose genome may integrate into human chromosomes. Chromosomally integrated HHV-6 (ciHHV-6) may be transmitted vertically from parents to children. HHV-6 DNA has been detected in semen, but its integrated or extrachromosomal status has not yet been characterised. The aim of this study was to determine the prevalence of HHV-6 DNA and to search for ciHHV-6 forms in spermatozoa purified from semen obtained from subjects explored for low fertility. A total of 184 sperm samples were purified using PureSperm(®) . HHV-6 viral load and species identification were performed by real-time polymerase chain reaction. Of 179 sperm specimens analysed, three were positive for HHV-6 (1.7%). Two samples (1.1%) had viral loads of 680 232 and 2 834 075 copies per million spermatozoa, compatible with loads expected for a ciHHV-6 form. The viral load of the third positive sample (73 684 copies per million spermatozoa) was lower than would be expected for ciHHV-6 infection, implying that the HHV-6 DNA detected in spermatozoa corresponds mainly to ciHHV-6. However, viral DNA may also be detected at a low level that is not in favour of the presence of ciHHV-6. Further studies are necessary to determine the origin of detected viral genomes.
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Affiliation(s)
- A N Godet
- Persistant Viral Infections Team, INSERM U1135, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Université Pierre et Marie Curie, Univ Paris 06, Paris, France
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Abstract
PURPOSE OF REVIEW This article summarizes the current state of the epidemiology, diagnosis, and management of human herpesvirus 6 (HHV-6) infection after solid organ transplantation. RECENT FINDINGS HHV-6 reactivates commonly during the early weeks after solid organ transplantation. However, disease due to HHV-6 is uncommon and is manifested as a febrile illness associated with rash and tissue-invasive manifestations such as encephalitis, hepatitis, pneumonitis, and gastrointestinal disease. HHV-6 has also been indirectly associated with other opportunistic infections such as cytomegalovirus and fungal infections. Molecular tests such as PCR assays are preferred methods for the diagnosis of HHV-6 infection. Recent guideline from the American Society of Transplantation Infectious Disease Community of Practice does not recommend specific antiviral prophylaxis or preemptive therapy for HHV-6 infection. For established disease, intravenous ganciclovir and foscarnet are considered first-line agents. SUMMARY Infection due to HHV-6 is a common after transplantation, but clinical disease is rare. Nonetheless, this infection has been indirectly associated with poor allograft and patient survival after transplantation. No specific prevention strategy is recommended, but treatment of established HHV-6 disease consists of antiviral therapy with intravenous ganciclovir and/or foscarnet, and reduction in immunosuppression.
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Al Fawaz T, Ng V, Richardson SE, Barton M, Allen U. Clinical consequences of human herpesvirus-6 DNAemia in peripheral blood in pediatric liver transplant recipients. Pediatr Transplant 2014; 18:47-51. [PMID: 24384048 DOI: 10.1111/petr.12176] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/16/2013] [Indexed: 01/20/2023]
Abstract
The significance of HHV6 DNAemia after solid organ transplantation has not been fully determined. Our objectives were to determine the prevalence of HHV6 DNAemia in pediatric liver transplant recipients and to describe the associated clinical characteristics and outcomes. This was a retrospective case-control study. Eligible liver transplant patients aged ≤ 18 yr with HHV6 DNAemia were matched with two subjects without HHV6 DNAemia. Matching was by age ± 6 months. Among 154 subjects, 25 patients (16%) had HHV6 DNAemia detected by PCR in whole blood or plasma (M:F ratio = 0.9:1). While 28% of subjects with DNAemia (7/25) had symptoms consistent with HHV6 infection, active infection was detected in only four subjects (2.6% of liver transplant patients). The major symptoms/signs were fever, vomiting, lethargy, splenomegaly, bone marrow suppression, and elevated transaminases. The prevalence of DNAemia due to other herpesviruses in cases vs. controls was EBV 56% vs. 60%, CMV 12% vs. 12%, HHV7 20% vs. 12%; p value is not significant for all pairwise comparisons. HHV6 DNAemia in pediatric liver transplant patients is not an uncommon entity. While the clinical relevance is still not entirely established, active HHV6 infection and attributable symptoms are relatively rare.
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Affiliation(s)
- Tariq Al Fawaz
- Division of Infectious Diseases, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Affiliation(s)
- Joshua A Hill
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA.
| | - Nagagopal Venna
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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Frequency of chromosomally-integrated human herpesvirus 6 in children with acute lymphoblastic leukemia. PLoS One 2013; 8:e84322. [PMID: 24386368 PMCID: PMC3873412 DOI: 10.1371/journal.pone.0084322] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 11/19/2013] [Indexed: 01/15/2023] Open
Abstract
Introduction Human herpesvirus 6 (HHV-6) is a ubiquitous pathogen infecting nearly 100% of the human population. Of these individuals, between 0.2% and 1% of them carry chromosomally-integrated HHV-6 (ciHHV-6). The biological consequences of chromosomal integration by HHV-6 remain unknown. Objective To determine and compare the frequency of ciHHV-6 in children with acute lymphoblastic leukemia to healthy blood donors. Methodology A total of 293 DNA samples from children with pre-B (n = 255), pre-pre-B (n = 4), pre-T (n = 26) and undetermined (n = 8) leukemia were analyzed for ciHHV-6 by quantitative TaqMan PCR (QPCR) using HHV-6 specific primers and probe. As control, DNA samples from 288 healthy individuals were used. Primers and probe specific to the cellular GAPDH gene were used to estimate integrity and DNA content. Results Out of 293 DNA samples from the leukemic cohort, 287 contained amplifiable DNA. Of these, only 1 (0.35%) contained ciHHV-6. Variant typing indicates that the ci-HHV-6 corresponds to variant A. None of the 288 DNA samples from healthy individuals contained ciHHV-6. Conclusion The frequency of ciHHV-6 in children with acute lymphoblastic leukemia is similar (p = 0.5) to that of healthy individuals. These results suggest that acute lymphoblastic leukemia does not originate as a consequence to integration of HHV-6 within the chromosomes.
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Kamijima M, Wang H, Yamanoshita O, Ito Y, Xia L, Yanagiba Y, Chen C, Okamura A, Huang Z, Qiu X, Song X, Cai T, Liu L, Ge Y, Deng Y, Naito H, Yoshikawa T, Tohyama M, Li L, Huang H, Nakajima T. Occupational trichloroethylene hypersensitivity syndrome: Human herpesvirus 6 reactivation and rash phenotypes. J Dermatol Sci 2013; 72:218-24. [DOI: 10.1016/j.jdermsci.2013.07.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 07/08/2013] [Accepted: 07/10/2013] [Indexed: 02/05/2023]
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Virological diagnosis of central nervous system infections by use of PCR coupled with mass spectrometry analysis of cerebrospinal fluid samples. J Clin Microbiol 2013; 52:212-7. [PMID: 24197874 DOI: 10.1128/jcm.02270-13] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Viruses are the leading cause of central nervous system (CNS) infections, ahead of bacteria, parasites, and fungal agents. A rapid and comprehensive virologic diagnostic testing method is needed to improve the therapeutic management of hospitalized pediatric or adult patients. In this study, we assessed the clinical performance of PCR amplification coupled with electrospray ionization-time of flight mass spectrometry analysis (PCR-MS) for the diagnosis of viral CNS infections. Three hundred twenty-seven cerebrospinal fluid (CSF) samples prospectively tested by routine PCR assays between 2004 and 2012 in two university hospital centers (Toulouse and Reims, France) were retrospectively analyzed by PCR-MS analysis using primers targeted to adenovirus, human herpesviruses 1 to 8 (HHV-1 to -8), polyomaviruses BK and JC, parvovirus B19, and enteroviruses (EV). PCR-MS detected single or multiple virus infections in 190 (83%) of the 229 samples that tested positive by routine PCR analysis and in 10 (10.2%) of the 98 samples that tested negative. The PCR-MS results correlated well with herpes simplex virus 1 (HSV-1), varicella-zoster virus (VZV), and EV detection by routine PCR assays (kappa values [95% confidence intervals], 0.80 [0.69 to 0.92], 0.85 [0.71 to 0.98], and 0.84 [0.78 to 0.90], respectively), whereas a weak correlation was observed with Epstein-Barr virus (EBV) (0.34 [0.10 to 0.58]). Twenty-six coinfections and 16 instances of uncommon neurotropic viruses (HHV-7 [n = 13], parvovirus B19 [n = 2], and adenovirus [n = 1]) were identified by the PCR-MS analysis, whereas only 4 coinfections had been prospectively evidenced using routine PCR assays (P < 0.01). In conclusion, our results demonstrated that PCR-MS analysis is a valuable tool to identify common neurotropic viruses in CSF (with, however, limitations that were identified regarding EBV and EV detection) and may be of major interest in better understanding the clinical impact of multiple or neglected viral neurological infections.
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Human herpesvirus 6A infection and immunopathogenesis in humanized Rag2⁻/⁻ γc⁻/⁻ mice. J Virol 2013; 87:12020-8. [PMID: 24006442 DOI: 10.1128/jvi.01556-13] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Although serious human diseases have been correlated with human herpesvirus 6A (HHV-6A) and HHV-6B, the lack of animal models has prevented studies which would more definitively link these viral infections to disease. HHV-6A and HHV-6B have recently been classified as two distinct viruses, and in this study we focused specifically on developing an in vivo model for HHV-6A. Here we show that Rag2⁻/⁻γc⁻/⁻ mice humanized with cord blood-derived human hematopoietic stem cells produce human T cells that express the major HHV-6A receptor, CD46. Both cell-associated and cell-free viral transmission of HHV-6A into the peritoneal cavity resulted in detectable viral DNA in at least one of the samples (blood, bone marrow, etc.) analyzed from nearly all engrafted mice. Organs and cells positive for HHV-6A DNA were the plasma and cellular blood fractions, bone marrow, lymph node, and thymic samples; control mice had undetectable viral DNA. We also noted viral pathogenic effects on certain T cell populations. Specific thymocyte populations, including CD3⁻ CD4⁺ CD8⁻ and CD3⁺ CD4⁻ cells, were significantly modified in humanized mice infected by cell-associated transmission. In addition, we detected significantly increased proportions of CD4⁺ CD8⁺ cells in the blood of animals infected by cell-free transmission. These findings provide additional evidence that HHV-6A may play a role in human immunodeficiencies. These results indicate that humanized mice can be used to study HHV-6A in vivo infection and replication as well as aspects of viral pathogenesis.
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Buyse S, Roque-Afonso AM, Vaghefi P, Gigou M, Dussaix E, Duclos-Vallée JC, Samuel D, Guettier C. Acute hepatitis with periportal confluent necrosis associated with human herpesvirus 6 infection in liver transplant patients. Am J Clin Pathol 2013; 140:403-9. [PMID: 23955460 DOI: 10.1309/ajcp0fwi2xahecbj] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To correlate human herpesvirus 6 (HHV-6) viral load with pathologic features in graft acute hepatitis of unknown origin. METHODS Liver frozen samples from 26 patients with graft hepatitis of unknown origin were available for HHV-6 DNA quantification. RESULTS In 10 (38.5%) of 26 liver samples, HHV-6 DNA was detectable, with a median viral load of 3.84 log10 copies/10⁶ cells. Confluent periportal necrosis was observed in 4 of 10 patients and associated with high viral load. These 4 patients responded to antiviral therapy. Mild unspecific hepatitis was observed in 4 patients with low intragraft viral load and in 2 patients with high viral load in a context of deep immunosuppression. Patients with HHV-6-negative graft hepatitis disclosed lobular necrotico-inflammatory activity without periportal necrosis. CONCLUSIONS Our study provides data supporting the pathogenic role of HHV-6 for liver allografts. The presence of confluent periportal necrosis could be a clue for prompt diagnosis of HHV-6-induced graft hepatitis.
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Affiliation(s)
- Sophie Buyse
- AP-HP, Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France
| | - Anne-Marie Roque-Afonso
- AP-HP, Hôpital Paul Brousse, Virology, Villejuif, France
- INSERM U785, Villejuif, France
- Univ Paris-Sud, UMR-S 785, Villejuif, France
| | | | - Michèle Gigou
- INSERM U785, Villejuif, France
- Univ Paris-Sud, UMR-S 785, Villejuif, France
| | - Elisabeth Dussaix
- AP-HP, Hôpital Paul Brousse, Virology, Villejuif, France
- INSERM U785, Villejuif, France
- Univ Paris-Sud, UMR-S 785, Villejuif, France
| | - Jean-Charles Duclos-Vallée
- AP-HP, Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France
- INSERM U785, Villejuif, France
- Univ Paris-Sud, UMR-S 785, Villejuif, France
| | - Didier Samuel
- AP-HP, Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France
- INSERM U785, Villejuif, France
- Univ Paris-Sud, UMR-S 785, Villejuif, France
| | - Catherine Guettier
- INSERM U785, Villejuif, France
- Univ Paris-Sud, UMR-S 785, Villejuif, France
- AP-HP, Hôpital Paul Brousse, Pathology, Villejuif, France
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Desmons A, Terrade C, Boulagnon C, Giusti D, Nguyen Y, Andreoletti L, Fornes P, Digeon B, Leveque N. Post-mortem diagnosis, of cytomegalovirus and varicella zoster virus co-infection by combined histology and tissue molecular biology, in a sudden unexplained infant death. J Clin Virol 2013; 58:486-9. [PMID: 24001883 PMCID: PMC7128706 DOI: 10.1016/j.jcv.2013.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 07/23/2013] [Accepted: 08/05/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND An autopsy case of a two-month-old male infant who suddenly and unexpectedly died during his sleep, eight days after the onset of benign varicella. OBJECTIVES To describe post-mortem combined histological and tissue molecular biological techniques for the diagnosis of cytomegalovirus and varicella zoster virus co-infection as a cause of death. STUDY DESIGN Real-time quantitative PCR and RT-PCR assays for Herpesviruses, respiratory viruses, Adenovirus, Enterovirus and Parvovirus B19 were performed on multi-organ frozen samples and paraffin-embedded tissues in combination with histology. RESULTS Cytomegalovirus and varicella zoster virus were detected by molecular biology with highest viral loads detected in the lungs (4.6×10(7) and 1.9×10(5) genome copies per million of cells, respectively). Pulmonary extensive necrotizing inflammation and immunohistochemistry correlated to virological data. Virological molecular biology was negative on paraffin-embedded tissues. CONCLUSIONS This case shows that thorough quantitative virological investigations on frozen tissues must be performed in combination with histology and immunohistochemistry for the determination of the cause of a sudden unexplained infant death.
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Affiliation(s)
- Aurore Desmons
- Clinical and Molecular Virology Unit, University Hospital, Reims, France; EA-4684 Cardiovir SFR-CAP Sante, Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France
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Bounaadja L, Piret J, Goyette N, Boivin G. Analysis of HHV-6 mutations in solid organ transplant recipients at the onset of cytomegalovirus disease and following treatment with intravenous ganciclovir or oral valganciclovir. J Clin Virol 2013; 58:279-82. [PMID: 23871165 DOI: 10.1016/j.jcv.2013.06.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 06/06/2013] [Accepted: 06/17/2013] [Indexed: 01/26/2023]
Abstract
BACKGROUND Human herpesvirus 6 (HHV-6) and human cytomegalovirus (HCMV) are major opportunistic pathogens in solid organ transplant (SOT) recipients. The use of antivirals for the treatment of HCMV disease can result in the development of drug resistance mutations in HCMV and also potentially in HHV-6. OBJECTIVES The emergence of HHV-6 drug resistance mutations was evaluated in SOT recipients at the onset of HCMV disease and following treatment with ganciclovir (GCV) or valganciclovir (VGCV). STUDY DESIGN Detection of HHV-6 was performed by real-time PCR from whole blood samples serially obtained from SOT recipients treated for HCMV disease with an induction dose of intravenous GCV or oral VGCV for 21 days followed by VGCV maintenance for 28 days in both arms. Baseline and last positive HHV-6 samples were tested for mutations in the genes encoding the protein kinase (U69) and the DNA polymerase (U38). RESULTS The rate of HHV-6 viraemia among SOT patients with HCMV disease at baseline was 3.2% (5/155). All isolates belonged to the HHV-6B species. Mutations L213I and Y479H were detected at baseline and at later times in the U69 kinase. Mutation L213I was previously reported as polymorphism whereas the role of mutation Y479H in drug resistance is unknown. Mutations D854E and E855Q found in the DNA polymerase were known as natural variants. CONCLUSIONS The incidence of HHV-6 viraemia in SOT recipients with established HCMV disease before initiation of antiviral therapy was low. Treatment with GCV or VGCV did not induce the emergence of HHV-6 drug resistance mutations.
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Affiliation(s)
- Lotfi Bounaadja
- Infectious Diseases Research Center of the CHU of Québec, and Laval University, Quebec City, Quebec, Canada G1V 4G2
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Porignaux R, Vuiblet V, Barbe C, Nguyen Y, Lavaud S, Toupance O, Andréoletti L, Rieu P, Lévêque N. Frequent occurrence of parvovirus B19 DNAemia in the first year after kidney transplantation. J Med Virol 2013; 85:1115-21. [DOI: 10.1002/jmv.23557] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2013] [Indexed: 12/11/2022]
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Tang YW. Laboratory diagnosis of CNS infections by molecular amplification techniques. ACTA ACUST UNITED AC 2013; 1:489-509. [PMID: 23496356 DOI: 10.1517/17530059.1.4.489] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The initial presentation of symptoms and clinical manifestations of CNS infectious diseases often makes a specific diagnosis difficult and uncertain, and the emergence of polymerase chain reaction-led molecular techniques have been used in improving organism-specific diagnosis. These techniques have not only provided rapid, non-invasive detection of microorganisms causing CNS infections, but also demonstrated several neurologic disorders linked to infectious pathogens. Molecular methods performed on cerebrospinal fluid are recognized as the new 'gold standard' for some of these infections caused by microorganisms that are difficult to detect and identify. Although molecular techniques are predicted to be widely used in diagnosing and monitoring CNS infections, the limitations as well as strengths of these techniques must be clearly understood by both clinicians and laboratory personnel.
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Affiliation(s)
- Yi-Wei Tang
- Vanderbilt University Medical Center, 4605 TVC, Nashville, TN 37232-5310, USA +1 615 322 2035 ; +1 615 343 8420 ;
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Evaluation of Epstein-Barr virus, human herpesvirus 6 (HHV-6), and HHV-8 antiviral drug susceptibilities by use of real-time-PCR-based assays. J Clin Microbiol 2013; 51:1244-6. [PMID: 23325820 DOI: 10.1128/jcm.03234-12] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Evaluation of candidate antiviral drugs against Epstein-Barr virus (EBV), human herpesvirus 6 (HHV-6), and HHV-8 is hampered by the lack of convenient laboratory assays. We developed real-time quantitative PCR assays performed on supernatants of lymphoma cell lines and determined the 50% inhibitory concentrations (IC50s) of nucleoside, nucleotide, and pyrophosphate analogues against these herpesviruses.
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