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Risk factors and outcome of concurrent and sequential multiviral cytomegalovirus, Epstein-Barr virus, BK virus, adenovirus and other viral reactivations in transplantation. Curr Opin Infect Dis 2022; 35:536-544. [PMID: 36255049 DOI: 10.1097/qco.0000000000000888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE OF REVIEW Reactivation of viral infections occurs frequently in immunosuppressed populations, particularly in solid organ (SOT) or allogeneic haematopoietic cell (HCT) transplant patients. Concurrent and sequential multivirus infections are common, yet risk factors and outcomes remain unclear. This review aims to identify the patients vulnerable to multivirus infections and characterize the impact of increased viral burden to formulate prevention and treatment strategies. RECENT FINDINGS Incidences of up to 89% in SOT and 36% in HCT have been reported for two viruses, and 32% in SOT and 28% in HCT for at least three viruses. Risk factors appear related to an increased burden of immunosuppression, with most viral coinfections occurring within 12 months of transplantation. Direct viral complications such as cytomegalovirus disease are more frequent in coinfected patients, with documented prolonged duration of viraemia, higher viral load and increased end-organ disease. Graft dysfunction, acute rejection and graft-vs.-host disease (GVHD) have also been associated. Increased mortality is reported in the HCT population. SUMMARY Multivirus infections occur in a significant proportion of transplant patients and is linked to immunosuppressive burden. There is increasing evidence that this leads to worse graft and patient outcomes. Further prospective studies are required to further comprehensively characterise viral epidemiology, mechanisms and treatment strategies to ameliorate this risk.
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Martini F, Champagne E. The Contribution of Human Herpes Viruses to γδ T Cell Mobilisation in Co-Infections. Viruses 2021; 13:v13122372. [PMID: 34960641 PMCID: PMC8704314 DOI: 10.3390/v13122372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 12/12/2022] Open
Abstract
γδ T cells are activated in viral, bacterial and parasitic infections. Among viruses that promote γδ T cell mobilisation in humans, herpes viruses (HHVs) occupy a particular place since they infect the majority of the human population and persist indefinitely in the organism in a latent state. Thus, other infections should, in most instances, be considered co-infections, and the reactivation of HHV is a serious confounding factor in attributing γδ T cell alterations to a particular pathogen in human diseases. We review here the literature data on γδ T cell mobilisation in HHV infections and co-infections, and discuss the possible contribution of HHVs to γδ alterations observed in various infectious settings. As multiple infections seemingly mobilise overlapping γδ subsets, we also address the concept of possible cross-protection.
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Association of HHV-6 With Outcomes in CMV-seronegative Liver Transplant Recipients With CMV-seropositive Donors Receiving Preemptive Antiviral Therapy. Transplantation 2021; 105:2427-2434. [PMID: 33587431 DOI: 10.1097/tp.0000000000003604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Risk factors, virological parameters, and outcomes associated with HHV-6 viremia in high-risk donor CMV-seropositive and recipient CMV-seronegative (D+R-) liver transplant recipients in the current era are incompletely defined. METHODS The study population consisted of patients in the preemptive therapy (PET) arm of a randomized, controlled trial of PET versus valganciclovir prophylaxis for CMV prevention in D+R- liver transplant recipients. Weekly blood samples through 100 d in the PET group were tested for HHV-6 viremia using a real-time quantitative polymerase chain reaction. Assessments included virological characteristics and relationship with CMV, risk factors, and impact of HHV-6 viremia with outcomes through 12 mo posttransplant. RESULTS HHV-6 viremia at any level developed in 42% (40 of 96). Older patient age (P = 0.03), longer hospitalization (P = 0.015), and ICU stay at transplantation (P = 0.029) were significantly associated with high-grade viremia. Concurrent HHV-6 and CMV viremia was associated with earlier onset of HHV-6 viremia (P = 0.004), higher HHV-6 area under the curve (P = 0.043), and higher peak HHV-6 viral load (P = 0.006) versus HHV-6 viremia alone. High-grade viremia was independently associated with biopsy-proven rejection within 12 mo (P = 0.045) posttransplant. CONCLUSIONS Among D+R- liver transplant recipients receiving valganciclovir as PET, high-grade HHV-6 viremia was associated with increased age and critical illness in ICU at time of transplant and was independently associated with allograft rejection.
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Bella R, Dolci M, Ferraresso M, Ticozzi R, Ghio L, Rizzo J, Signorini L, Villani S, Elia F, Ferrante P, Delbue S. Human herpesvirus-6 and polyomaviruses DNAemia in children and young adult patients after kidney transplantation. Future Virol 2015. [DOI: 10.2217/fvl.15.98] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Aims: Human herpesvirus-6 (HHV-6) and polyomaviruses (HPyV) establish latency and reactivate in immunocompromised hosts. The prevalence of their infections was investigated in pediatric and young adult kidney transplant recipients. Materials & methods: Blood was obtained from 83 patients. Quantitative real-time polymerase chain reactions were conducted to quantify HHV-6 and HPyV loads; nested PCR and reverse transcriptase-PCR assays were conducted to differentiate HHV-6A from 6B and to evaluate the presence of transcripts. Results: HHV-6 and HPyV DNAemia were detected in 19.3 and 18.1% patients, respectively. No association between HHV-6 and HPyV DNA presence, age of patients and time from transplant was observed. Conclusion: HHV-6 infection in immunosuppression setting was as common as those of HPyVs that are commonly recognized as opportunistic agents.
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Affiliation(s)
- Ramona Bella
- Department of Biomedical, Surgical & Dental Sciences, University of Milan, Milan, Italy
| | - Maria Dolci
- Department of Biomedical, Surgical & Dental Sciences, University of Milan, Milan, Italy
| | - Mariano Ferraresso
- Department of Clinical Sciences & Community Health, University of Milan, Milan, Italy
- Division of Kidney Transplantation, Fondazione Ca’ Granda-Ospedale Maggiore IRCCS, Milan, Italy
| | - Rosalia Ticozzi
- Department of Biomedical, Surgical & Dental Sciences, University of Milan, Milan, Italy
| | - Luciana Ghio
- Division of Kidney Transplantation, Fondazione Ca’ Granda-Ospedale Maggiore IRCCS, Milan, Italy
- Nephrology, Dialysis & Transplantation Unit, Clinica Pediatrica De Marchi, Milan, Italy
| | - Jacopo Rizzo
- Department of Clinical Sciences & Community Health, University of Milan, Milan, Italy
| | - Lucia Signorini
- Department of Biomedical, Surgical & Dental Sciences, University of Milan, Milan, Italy
| | - Sonia Villani
- Department of Biomedical, Surgical & Dental Sciences, University of Milan, Milan, Italy
| | - Francesca Elia
- Department of Biomedical, Surgical & Dental Sciences, University of Milan, Milan, Italy
| | - Pasquale Ferrante
- Department of Biomedical, Surgical & Dental Sciences, University of Milan, Milan, Italy
| | - Serena Delbue
- Department of Biomedical, Surgical & Dental Sciences, University of Milan, Milan, Italy
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Coreactivation of Human Herpesvirus 6 and Cytomegalovirus Is Associated With Worse Clinical Outcome in Critically Ill Adults. Crit Care Med 2015; 43:1415-22. [PMID: 25821919 DOI: 10.1097/ccm.0000000000000969] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Human herpesvirus 6 is associated with a variety of complications in immunocompromised patients, but no studies have systematically and comprehensively assessed the impact of human herpesvirus 6 reactivation, and its interaction with cytomegalovirus, in ICU patients. DESIGN We prospectively assessed human herpesvirus 6 and cytomegalovirus viremia by twice-weekly plasma polymerase chain reaction in a longitudinal cohort study of 115 adult, immunocompetent ICU patients. The association of human herpesvirus 6 and cytomegalovirus reactivation with death or continued hospitalization by day 30 (primary endpoint) was assessed by multivariable logistic regression analyses. SETTING This study was performed in trauma, medical, surgical, and cardiac ICUs at two separate hospitals of a large tertiary care academic medical center. PATIENTS A total of 115 cytomegalovirus seropositive, immunocompetent adults with critical illness were enrolled in this study. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Human herpesvirus 6 viremia occurred in 23% of patients at a median of 10 days. Human herpesvirus 6B was the species detected in eight samples available for testing. Most patients with human herpesvirus 6 reactivation also reactivated cytomegalovirus (70%). Severity of illness was not associated with viral reactivation. Mechanical ventilation, burn ICU, major infection, human herpesvirus 6 reactivation, and cytomegalovirus reactivation were associated with the primary endpoint in unadjusted analyses. In a multivariable model adjusting for mechanical ventilation and ICU type, only coreactivation of human herpesvirus 6 and cytomegalovirus was significantly associated with the primary endpoint (adjusted odds ratio, 7.5; 95% CI, 1.9-29.9; p = 0.005) compared to patients with only human herpesvirus 6, only cytomegalovirus, or no viral reactivation. CONCLUSIONS Coreactivation of both human herpesvirus 6 and cytomegalovirus in ICU patients is associated with worse outcome than reactivation of either virus alone. Future studies should define the underlying mechanism(s) and determine whether prevention or treatment of viral reactivation improves clinical outcome.
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Gentile G, Antonelli G. Interplay between β herpesviruses and fungal infections in transplant patients: from the bench to the bedside. Future Virol 2015. [DOI: 10.2217/fvl.15.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
ABSTRACT The studies on the interplay between β-herpesviruses (CMV, human herpes viruses 6 and 7) and fungi in immunocompromised hosts, have demonstrated that a detailed knowledge of the interaction between the host and the above infectious agents may have a significant clinical relevance. β-herpesviruses may directly be associated to different pathological conditions and may indirectly be involved in the development of opportunistic infections (e.g., fungal infections), allograft rejection and decreased patient survival. Recent in vitro and in vivo studies have pointed out the importance of the microbiome, exposure to microbes and the innate immune system in determining the risk of developing infections; such microbial interactions may modulate the expression of the infection, change the microbial pathogenicity, or increase the immunosuppression.
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Affiliation(s)
- Giuseppe Gentile
- Department of Cellular Biotechnologies & Hematology, Rome, Italy
| | - Guido Antonelli
- Department of Molecular Medicine, Sapienza University, Rome, Italy
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Kühl U, Lassner D, Wallaschek N, Gross UM, Krueger GR, Seeberg B, Kaufer BB, Escher F, Poller W, Schultheiss HP. Chromosomally integrated human herpesvirus 6 in heart failure: prevalence and treatment. Eur J Heart Fail 2014; 17:9-19. [DOI: 10.1002/ejhf.194] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 08/25/2014] [Accepted: 08/28/2014] [Indexed: 11/10/2022] Open
Affiliation(s)
- Uwe Kühl
- Department of Cardiology & Pneumology, Campus Benjamin Franklin; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - Dirk Lassner
- Institut Kardiale Diagnostik und Therapie (IKDT); Berlin Germany
| | - Nina Wallaschek
- Institut für Virologie; Freie Universität Berlin; Berlin Germany
| | - Ulrich M. Gross
- Institut Kardiale Diagnostik und Therapie (IKDT); Berlin Germany
| | - Gerhard R.F. Krueger
- Department of Pathology& Laboratory Medicine; The University of Texas-Houston Medical School; Houston TX USA
| | - Bettina Seeberg
- Department of Cardiology & Pneumology, Campus Benjamin Franklin; Charité-Universitätsmedizin Berlin; Berlin Germany
| | | | - Felicitas Escher
- Department of Cardiology & Pneumology, Campus Benjamin Franklin; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - Wolfgang Poller
- Department of Cardiology & Pneumology, Campus Benjamin Franklin; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - Heinz-Peter Schultheiss
- Department of Cardiology & Pneumology, Campus Benjamin Franklin; Charité-Universitätsmedizin Berlin; Berlin Germany
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EBV, HCMV, HHV6, and HHV7 screening in bone marrow samples from children with acute lymphoblastic leukemia. BIOMED RESEARCH INTERNATIONAL 2014; 2014:548097. [PMID: 25309913 PMCID: PMC4189769 DOI: 10.1155/2014/548097] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 08/26/2014] [Accepted: 08/26/2014] [Indexed: 12/25/2022]
Abstract
Acute lymphoblastic leukemia (ALL) is the most common cancer in childhood worldwide and Mexico has reported one of the highest incidence rates. An infectious etiology has been suggested and supported by epidemiological evidences; however, the identity of the involved agent(s) is not known. We considered that early transmitted lymphotropic herpes viruses were good candidates, since transforming mechanisms have been described for them and some are already associated with human cancers. In this study we interrogated the direct role of EBV, HCMV, HHV6, and HHV7 human herpes viruses in childhood ALL. Viral genomes were screened in 70 bone marrow samples from ALL patients through standard and a more sensitive nested PCR. Positive samples were detected only by nested PCR indicating a low level of infection. Our result argues that viral genomes were not present in all leukemic cells, and, hence, infection most likely was not part of the initial genetic lesions leading to ALL. The high statistical power of the study suggested that these agents are not involved in the genesis of ALL in Mexican children. Additional analysis showed that detected infections or coinfections were not associated with prognosis.
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Le J, Gantt S. Human herpesvirus 6, 7 and 8 in solid organ transplantation. Am J Transplant 2013; 13 Suppl 4:128-37. [PMID: 23465006 DOI: 10.1111/ajt.12106] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- J Le
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
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Wolz MM, Sciallis GF, Pittelkow MR. Human herpesviruses 6, 7, and 8 from a dermatologic perspective. Mayo Clin Proc 2012; 87:1004-14. [PMID: 22819486 PMCID: PMC3538396 DOI: 10.1016/j.mayocp.2012.04.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 03/30/2012] [Accepted: 04/05/2012] [Indexed: 12/13/2022]
Abstract
Human herpesviruses (HHVs) have frequently been suspected as etiologic agents or cofactors in cutaneous disease. However, clearly established associations are rare. Investigations into an etiologic association between HHVs and cutaneous disease are complicated by the ubiquity and nearly universal prevalence of some herpesviruses. This article summarizes the associations between cutaneous disease and HHV-6, HHV-7, and HHV-8. In addition to a personal library of references, the PubMed database of biomedical literature was searched using the following Medical Subject Heading terms: HHV-6, HHV-7, and HHV-8, each in conjunction with cutaneous manifestations, virology, epidemiology, dermatopathology, and therapeutics, between 1998 and March 2011. Free-text searches with known or suspected disease associations were added for broader coverage. The results have been summarized to provide a practical review for the physician likely to encounter cutaneous diseases.
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Affiliation(s)
| | - Gabriel F. Sciallis
- Correspondence: Address to Gabriel F. Sciallis, MD, Division of Clinical Dermatology, Mayo Clinic, 200 First St SW, Rochester, MN 55905
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11
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Early HHV-6 replication is associated with morbidity non-related to CMV infection after kidney transplantation. Braz J Infect Dis 2012; 16:146-52. [PMID: 22552456 DOI: 10.1016/s1413-8670(12)70296-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 08/17/2011] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED Human herpesvirus type 6-(HHV-6) has been associated with morbidity after liver transplantation. OBJECTIVE The aim of this study was to determine the HHV-6 seroprevalence among donor-recipient pairs, analyze the incidence of early active infection, its clinical manifestation, interaction with CMV, and the related morbidity in the first year after kidney transplantation. METHODS 46 donor-recipient pairs had IgG evaluated by ELISA before transplantation: HHV-6(Pambio - USA) and CMV-(Roche - USA). A frozen whole blood sample collected weekly (from the 1st to the 6th week) was retrospectively tested for HHV-6 viral load (VL) determination by real time quantitative PCR (qPCR, Nanogen - Italy). Patients were preemptively surveyed for CMV by pp65 antigenemia (Ag, APAAP, immunohistochemistry, Biotest - Germany) from the 4th to the 12th week after transplantation. Active infection was defined as qPCR-HHV6+ (viral-load/mL-VL) and Ag+ (+cells/100.000 granulocytes), for HHV-6 and CMV, respectively. DCMV was defined as simultaneous positive antigenemia and suggestive signs/symptoms. Concerning +qPCR-HHV6, associated factors, clinical manifestation, interaction with CMV and morbidity were searched. RESULTS Pre-transplant HHV-6 seroprevalence was significantly higher among kidney recipients compared to their donors (82.6x54.8%; p = 0.005 [3.9 (1.4-10.4)]). Active infection by this virus occurred in 26.1% (12/46), with no association with previous IgG (p = 0.412). Median VL was 125 copies/mL (53-11.264), and the median Ag was 21 +cells (2-740). There was no association between HHV-6 and CMV activation after transplantation (p = 0.441), neither concerning DCMV (p = 0.596). Median highest Ag+ and days of ganciclovir treatment were similar between qPCR-HHV6 + or - (p = 0.206 and p = 0.124, respectively). qPCR-HHV6+ was associated with higher incidence of bacterial (p = 0.009) and fungal (p = 0.001) infections, and higher number (p = 0.001) of hospital admission and longer duration of hospitalization over the first 6 and 12 months post-transplantation (p = 0.033 and p = 0.001). CONCLUSION Latent HHV-6 infection is more common among recipients than donors before transplantation. Early active infection by this pathogen after transplantation does not increase DCMV incidence or severity during the first 3 months of follow-up. However, early HHV-6 replication is associated with other infections and hospitalizations in the first year.
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Lautenschlager I, Razonable RR. Human herpesvirus-6 infections in kidney, liver, lung, and heart transplantation: review. Transpl Int 2012; 25:493-502. [PMID: 22356254 DOI: 10.1111/j.1432-2277.2012.01443.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Human herpesvirus-6 (HHV-6), which comprises of HHV-6A and HHV-6B, is a common infection after solid organ transplantation. The rate of HHV-6 reactivation is high, although clinical disease is not common. Only 1% of transplant recipients will develop clinical illness associated with HHV-6 infection, and most are ascribable to HHV-6B. Fever, myelosuppression, and end-organ disease, including hepatitis and encephalitis, have been reported. HHV-6 has also been associated with various indirect effects, including a higher rate of CMV disease, acute and chronic graft rejection, and opportunistic infection such as invasive fungal disease. All-cause mortality is increased in solid organ transplant recipients with HHV-6 infection. HHV-6 is somewhat unique among human viruses because of its ability to integrate into the host chromosome. The clinical significance of chromosomally integrated HHV-6 is not yet defined, although a higher rate of bacterial infection and allograft rejection has been suggested. The diagnosis of HHV-6 is now commonly made using nucleic acid testing for HHV-6 DNA in clinical samples, but this can be difficult to interpret owing to the common nature of asymptomatic viral reactivation. Treatment of HHV-6 is indicated in established end-organ disease such as encephalitis. Foscarnet, ganciclovir, and cidofovir have been used for treatment.
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Affiliation(s)
- Irmeli Lautenschlager
- Department of Virology, Helsinki University Hospital, and Helsinki University, Helsinki, Finland.
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13
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Csoma E, Mészáros B, Gáll T, Asztalos L, Kónya J, Gergely L. Dominance of variant A in human herpesvirus 6 viraemia after renal transplantation. Virol J 2011; 8:403. [PMID: 21843348 PMCID: PMC3166939 DOI: 10.1186/1743-422x-8-403] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 08/15/2011] [Indexed: 11/18/2022] Open
Abstract
Background Human herpesvirus 6 (HHV-6), mostly variant B reactivation in renal transplant patients has been published by other authors, but the pathogenetic role of HHV-6 variant A has not been clarified. Our aims were to examine the prevalence of HHV-6, to determine the variants, and to investigate the interaction between HHV-6 viraemia, human cytomegalovirus (HCMV) infection and clinical symptoms. Methods Variant-specific HHV-6 nested PCR and quantitative real-time PCR were used to examine blood samples from renal transplant patients and healthy blood donors for the presence and load of HHV-6 DNA and to determine the variants. Active HHV-6 infection was proved by RT-PCR, and active HCMV infection was diagnosed by pp65 antigenaemia test. Results HHV-6 viraemia was significantly more frequent in renal transplant patients compared to healthy blood donors (9/200 vs. 0/200; p = 0.004), while prevalence of HHV-6 latency was not significantly different (13/200 vs. 19/200; p > 0.05). Dominance of variant A was revealed in viraemias (8/9), and the frequency of HHV-6A was significantly higher in active infections compared with latency in renal transplant patients (8/9 vs. 2/13; p = 0.0015). Latency was established predominantly by HHV-6B both in renal transplant patients and in healthy blood donors (11/13 and 18/19). There was no statistical significant difference in occurrence of HCMV and HHV-6 viraemia in renal transplant patients (7/200 vs. 9/200). Statistical analysis did not reveal interaction between HHV-6 viraemia and clinical symptoms in our study. Conclusions Contrary to previous publications HHV-6A viraemia was found to be predominant in renal transplant patients. Frequency of variant A was significantly higher in cases of active infection then in latency.
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Affiliation(s)
- Eszter Csoma
- Institute of Medical Microbiology, University of Debrecen, Nagyerdei krt, 98, Debrecen, Hungary.
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Altay M, Akay H, Ünverdi S, Altay F, Çeri M, Altay FA, Cesur S, Duranay M, Demiroz AP. Human Herpesvirus 6 Infection in Hemodialysis and Peritoneal Dialysis Patients. Perit Dial Int 2011; 31:320-4. [DOI: 10.3747/pdi.2010.00093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Human herpesvirus 6 (HHV-6) infection occurs worldwide and can be reactivated from latency during periods of immunosuppression, especially after organ transplantation. No previous study has evaluated the influence of dialysis type on HHV-6 infection. The aim of the present study was to determine the prevalence of HHV-6 antibodies in hemodialysis (HD) and peritoneal dialysis (PD) patients. Methods W e studied 36 PD patients, 35 HD patients, and 20 healthy subjects, all with no history of organ transplantation. After systematic inquiries and a physical examination, blood was drawn for determination of biochemical parameters, cytomegalovirus immunoglobulin M (IgM) and immunoglobulin G (IgG), hepatitis B surface antigen, and the hepatitis C and human immunodeficiency virus antibodies. Titers of HHV-6 IgM and IgG antibodies were determined by ELISA. Results Titers for HHV-6 IgM antibody were positive in 9 HD patients (25.7%), 8 PD patients (22.2%), and 2 control subjects (10.0%, p > 0.05). More HD patients (20.0%) than PD patients (5.6%, p = 0.07) or control subjects (0.0%, p =0.03) were positive for HHV-6 IgG antibody. In HD patients, HHV-6 IgG seropositivity and duration of dialysis were positively correlated (R = 0.33, p = 0.05). Conclusions Infection with HHV-6 is not rare in PD and HD patients. In addition, HHV-6 IgG seropositivity was significantly higher in H D patients than in control subjects and approached significance when compared with seropositivity in PD patients. Moreover, in HD patients, HHV-6 IgG seropositivity correlated with duration on HD. These preliminary findings provide insight into the pre-transplantation period for patients and may aid our understanding of how to best protect patients against HHV-6 after transplantation.
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Affiliation(s)
- Mustafa Altay
- Department of Internal Medicine, Ankara Education and Research Hospital
| | - Hatice Akay
- Department of Microbiology, Ankara Diskapi Pediatric Education and Research Hospital
| | - Selman Ünverdi
- Department of Nephrology and Department of Infectious Disease
| | - Filiz Altay
- Department of Microbiology, Ankara Diskapi Pediatric Education and Research Hospital
| | - Mevlüt Çeri
- Department of Nephrology and Department of Infectious Disease
| | | | - Salih Cesur
- Ankara Education and Research Hospital, Ankara, Turkey
| | - Murat Duranay
- Department of Nephrology and Department of Infectious Disease
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Herpes viruses in transplant recipients: HSV, VZV, human herpes viruses, and EBV. Hematol Oncol Clin North Am 2011; 25:171-91. [PMID: 21236397 DOI: 10.1016/j.hoc.2010.11.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The herpes viruses are responsible for a wide range of diseases in patients following transplant, resulting from direct viral effects and indirect effects, including tumor promotion. Effective treatments and prophylaxis exist for the neurotropic herpes viruses HSV-1, HSV-2, varicella zoster virus, and possibly HHV-6. Antivirals seem to be less effective at prevention of the tumor-promoting effects of Epstein-Barr virus and HHV-8. Reduction in immunosuppression is the cornerstone to treatment of many diseases associated with herpes virus infections.
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Shiley K, Blumberg E. Herpes Viruses in Transplant Recipients: HSV, VZV, Human Herpes Viruses, and EBV. Infect Dis Clin North Am 2010; 24:373-93. [DOI: 10.1016/j.idc.2010.01.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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17
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Li YT, Emery VC, Surah S, Jarmulowicz M, Sweny P, Kidd IM, Griffiths PD, Clark DA. Extensive human cytomegalovirus (HCMV) genomic DNA in the renal tubular epithelium early after renal transplantation: Relationship with HCMV DNAemia and long-term graft function. J Med Virol 2010; 82:85-93. [DOI: 10.1002/jmv.21662] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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18
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Razonable RR, Zerr DM. HHV-6, HHV-7 and HHV-8 in solid organ transplant recipients. Am J Transplant 2009; 9 Suppl 4:S97-100. [PMID: 20070702 DOI: 10.1111/j.1600-6143.2009.02899_1.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- R R Razonable
- Division of Infectious Diseases, College of Medicine, Mayo Clinic, Rochester, MN, USA.
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19
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Galan A, McNiff JM, Choi JN, Lazova R. Fatal HHV6 infection in an immunocompromised patient presenting with skin involvement. J Cutan Pathol 2009; 37:277-81. [PMID: 19522847 DOI: 10.1111/j.1600-0560.2009.01291.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Infection with human herpesvirus-6 (HHV6) has a broad distribution in the human population, with a seroprevalence approaching 100% worldwide. Primary infection takes place during childhood, after which the virus remains latent mostly in lymphocytes and monocytes at various sites. Immunosuppression can result in viral reactivation, associated with clinical sequelae and even death. We report a case of a disseminated HHV6 infection in a 53-year-old patient, who was immunocompromised after allogeneic bone marrow transplant treatment for acute lymphocytic leukemia. Initially, he presented with a macular eruption of the skin, followed by involvement of other sites. Histopathologic analysis of skin biopsies revealed superficial perivascular large atypical mononuclear cells with intranuclear and intracytoplasmic inclusions. Most affected cells labeled with antibodies to CD3 and CD43 as lymphocytes, and some labeled with CD68 as macrophages. Polymerase chain reaction (PCR) studies of the blood, skin, liver, colon, cerebrospinal fluid and brain were positive for HHV6 virus. Additionally, the serologic titers for HHV6 were high. Viral particles were also detected by electron microscopy (EM) in the colon. Although rare, HHV6 virus may be an important pathogen in immunocompromised patients, and may present initially in the skin. Awareness of this infection is critical to diagnosis in acute settings.
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Affiliation(s)
- Anjela Galan
- Department of Dermatology, Yale University School of Medicine, New Haven, CT 06520-8059, USA.
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Behzad-Behbahani A, Entezam M, Mojiri A, Pouransari R, Rahsaz M, Banihashemi M, Heidari T, Farhadi A, Azarpira N, Yaghobi R, Jowkar Z, Ramzi M, Robati M. INCIDENCE OF HUMAN HERPES VIRUS-6 AND HUMAN CYTOMEGALOVIRUS INFECTIONS IN DONATED BONE MARROW AND UMBILICAL CORD BLOOD HEMATOPOIETIC STEM CELLS. Indian J Med Microbiol 2008. [DOI: 10.1016/s0255-0857(21)01874-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Yee-Guardino S, Gowans K, Yen-Lieberman B, Berk P, Kohn D, Wang FZ, Danziger-Isakov L, Sabella C, Worley S, Pellett PE, Goldfarb J. β-Herpesviruses in Febrile Children with Cancer. Emerg Infect Dis 2008; 14:579-85. [DOI: 10.3201/eid1404.070651] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Kate Gowans
- Cleveland Clinic Children’s Hospital, Cleveland, Ohio, USA
| | | | | | | | - Fu-Zhang Wang
- Cleveland Clinic, Cleveland, Ohio, USACurrent affiliation: University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lara Danziger-Isakov
- Cleveland Clinic Children’s Hospital, Cleveland, Ohio, USACleveland Clinic, Cleveland, Ohio, USA
| | - Camille Sabella
- Cleveland Clinic Children’s Hospital, Cleveland, Ohio, USACleveland Clinic, Cleveland, Ohio, USA
| | | | - Philip E. Pellett
- Cleveland Clinic, Cleveland, Ohio, USACurrent affiliation: Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Johanna Goldfarb
- Cleveland Clinic Children’s Hospital, Cleveland, Ohio, USACleveland Clinic, Cleveland, Ohio, USA
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Delbridge MS, Karim MS, Shrestha BM, McKane W. Colitis in a renal transplant patient with human herpesvirus-6 infection. Transpl Infect Dis 2006; 8:226-8. [PMID: 17116137 DOI: 10.1111/j.1399-3062.2006.00143.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A male patient developed colitis and a thrombotic microangiopathy 3 weeks after renal transplantation. Immunosuppression at the time of presentation was with sirolimus, mycophenolate mofetil, and prednisolone, but without a calcineurin inhibitor. Cytomegalovirus infection was excluded. However, human herpesvirus-6 DNA was detected at high copy number in both blood and colonic epithelium. The patient recovered after reduction in immunosuppression, with nutritional support and ganciclovir therapy.
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Keightley MC, Rinaldo C, Bullotta A, Dauber J, St George K. Clinical utility of CMV early and late transcript detection with NASBA in bronchoalveolar lavages. J Clin Virol 2006; 37:258-64. [PMID: 16978918 DOI: 10.1016/j.jcv.2006.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2005] [Revised: 08/02/2006] [Accepted: 08/17/2006] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) infection can cause severe disease in immunocompromised individuals, with CMV pneumonia, most commonly seen in lung or bone marrow transplant recipients, carrying a particularly high fatality rate. Early and accurate diagnosis of CMV pneumonia is therefore critical. OBJECTIVES Current diagnostic tests for CMV pneumonia in bronchoalveolar lavage (BAL) specimens are either insensitive or poor prognostic indicators of disease. We therefore examined nucleic acid sequence-based amplification (NASBA) assays for CMV transcripts in BAL for the prediction of CMV pneumonia and associated diseases. STUDY DESIGN A total of 220 BAL specimens from lung transplant recipients and other patients with suspected viral pneumonia were studied. Ninety-nine samples had previously tested positive for CMV by shell vial (SV) culture, while the other 121 had tested negative. All specimens were assayed for CMV pp67 and immediate early (IE) transcripts by NASBA. Results were correlated with evidence of concurrent or subsequent CMV pneumonia, rejection, and infection with other microbes. RESULTS From a total of 220 BAL specimens, 27 tested positive for pp67 mRNA, 25 tested positive for IE mRNA, and 17 tested positive for both. Only 10 specimens tested positive for CMV by either or both NASBA assays while testing negative by SV assay. However, 74 specimens were SV positive but negative in both NASBA assays. Detection of CMV by any of the three methods was associated with an increased prevalence of pneumonia (i.e., pulmonary interstitial inflammation with radiographic or clinical evidence of lung injury), but not with pulmonary CMV pathology. Detection of CMV by SV was associated with moderate to severe graft rejection. There was no evidence of increased bacterial or fungal pulmonary infections associated with a positive CMV result by any of the three assays. CONCLUSIONS Detection of either CMV pp67 or IE mRNA transcripts by NASBA in BAL specimens can occasionally identify CMV infections that are negative by conventional shell vial culture, but does not have sufficient sensitivity or positive predictive value to be employed routinely for pre emptive management of pulmonary CMV disease in transplant recipients.
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Affiliation(s)
- Maria Cristina Keightley
- Clinical Virology Laboratory, University of Pittsburgh Medical Center, A-912, Presbyterian, 200 Lothrop St., Pittsburgh, PA 15213, United States
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Pradeau K, Couty L, Szelag JC, Turlure P, Rolle F, Ferrat P, Bordessoule D, Le Meur Y, Denis F, Ranger-Rogez S. Multiplex real-time PCR assay for simultaneous quantitation of human cytomegalovirus and herpesvirus-6 in polymorphonuclear and mononuclear cells of transplant recipients. J Virol Methods 2006; 132:77-84. [PMID: 16300835 DOI: 10.1016/j.jviromet.2005.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2005] [Revised: 08/31/2005] [Accepted: 09/06/2005] [Indexed: 01/01/2023]
Abstract
Human cytomegalovirus (HCMV) and human herpesvirus-6 (HHV-6) are two closely related viruses, which belong to the Herpesviridae family. Following primary infection, they are thought to persist for life as latent forms in mononuclear cells. HCMV and HHV-6 can cause considerable morbidity in immunocompromised individuals, such as transplant patients. A sensitive and specific LightCycler multiplex real-time PCR assay based on fluorescence energy transfer (known as FRET) was developed. This assay, by using two sets of hybridization probes specific for HHV-6 (A and B) and HCMV, can differentiate reliably and quantify simultaneously both viruses in order to diagnose reactivation processes. The assay was optimized and the lower limit of detection for both viruses was determined to be 10 viral genome copies per reaction. Both viruses were quantified in 83 peripheral blood mononuclear cells (PBMCs) and 87 polymorphonuclear leukocytes (PMNLs) collected from 32 transplant recipients. This multiplex real-time quantitative PCR was finally compared with two other quantitation and detection assays used daily in laboratory (PCR DIG detection and antigenemia for HCMV, TaqMan Assay for HHV-6). This technique can be useful for the differentiation and quantitation of HCMV and HHV-6 for monitoring transplant patients.
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Affiliation(s)
- Karine Pradeau
- Laboratoire de Virologie, CHU Dupuytren, Limoges, France
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25
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Deborska-Materkowska D, Lewandowski Z, Sadowska A, Nowacka-Cieciura E, Chudziński W, Czerwiński J, Paczek L, Durlik M. Fever, Human Herpesvirus-6 (HHV-6) Seroconversion, and Acute Rejection Episodes as a Function of the Initial Seroprevalence for HHV-6 in Renal Transplant Recipients. Transplant Proc 2006; 38:139-43. [PMID: 16504686 DOI: 10.1016/j.transproceed.2005.11.093] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Human herpesvirus-6 (HHV-6) is an opportunistic viral pathogen of emerging clinical significance in immunocompromised patients. We performed a seroepidemiological survey to test the relation between seroprevalence among donors and recipients for HHV-6 at three endpoints. Before transplantation sera obtained from cadaveric donors and from potential recipients were tested for IgG antibodies against HHV-6 using an enzyme-linked immunoassay. The group of recipient sera, including samples obtained before as well as 2, 4, 12, and 48 weeks after transplantation, were tested for anti-HHV-6 IgM antibodies using an indirect immunofluorescence assay. The statistical analysis was performed with the Cox proportional hazards models. The HHV-6 seronegative group (n = 11) compared with the HHV-6 seropositive group (n = 109) showed twice the risk of HHV-6 IgM seroconversion (RR = 2.24; P < .04), with a greater risk of fever, namely 3.8, which was on the verge of statistical significance. The opposite trend toward an association with acute rejection episodes was observed among HHV-6 seronegative patients (RR = 1.81). The presence of IgG antibody in the sera of donors to IgG seropositive recipients had no association with the occurrence of IgM seroconversion. In contrast, IgM antibodies to HHV-6 appeared in four of five seronegative patients who received allografts from IgG seropositive donors. These preliminary data suggest that the effects seem to be the consequence of HHV-6 transmission through a renal allograft.
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Affiliation(s)
- D Deborska-Materkowska
- Transplantation Institute, Department of Transplant Medicine and Nephrology, Warsaw Medical University, ul. Nowogrodzka 59, 02-006 Warsaw, Poland.
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Torre-Cisneros J, Del Castillo M, Castón JJ, Castro MC, Pérez V, Collantes E. Infliximab does not activate replication of lymphotropic herpesviruses in patients with refractory rheumatoid arthritis. Rheumatology (Oxford) 2005; 44:1132-5. [PMID: 15927999 DOI: 10.1093/rheumatology/keh696] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The reactivation of human lymphotropic herpesviruses can be related to the intensity of immunosuppression. We analysed the risk of reactivation of lymphotropic herpesviruses in patients with refractory rheumatoid arthritis treated with an anti-tumour necrosis factor-alpha (TNF-alpha) agent (infliximab). METHODS Fifteen patients were treated with infliximab (3 mg/kg) at weeks 0, 2 and 6. Samples of both plasma and peripheral blood mononuclear cells (PBMC) were obtained before treatment (week 0) and before each infusion at weeks 2 and 6. Samples were analysed using a multiplex qualitative polymerase chain reaction (PCR) for lymphotropic herpesviruses. Quantification of cytomegalovirus (CMV) viral load (copies/ml) was performed using quantitative PCR. Reactivation was defined as the presence of viral DNA in plasma. Latent infection was defined as the presence of viral DNA in PBMC samples but not in plasma. RESULTS On baseline, latent CMV infection was detected in eight patients (53.3%), human herpesviruses-6 (HHV-6) in two (13.3%), Epstein-Barr virus (EBV) in seven (46.6%), CMV + HHV-6 in one (6.6%), CMV + EBV in two (13.3%) and HHV-6 + EBV in one (6.6%). Viral reactivation related to infliximab treatment was not observed. There was only one patient who had HHV-6 reactivation, but this was already detected in the baseline sample. CONCLUSIONS Infliximab treatment does not induce replication of human lymphotropic herpesviruses in patients with rheumatoid arthritis. Thus, herpesviruses prophylaxis would not be indicated in these patients.
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Affiliation(s)
- J Torre-Cisneros
- Section of Infectious Diseases, Reina Sofía University Hospital, Córdoba, Spain.
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27
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Singh N. Interactions between viruses in transplant recipients. Clin Infect Dis 2005; 40:430-6. [PMID: 15668868 DOI: 10.1086/427214] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2004] [Accepted: 09/24/2004] [Indexed: 01/31/2023] Open
Abstract
Viral coinfections may modulate disease expression, enhance pathogenicity, and lead to greater cumulative immunosuppression in the host. The pathophysiological basis of these may be direct virus-virus interactions, effect of cohabitating viruses on host cell function, or impaired host immune responses. The interrelationship between viral pathogens has become increasingly more relevant and its scope wider as new or previously unrecognized viruses continue to emerge as pathogens in transplant recipients. The pathways and mediators that modulate biological activity represent potential targets for immunomodulatory interventions as adjunctive therapies for transplant recipients.
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Affiliation(s)
- Nina Singh
- Veterans Affairs Medical Center and University of Pittsburgh, Pittsburgh, PA 15240, USA. nis5+@pitt.edu
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28
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De Bolle L, Naesens L, De Clercq E. Update on human herpesvirus 6 biology, clinical features, and therapy. Clin Microbiol Rev 2005; 18:217-45. [PMID: 15653828 PMCID: PMC544175 DOI: 10.1128/cmr.18.1.217-245.2005] [Citation(s) in RCA: 341] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Human herpesvirus 6 (HHV-6) is a betaherpesvirus that is closely related to human cytomegalovirus. It was discovered in 1986, and HHV-6 literature has expanded considerably in the past 10 years. We here present an up-to-date and complete overview of the recent developments concerning HHV-6 biological features, clinical associations, and therapeutic approaches. HHV-6 gene expression regulation and gene products have been systematically characterized, and the multiple interactions between HHV-6 and the host immune system have been explored. Moreover, the discovery of the cellular receptor for HHV-6, CD46, has shed a new light on HHV-6 cell tropism. Furthermore, the in vitro interactions between HHV-6 and other viruses, particularly human immunodeficiency virus, and their relevance for the in vivo situation are discussed, as well as the transactivating capacities of several HHV-6 proteins. The insight into the clinical spectrum of HHV-6 is still evolving and, apart from being recognized as a major pathogen in transplant recipients (as exemplified by the rising number of prospective clinical studies), its role in central nervous system disease has become increasingly apparent. Finally, we present an overview of therapeutic options for HHV-6 therapy (including modes of action and resistance mechanisms).
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Affiliation(s)
- Leen De Bolle
- Rega Institute for Medical Research, Minderbroedersstraat 10, B-3000 Leuven, Belgium
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Macé M, Manichanh C, Bonnafous P, Précigout S, Boutolleau D, Gautheret-Dejean A, Agut H. Real-time PCR as a versatile tool for investigating the susceptibility of human herpesvirus 6 to antiviral agents. Antimicrob Agents Chemother 2003; 47:3021-4. [PMID: 12937019 PMCID: PMC182648 DOI: 10.1128/aac.47.9.3021-3024.2003] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A quantitative real-time PCR assay was developed for the determination of antiviral drug susceptibility and growth kinetics of human herpesvirus 6. The susceptibility and fitness of a sensitive strain, HST, and its ganciclovir-resistant derivative, GCVR1, were then characterized, leading us to conclude that the mutations of this latter virus did not alter its fitness significantly.
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Affiliation(s)
- Muriel Macé
- Laboratoire de Virologie, UPRES EA2387, CERVI, Groupe Hospitalier Pitié-Salpêtrière, 75013 Paris, France
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31
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Razonable RR, Rivero A, Brown RA, Hart GD, Espy MJ, van Cruijsen H, Wilson J, Groettum C, Kremers W, Smith TF, Paya CV. Detection of simultaneous beta-herpesvirus infections in clinical syndromes due to defined cytomegalovirus infection. Clin Transplant 2003; 17:114-20. [PMID: 12709076 DOI: 10.1034/j.1399-0012.2003.02104.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Human herpesvirus (HHV)-6 and HHV-7 are increasingly being recognized as emerging pathogens among transplant recipients. Using quantitative polymerase chain reaction assays, we demonstrate the presence of HHV-6 and/or HHV-7 in 18 of 20 episodes of clinically presumed or microbiologically confirmed cytomegalovirus (CMV) infection. Seventeen (89%) of 19 microbiologically confirmed cytomegalovirus (CMV)-infected patients had concomitant HHV-6 variant B (47%) and/or HHV-7 (63%) infection. The degree of HHV-6 coinfection was significantly correlated with hyperbilirubinemia while HHV-7 coinfection demonstrated a non-significant trend toward cytopenias. In one of the 20 episodes described herein, the 'viral syndrome' was due solely to HHV-7 infection; clinical and virological response was observed during intravenous ganciclovir therapy in this patient. While this study emphasizes the significance of HHV-6 and/or HHV-7 coinfection during episodes of CMV infection, it significantly highlights the novel observation of the causal role of HHV-7 (in the absence of HHV-6 and CMV) in a clinical illness presumed to be caused CMV. Thus, HHV-7 (and HHV-6) should be considered as a pathogen (or copathogen) in the viral syndromes following organ transplantation.
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Affiliation(s)
- Raymund R Razonable
- Division of Infectious Diseases and Internal Medicine, Mayo Clinic and Foundation, Rochester, MN 55905, USA
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Pacsa AS, Essa S, Voevodin A, el-Shazly A, Kazak H, Nampoory MRN, Johny KV, Said T, Al-Nakib W. Correlation between CMV genotypes, multiple infections with herpesviruses (HHV-6, 7) and development of CMV disease in kidney recipients in Kuwait. FEMS IMMUNOLOGY AND MEDICAL MICROBIOLOGY 2003; 35:125-30. [PMID: 12628547 DOI: 10.1016/s0928-8244(03)00006-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The possible correlation between cytomegalovirus, human herpesvirus types 6, 7 and cytomegalovirus-related clinical symptoms was studied in kidney transplant patients in Kuwait. Cytomegalovirus infection was diagnosed using the pp65 antigenemia assay. DNA of cytomegalovirus was detected by nested polymerase chain reaction (nested-PCR). PCR was also used to amplify the genes coding for structural proteins of human herpesvirus-6 (240 bp) and human herpesvirus-7 (186 bp). Glycoprotein B genotypes of cytomegalovirus were determined by restriction fragment length polymorphism. The average number of cells positive for cytomegalovirus pp65 antigen showed a steady increase with the severity of the cytomegalovirus-related symptoms. Furthermore, cytomegalovirus pp65 antigen positivity was significantly more frequent among recipients of cadaver kidney (45.5%) than among those who received live related kidneys (22.6%). Cytomegalovirus gB genotype 1 was detected more frequently (P<0.036) in recipients with live related donor kidney (38%) than in patients of cadaver kidney (13%). The genome of human herpesvirus-6 was detected at the same rate in patients with or without cytomegalovirus-related symptoms. However, the genome of human herpesvirus-7 was detected significantly more frequently (P<0.0001) in asymptomatic patients (41.7%) than in recipients with symptomatic cytomegalovirus infection (17%). We conclude that cytomegalovirus gB genotypes are not associated with the outcome of a cytomegalovirus infection in kidney transplant patients, that human herpesvirus-6 does not play a role in cytomegalovirus pathogenesis and that the role of human herpesvirus-7 in cytomegalovirus-related morbidity in kidney recipients remains unclear.
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Affiliation(s)
- A S Pacsa
- Department of Microbiology, Faculty of Medicine, Health Science Center, Kuwait University, P.O. Box 24923, 13110 Kuwait, Kuwait.
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Clark DA, Griffiths PD. Human herpesvirus 6: relevance of infection in the immunocompromised host. Br J Haematol 2003; 120:384-95. [PMID: 12580952 DOI: 10.1046/j.1365-2141.2003.04048.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Duncan A Clark
- Department of Virology, Royal Free and University College Medical School of UCL, Royal Free Campus, London, UK.
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Jenkins FJ, Rowe DT, Rinaldo CR. Herpesvirus infections in organ transplant recipients. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 2003; 10:1-7. [PMID: 12522031 PMCID: PMC145294 DOI: 10.1128/cdli.10.1.1-7.2003] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Frank J Jenkins
- Department of Pathology and Infectious Diseases, University of Pittsburgh School of Medicine, Graduate School of Public Health, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania 15261, USA.
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35
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Benito N, Moreno A, Pumarola T, Marcos MA. Virus del herpes humano tipo 6 y tipo 7 en receptores de trasplantes. Enferm Infecc Microbiol Clin 2003; 21:424-32. [PMID: 14525708 DOI: 10.1016/s0213-005x(03)72980-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Recent years have witnessed a growing interest in the role of human herpesvirus (HHV) type 6 and type 7 as emerging pathogens or copathogens in transplant recipients. Both HHV-6 and HHV-7 belong to the beta-herpesvirus family and are closely related to another member of the family, cytomegalovirus. After the primary infection, these viruses remain latent in the human host and can reactivate after transplantation. Various clinical processes such as fever, rash, pneumonitis, encephalitis, hepatitis, and myelosuppression have been described in association with herpesvirus. Moreover, a growing body of evidence suggests that the major impact of HHV-6 and HHV-7 reactivation in transplantation is related to indirect effects, such as their association with cytomegalovirus disease, increased opportunistic infections, and graft dysfunction and rejection. The pathogenesis of HHV-6 and HHV-7 during the post-transplantation period, the methods used for their diagnosis, and the evaluation of antiviral drugs and strategies for their prevention and treatment are now the subject of extensive research.
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Affiliation(s)
- Natividad Benito
- Servicio de Infecciones. Institut Clínic d'Infeccions i Inmunologia. Hospital Clínic Universitari-IDIBAPS. Barcelona. España.
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36
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Turner S, DiLuca D, Gompels U. Characterisation of a human herpesvirus 6 variant A 'amplicon' and replication modulation by U94-Rep 'latency gene'. J Virol Methods 2002; 105:331-41. [PMID: 12270665 DOI: 10.1016/s0166-0934(02)00130-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The human herpesvirus 6 (HHV-6) variant A genome has conserved sequences which are signals for initiating lytic replication (origin, 'ori-lyt') and DNA packaging into the virion (pac2/1). Here these are functionally characterised and used to construct a gene-expression amplifiable-vector, an 'amplicon', with applications for gene delivery to lymphoid-myeloid cells or their progenitor stem cells. A minimal efficient ori-lyt for replication was identified which was enhanced in the presence of the imperfect direct repeated DNA domain (IDR). In A variant strains these are arranged as three adjacent repeats with the most divergence in IDR3. Addition of the pac2/1 sequences also enhanced detection of ori-lyt replication and conferred DNA packaging properties, thus, the amplicon could be packaged with 'helper' virus. An HHV-6 specific factor, which inhibits amplicon replication was identified by trans replication assays. This is the U94-Rep 'latency' gene product, which can modulate efficiency of such amplifiable vectors, based on the lytic origin. It could also affect maintenance of viral genomes or vectors during latency.
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Affiliation(s)
- Simon Turner
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, University of London, Keppel St., London WC1E 7HT, UK
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37
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Cainelli F, Vento S. Infections and solid organ transplant rejection: a cause-and-effect relationship? THE LANCET. INFECTIOUS DISEASES 2002; 2:539-49. [PMID: 12206970 DOI: 10.1016/s1473-3099(02)00370-5] [Citation(s) in RCA: 135] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Although evidence is far from being conclusive, several studies have suggested that infections could trigger rejection in different transplant settings. In this review we examine the evidence linking cytomegalovirus (CMV), adenovirus, enterovirus, parvovirus, and herpes simplex virus infections to the vasculopathy leading to cardiac allograft rejection, the association between CMV and chronic kidney, lung, and liver graft rejection, and the association of human herpesvirus 6 reactivation with CMV-related disease in kidney and liver transplant recipients. We also review the numerous antiviral prophylactic or pre-emptive treatments in use to control CMV infection, and suggest that they do not limit immune reactions leading to graft rejection or lower the risk of developing post-transplantation atherosclerosis in allograft recipients. Finally, we emphasise the need for prospective, international studies to clarify the role of infections in transplant rejection, to look at virus-to-virus interactions, and to establish specific therapeutic strategies. Such strategies must not rely exclusively on expensive antiviral agents but also on vaccination or other, innovative approaches, such as the use of agents able to inhibit the activity of natural killer cells, which might have an important role in acute allograft rejection.
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Affiliation(s)
- Francesca Cainelli
- Section of Infectious Diseases, Department of Pathology, University of Verona, Verona, Italy.
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Clark DA. Human herpesvirus 6 and human herpesvirus 7: emerging pathogens in transplant patients. Int J Hematol 2002; 76 Suppl 2:246-52. [PMID: 12430932 DOI: 10.1007/bf03165124] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Human herpesvirus 6 (HHV-6) and HHV-7 are two recently identified beta-herpesviruses, genetically related to human cytomegalovirus (CMV). Infection with both viruses is common worldwide with rates of seropositivity in adults over 90%. Infection with both viruses usually occurs in early childhood. In this age group HHV-6 is a cause of febrile illness including exanthem subitum, and likewise, primary HHV-7 infection has been associated with febrile illness. Similar to the other human herpesviruses, in particular CMV, the viruses have the potential for enhanced pathogenicity in the immunocompromised host. Active infection with both viruses is common following bone marrow or solid organ transplantation, most likely through reactivation of recipient's virus or re-infection considering their high prevalence in the population. Both viruses can be detected by PCR in the peripheral blood of healthy individuals and although the significance of blood-borne transmission is not clear, a preliminary study suggested that it was not significant for HHV-6. However, there is growing evidence that these viruses may be medically important in the post-transplant period. In bone marrow transplant patients HHV-6 has been associated with a range of clinical disease including encephalitis, interstitial pneumonitis, early and late graft failure and bone marrow suppression. There is also growing evidence for potential interactions among the beta-herpesviruses in liver and renal transplant patients. HHV-6 infection has been associated with an increased risk of developing CMV disease and opportunistic infections and HHV-7 infection has also been linked to an increased risk of CMV disease.
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Affiliation(s)
- Duncan A Clark
- Department of Virology, Royal Free and University College Medical School of UCL, London, UK
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Abstract
Opportunistic infection is a serious clinical complication in patients receiving immunosuppressive therapy after kidney transplantation. This article deals with some of the possible infectious agents that were recently encountered at our transplantation centre in Düsseldorf, Germany. Opportunistic organsims such as human herpesviruses 6-8, polyomavirus, parvovirus B19, varicella zoster virus, Nocardia and Listeria monocytogenes are rare but severe complications that are presented in this overview. As a result of the use of new immunosuppresive drugs like tacrolimus and mycophenolate mofetil these infections are now seen more frequently, so they should always be included in differential diagnostic considerations. New diagnostic procedures and new treatment strategies should allow early detection and successful treatment of opportunistic infections in the majority of kidney transplant recipients.
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Affiliation(s)
- Matthias P Hörl
- Department of Nephrology and Rheumatology, University of Düsseldorf, Düsseldorf, Germany
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41
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Humar A, Kumar D, Caliendo AM, Moussa G, Ashi-Sulaiman A, Levy G, Mazzulli T. Clinical impact of human herpesvirus 6 infection after liver transplantation. Transplantation 2002; 73:599-604. [PMID: 11889438 DOI: 10.1097/00007890-200202270-00021] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Reactivation of human herpesvirus 6 (HHV-6) appears to be common after transplant. Viral reactivation may result in febrile illness and may also play an immunomodulatory role that leads to indirect effects such as opportunistic infections and rejection. The objective of this study was to determine the clinical impact of HHV-6 infection after liver transplantation including both direct and indirect effects. METHODS This was a prospective single center cohort study of 200 consecutive patients undergoing liver transplantation. Systemic serial HHV-6 viral load measurements and all clinical outcomes including development of opportunistic infections, cytomegalovirus (CMV) disease, and rejection were determined. RESULTS HHV-6 infection (defined as viral load > or = 2 log10 copies/microg input DNA) occurred in 56/200 (28%) patients. Symptomatic disease attributable to HHV-6 alone occurred in 2/200 (1%) patients. Univariate analysis revealed HHV-6 infection was associated with the development of opportunistic infection and CMV disease. In a multivariate analysis designed to control for the level of immunosuppression, the risk of opportunistic infection increased by 3.68-fold in patients with HHV-6 infection (95% confidence interval [CI], 1.86-7.27; P=0.001). In a similar multivariate analysis, the risk of CMV disease increased by 3.59-fold in patients with HHV-6 infection (95% CI, 1.53-8.44; P=0.003). HHV-6 infection was not associated with rejection except in the subgroup of patients with rejection after 30 days posttransplant (odds ration 2.27; 95% CI, 1.09-4.77; P=0.029). CONCLUSIONS HHV-6 reactivation after transplant is common and is associated with the development of opportunistic infections and CMV disease and possibly with a subgroup of acute rejection episodes. HHV-6 infection likely has a significant impact in transplant recipients through indirect effects of viral replication.
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Affiliation(s)
- Atul Humar
- Toronto General Hospital, Toronto, Ontario, Canada, M5G 2C4.
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Paterson DA, Dyer AP, Milne RSB, Sevilla-Reyes E, Gompels UA. A role for human cytomegalovirus glycoprotein O (gO) in cell fusion and a new hypervariable locus. Virology 2002; 293:281-94. [PMID: 11886248 DOI: 10.1006/viro.2001.1274] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A cell fusion assay using fusion-from-without (FFWO) recombinant adenoviruses (RAds) and specific antibody showed a role in fusion modulation for glycoprotein gO, the recently identified third component of the gH/gL gCIII complex of human cytomegalovirus (HCMV). As in HCMV, RAd gO expressed multiple glycosylated species with a mature product of 125 kDa. Coexpression with gH/gL RAds showed gCIII reconstitution in the absence of other HCMV products and stabilisation by intermolecular disulfide bonds. Properties of HCMV clinical isolate, Pt, also implicated gO in cell spread. Compared to laboratory strain AD169, Pt was resistant to gH antibody plaque inhibition, but mature gH was identical. However, the gO sequences were highly divergent (20%), with further variation in laboratory strain Towne gO (34%). Thus, gO forms gCIII with gH/gL, performs in cell fusion, and is a newly identified HCMV hypervariable locus which may influence gCIII's function in mediating infection.
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Affiliation(s)
- David A Paterson
- Pathogen Molecular Biology and Biochemistry Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, University of London, Keppel Street, London WC1E 7HT, United Kingdom
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43
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Kuriyama K, Todo S, Ikushima S, Fujii N, Yoshihara T, Tsunamoto K, Naya M, Hojo M, Hibi S, Morimoto A, Imashuku S. Risk factors for cytomegalovirus retinitis following bone marrow transplantation from unrelated donors in patients with severe aplastic anemia or myelodysplasia. Int J Hematol 2001; 74:455-60. [PMID: 11794704 DOI: 10.1007/bf02982092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Two cases of cytomegalovirus (CMV) retinitis following bone marrow transplantation (BMT) from unrelated donors are reported. 1 patient had been treated for severe aplastic anemia (SAA) and the other for hypoplastic myelodysplastic syndrome (MDS). Because first line therapy with antithymocyte globulin (ATG) and cyclosporin A (CsA) had failed, BMT was performed following a conditioning regimen of ATG, cyclophosphamide, and total lymphoid irradiation. Treatment for CMV retinitis was successfully carried out with gancyclovir (systemic and intraocular injection), foscarnet, and photocoagulation (Case 1) and gancyclovir and foscarnet (Case 2). Both patients also developed Epstein-Barr virus-associated lymphoproliferative disease (EBV-LPD). We compared these 2 cases with 14 SAA patients who did not develop CMV retinitis after BMT using marrow from either HLA-identical siblings (n = 9) or from unrelated donors (n = 5). Unlike the retinitis patients, the latter 5 patients received ATG only once. The retinitis patients had significantly lower CD4+ T-cell levels in their peripheral blood than the 14 patients who did not develop CMV retinitis. We believe that repeated treatment with ATG and transplantation from unrelated donors may lead to immune dysfunction that could increase the likelihood of CMV retinitis, as well as LPD. For such BMT patients, regular ophthalmic examinations and careful testing for CMV antigenemia are recommended.
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Affiliation(s)
- K Kuriyama
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Japan.
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Manichanh C, Olivier-Aubron C, Lagarde JP, Aubin JT, Bossi P, Gautheret-Dejean A, Huraux JM, Agut H. Selection of the same mutation in the U69 protein kinase gene of human herpesvirus-6 after prolonged exposure to ganciclovir in vitro and in vivo. J Gen Virol 2001; 82:2767-2776. [PMID: 11602788 DOI: 10.1099/0022-1317-82-11-2767] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
After serial passage in the presence of increasing concentrations of ganciclovir (GCV) in vitro, a human herpesvirus-6 (HHV-6) mutant exhibiting a decreased sensitivity to the drug was isolated. Analysis of drug susceptibility showed that the IC(50) of this mutant was 24-, 52- and 3-fold higher than that of the wild-type (wt) IC(50) in the case of GCV, cidofovir and foscarnet, respectively. Genotypic analysis showed two single nucleotide changes as compared to the wild-type: an A-->G substitution of the U69 protein kinase (PK) gene resulted in an M(318)V amino acid substitution and the other change, located in the C-terminal part of the U38 gene, resulted in an A(961)V amino acid substitution within the DNA polymerase. The M(318)V change was located within the consensus sequence DISPMN of the putative catalytic domain VI of the PK. This change was homologous to the M(460)V and M(460)I changes that had been reported previously within the consensus sequence DITPMN of the human cytomegalovirus (HCMV) UL97 PK and associated with the resistance of HCMV to GCV. The M(318)V change was also detected by PCR in HHV-6-infected PBMCs from an AIDS patient who had been treated with GCV for a long period of time and exhibited a clinically GCV-resistant HCMV infection. These findings provide strong circumstantial evidence that the M(318)V change of the PK gene is associated with resistance to GCV and raise the question of cross resistance to this drug among different betaherpesviruses.
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Affiliation(s)
- Chaysavanh Manichanh
- Laboratoire de Virologie, UPRES EA 2387, CERVI1, Laboratoire de Génétique Moléculaire, Service de Biochimie Médicale2 and Service des Maladies Infectieuses et Tropicales3, Groupe Hospitalier Pitié-Salpêtrière, 83 Bld de l'Hôpital, 75651 Paris Cedex 13, France
| | - Camille Olivier-Aubron
- Laboratoire de Virologie, UPRES EA 2387, CERVI1, Laboratoire de Génétique Moléculaire, Service de Biochimie Médicale2 and Service des Maladies Infectieuses et Tropicales3, Groupe Hospitalier Pitié-Salpêtrière, 83 Bld de l'Hôpital, 75651 Paris Cedex 13, France
| | - Jean-Pierre Lagarde
- Laboratoire de Virologie, UPRES EA 2387, CERVI1, Laboratoire de Génétique Moléculaire, Service de Biochimie Médicale2 and Service des Maladies Infectieuses et Tropicales3, Groupe Hospitalier Pitié-Salpêtrière, 83 Bld de l'Hôpital, 75651 Paris Cedex 13, France
| | - Jean-Thierry Aubin
- Laboratoire de Virologie, UPRES EA 2387, CERVI1, Laboratoire de Génétique Moléculaire, Service de Biochimie Médicale2 and Service des Maladies Infectieuses et Tropicales3, Groupe Hospitalier Pitié-Salpêtrière, 83 Bld de l'Hôpital, 75651 Paris Cedex 13, France
| | - Phillipe Bossi
- Laboratoire de Virologie, UPRES EA 2387, CERVI1, Laboratoire de Génétique Moléculaire, Service de Biochimie Médicale2 and Service des Maladies Infectieuses et Tropicales3, Groupe Hospitalier Pitié-Salpêtrière, 83 Bld de l'Hôpital, 75651 Paris Cedex 13, France
| | - Agnès Gautheret-Dejean
- Laboratoire de Virologie, UPRES EA 2387, CERVI1, Laboratoire de Génétique Moléculaire, Service de Biochimie Médicale2 and Service des Maladies Infectieuses et Tropicales3, Groupe Hospitalier Pitié-Salpêtrière, 83 Bld de l'Hôpital, 75651 Paris Cedex 13, France
| | - Jean-Marie Huraux
- Laboratoire de Virologie, UPRES EA 2387, CERVI1, Laboratoire de Génétique Moléculaire, Service de Biochimie Médicale2 and Service des Maladies Infectieuses et Tropicales3, Groupe Hospitalier Pitié-Salpêtrière, 83 Bld de l'Hôpital, 75651 Paris Cedex 13, France
| | - Henri Agut
- Laboratoire de Virologie, UPRES EA 2387, CERVI1, Laboratoire de Génétique Moléculaire, Service de Biochimie Médicale2 and Service des Maladies Infectieuses et Tropicales3, Groupe Hospitalier Pitié-Salpêtrière, 83 Bld de l'Hôpital, 75651 Paris Cedex 13, France
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Ihira M, Yoshikawa T, Suzuki K, Ohashi M, Suga S, Asonuma K, Tanaka K, Asano Y. Correlation between human herpesvirus 6 and 7 infections after living related liver transplantation. Microbiol Immunol 2001; 45:225-32. [PMID: 11345532 DOI: 10.1111/j.1348-0421.2001.tb02611.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Human herpesvirus 6 (HHV-6) and human herpesvirus 7 (HHV-7) are closely related to each other. Interaction between the two viruses at the time of primary HHV-7 infection is suggested by in vivo and in vitro studies. However, interaction between the two viruses in organ transplant recipients has not been analyzed. We analyzed serially collected plasma samples obtained from 40 living related liver transplant recipients by serological assay (indirect immunofluorescence assay, IFA) and polymerase chain reaction (PCR). Significant increase or seroconversion of HHV-6 IgG and HHV-7 IgG antibody titers were observed in 45% and 58% of recipients respectively. Positive rate of IgM HHV-6 antibody increased up to 35% at 4 weeks after transplantation. However, no remarkable peak in the positive rate of HHV-7 IgM antibody was demonstrated. HHV-6 and HHV-7 DNA were detected in plasma in 15 (38%) and 16 (40%) of the 40 recipients respectively. HHV-6 DNA was detected in 10 (26%) of the 38 recipients at 2 weeks after transplantation. The positive rate of the virus genome in plasma gradually decreased after that time. HHV-7 DNA was detected in 5 (14%) of the 37 recipients at 2 weeks after transplantation; no obvious peak in the positive rate of HHV-7 DNA was demonstrated. Antibody responses involving both HHV-6 and HHV-7, including either a significant increase in IgG antibody titers or positive identification of IgM antibody were observed in 17 (43%) of the 40 recipients. Thirteen out of the 17 recipients demonstrated concurrent antibody response against both viruses. HHV-7 antibody response preceded the HHV-6 antibody response in 2 of the remaining 4 recipients, whereas the opposite was true in the other 2 recipients. Both HHV-6 and HHV-7 DNA were detected in 7 (18%) of the 40 recipients. In 4 of those 7 recipients, DNA from both viruses was concurrently detected, 3 of whom had HHV-7 DNA repeatedly detected after first detection of the virus DNA. The detection of HHV-7 DNA preceded the detection of HHV-6 DNA in 2 recipients, whereas HHV-6 DNA appeared first in 1 recipient.
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Affiliation(s)
- M Ihira
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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46
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Abstract
The rate of infectious complications in SOT recipients has declined dramatically. As improvements in immunosuppressive therapy, surgical techniques, and diagnostics and antimicrobial treatment continue, further declines in infectious complications are expected. Refinements to preemptive therapy for high-risk patients are likely to contribute further to this decrease. Further investigation is required to define what role various infectious agents play in chronic allograft injury and rejection.
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Affiliation(s)
- D M Simon
- Department of Medicine, Section of Infectious Diseases, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois, USA
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47
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Ross DJ, Chan RC, Kubak B, Laks H, Nichols WS. Bronchiolitis obliterans with organizing pneumonia: possible association with human herpesvirus-7 infection after lung transplantation. Transplant Proc 2001; 33:2603-6. [PMID: 11406259 DOI: 10.1016/s0041-1345(01)02109-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- D J Ross
- Division of Pulmonary and Critical Care Medicine, University of California, Los Angeles, California, USA
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48
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Hasegawa T, Kimura T, Sasaki T, Okada A, Tanaka-Taya K, Miyagawa H, Amou K, Mushiake S, Yamanishi K, Ishikawa S. Sequential measurement of human herpesvirus 6 DNA with polymerase chain reaction method in pediatric living-related liver transplantation. Clin Transplant 2001; 15:208-13. [PMID: 11389712 DOI: 10.1034/j.1399-0012.2001.150310.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Human herpesvirus 6 (HHV-6), a causative virus of exanthem subitum, may occasionally present with a severe clinical form in immunosuppressed patients after transplantation. In this study, HHV-6 DNA was sequentially measured with a polymerase chain reaction (PCR) method, a quick and sensitive modality in pediatric living-related liver transplantation (LTx). METHODS Subjects consisted of 5 post-operative biliary atresia patients undergoing living-related LTx at ages from 8 months to 4 yr. Immunosuppression was performed with Tacrolimus (blood trough level 8-18 within 1 month and 5-10 ng/mL thereafter) and low-dose steroid. Specimens were peripheral blood mononuclear cells (PBMC), plasma, and liver biopsy tissue. The amount of HHV-6 DNA was semiquantified as follows: 1+, 1-10; 2+, 10-100; 3+, 100-1000; 4+, over 1000 copies/105 PBMCs. RESULTS A total of 69 blood samples and three liver biopsies were provided for the examination. HHV-6 DNA in PBMC was positive in 2 donors and 3 recipients before LTx. Two patients with negative DNA were converted to 3+ at 2-3 wk after LTx and 3 with positive DNA remained 2+ to 3+ throughout the post-LTx period. Only 1 patient developed clinical symptoms, such as fever, liver dysfunction, petechiae, idiopathic thrombocytopenic purpura, and finally bone marrow suppression. HHV-6 DNA in the liver biopsy tissue and plasma in this patient were 4+ and 2+, respectively. CONCLUSION HHV-6 DNA in PBMC measured by the PCR method may be persistently high in pediatric recipients after living-related LTx. Although HHV-6 DNA in PBMC may be positive in case of evident infection, positivity in PBMC may not be always associated with the clinical symptoms.
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Affiliation(s)
- T Hasegawa
- Department of Pediatric Surgery, Osaka University, Medical School, Osaka, Japan
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49
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Emery VC. Human herpesviruses 6 and 7 in solid organ transplant recipients. Clin Infect Dis 2001; 32:1357-60. [PMID: 11303272 DOI: 10.1086/320000] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2000] [Revised: 01/22/2001] [Indexed: 01/24/2023] Open
Abstract
The impact of cytomegalovirus, a member of the beta-herpesvirus subgroup of the Herpesviridae, on patients who have undergone transplantation cannot be overstated. However, in the last 15 years, 2 additional members of the human beta-herpesvirus family have been discovered: human herpesviruses 6 and 7 (HHV-6 and HHV-7). The impact of HHV-6 and HHV-7 is assessed, as is the well-being of transplant recipients. Also discussed is whether the data on the pathological consequences of infection warrant routine screening for these viruses in solid organ transplant recipients.
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Affiliation(s)
- V C Emery
- Royal Free and University College Medical School, Hampstead, London, United Kingdom.
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50
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Abstract
Viral infections are a leading cause of posttransplantation morbidity and mortality. A number of recent developments have altered our understanding and management of these disorders. The pathogenetic roles of several viruses, including human herpesviruses 6 and 8, have been newly established. Molecular-based diagnostic tests now make more rapid diagnosis possible. The licensing of new potent antiviral agents offers a wider choice of drugs for viral prophylaxis and treatment. The use of more potent immunosuppressive agents is responsible in part for the increasing incidence of some viral infections, but this varies among drugs, and individual viruses differ in their sensitivity to immunosuppressive agents. This review summarizes the natural history, diagnosis, prevention, and treatment of many common viral infections after renal transplantation.
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Affiliation(s)
- S R Smith
- Divisions of Nephrology and Infectious Diseases, Duke University Medical Center, Durham, NC 27710, USA
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