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Hill JA, Lee YJ, Vande Vusse LK, Xie H, Chung EL, Waghmare A, Cheng GS, Zhu H, Huang ML, Hill GR, Jerome KR, Leisenring WM, Zerr DM, Gharib SA, Dadwal S, Boeckh M. HHV-6B detection and host gene expression implicate HHV-6B as pulmonary pathogen after hematopoietic cell transplant. Nat Commun 2024; 15:542. [PMID: 38228644 PMCID: PMC10791683 DOI: 10.1038/s41467-024-44828-9] [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: 09/21/2023] [Accepted: 01/05/2024] [Indexed: 01/18/2024] Open
Abstract
Limited understanding of the immunopathogenesis of human herpesvirus 6B (HHV-6B) has prevented its acceptance as a pulmonary pathogen after hematopoietic cell transplant (HCT). In this prospective multicenter study of patients undergoing bronchoalveolar lavage (BAL) for pneumonia after allogeneic HCT, we test blood and BAL fluid (BALF) for HHV-6B DNA and mRNA transcripts associated with lytic infection and perform RNA-seq on paired blood. Among 116 participants, HHV-6B DNA is detected in 37% of BALs, 49% of which also have HHV-6B mRNA detection. We establish HHV-6B DNA viral load thresholds in BALF that are highly predictive of HHV-6B mRNA detection and associated with increased risk for overall mortality and death from respiratory failure. Participants with HHV-6B DNA in BALF exhibit distinct host gene expression signatures, notable for enriched interferon signaling pathways in participants clinically diagnosed with idiopathic pneumonia. These data implicate HHV-6B as a pulmonary pathogen after allogeneic HCT.
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Affiliation(s)
- Joshua A Hill
- Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA.
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA.
- Clinical Research Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA.
| | - Yeon Joo Lee
- Infectious Diseases Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
- Weill Cornell Medical College, 400 E 67th St, New York, NY, 10065, USA
| | - Lisa K Vande Vusse
- Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Hu Xie
- Clinical Research Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
| | - E Lisa Chung
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
| | - Alpana Waghmare
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
- Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Guang-Shing Cheng
- Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
| | - Haiying Zhu
- Department of Laboratory Medicine and Pathology, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Meei-Li Huang
- Department of Laboratory Medicine and Pathology, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Geoffrey R Hill
- Clinical Research Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
| | - Keith R Jerome
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
- Department of Laboratory Medicine and Pathology, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Wendy M Leisenring
- Clinical Research Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
| | - Danielle M Zerr
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
- Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Sina A Gharib
- Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Sanjeet Dadwal
- City of Hope National Medical Center, 1500 E Duarte Rd, Duarte, CA, 91010, USA
| | - Michael Boeckh
- Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
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2
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Ishimaru S, Kawamura Y, Miura H, Shima S, Ueda A, Watanabe H, Mutoh T, Yoshikawa T. Detection of human herpesviruses in cerebrospinal fluids collected from patients suspected of neuroinfectious diseases. J Neurovirol 2021; 28:92-98. [PMID: 34970721 DOI: 10.1007/s13365-021-01040-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 11/21/2021] [Accepted: 12/09/2021] [Indexed: 11/28/2022]
Abstract
The full spectrum of human herpesviruses (HHV)-associated neuroinfectious diseases in immunocompetent adults remains unclear. Hence, we sought to elucidate the epidemiology and clinical features of these diseases. The study subjects were patients over 16 years old suspected of neuroinfectious diseases who underwent spinal tap performed by neurologists in our university hospital between April 2013 and March 2018. The presence of seven HHV DNAs in cerebrospinal fluid (CSF) was determined by real-time PCR. HHV DNAs were detected in 33 (10.2%) of the 322 patients. The most frequently detected herpesvirus was varicella zoster virus (VZV) (19 patients), followed by HHV-6 (four patients), herpes simplex virus (HSV)-1 (three patients), HSV-2 (three patients), and Epstein-Barr virus (two patients). HHV DNAs were detected in CSF collected from patients with various neuroinfectious diseases, including myelitis, peripheral neuritis, encephalitis, and meningitis. All patients with HSV-1 DNA had encephalitis, whereas all patients with HSV-2 DNA had meningitis. Eleven of the 19 patients with VZV DNA had meningitis. Patients with VZV-associated encephalitis (median age, 80 years) were significantly older than non-encephalitis patients (median age, 60.5 years) (P = 0.046). Although post-herpetic neuralgia was observed in seven (54%) of the 13 patients with VZV and without encephalitis, no such neurological sequela was observed in the four encephalitis patients. In conclusion, HHVs were associated with approximately 10% of neuroinfectious diseases in this cohort. VZV was the most common pathogen, probably due to the large number of VZV meningitis patients. In addition, patients with VZV-associated meningitis were significantly younger than patients with VZV-associated encephalitis.
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Affiliation(s)
- Soichiro Ishimaru
- Department of Pediatrics, Fujita Health University School of Medicine, 1-98, Kutsukake-cho, Dengakugakubo, Toyoake, Aichi, 470-1192, Japan
| | - Yoshiki Kawamura
- Department of Pediatrics, Fujita Health University School of Medicine, 1-98, Kutsukake-cho, Dengakugakubo, Toyoake, Aichi, 470-1192, Japan.
| | - Hiroki Miura
- Department of Pediatrics, Fujita Health University School of Medicine, 1-98, Kutsukake-cho, Dengakugakubo, Toyoake, Aichi, 470-1192, Japan
| | - Sayuri Shima
- Department of Neurology, Fujita Health University School of Medicine, 1-98, Kutsukake-cho, Dengakugakubo, Toyoake, Aichi, 470-1192, Japan
| | - Akihiro Ueda
- Department of Neurology, Fujita Health University School of Medicine, 1-98, Kutsukake-cho, Dengakugakubo, Toyoake, Aichi, 470-1192, Japan
| | - Hirohisa Watanabe
- Department of Neurology, Fujita Health University School of Medicine, 1-98, Kutsukake-cho, Dengakugakubo, Toyoake, Aichi, 470-1192, Japan
| | - Tatsuro Mutoh
- Department of Neurology, Fujita Health University School of Medicine, 1-98, Kutsukake-cho, Dengakugakubo, Toyoake, Aichi, 470-1192, Japan
| | - Tetsushi Yoshikawa
- Department of Pediatrics, Fujita Health University School of Medicine, 1-98, Kutsukake-cho, Dengakugakubo, Toyoake, Aichi, 470-1192, Japan
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3
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Rebechi MT, Bork JT, Riedel DJ. HHV-6 Encephalitis After Chimeric Antigen Receptor T-cell Therapy (CAR-T): 2 Case Reports and a Brief Review of the Literature. Open Forum Infect Dis 2021; 8:ofab470. [PMID: 34738024 PMCID: PMC8562470 DOI: 10.1093/ofid/ofab470] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 09/22/2021] [Indexed: 01/04/2023] Open
Abstract
Human herpesvirus 6 (HHV-6) reactivation can occur in patients who are highly immunosuppressed, including those who have undergone hematopoietic stem cell transplantation (HSCT). HHV-6 encephalitis is a severe manifestation that is well described in the HSCT population. Chimeric antigen receptor T-cell (CAR-T) therapy is a novel cancer-directed immunotherapy that results in severe immunosuppression. Patients undergoing CAR-T therapy may be at risk for HHV-6 encephalitis, which can be difficult to distinguish from a common adverse effect of CAR-T therapy, neurotoxicity. Herein, we describe 2 patients diagnosed with HHV-6 encephalitis after CAR-T therapy and discuss the diagnostic approach and differential diagnosis for altered mental status after CAR-T therapy. Diagnosing HHV-6 encephalitis can be difficult in this patient population as altered mental status is common after CAR-T therapy and may be attributed to CAR-T-associated neurotoxicity.
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Affiliation(s)
| | - Jacqueline T Bork
- University of Maryland School of Medicine, Baltimore Maryland,USA.,Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland,USA
| | - David J Riedel
- University of Maryland School of Medicine, Baltimore Maryland,USA.,Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland,USA
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Handley G, Khawaja F, Kondapi DS, Lee HJ, Kaufman GP, Neelapu SS, Fayad LE, Tummala S, Chi L, Strati P, Mulanovich VE. Human herpesvirus 6 myelitis after chimeric antigen receptor T-cell therapy. Int J Infect Dis 2021; 112:327-329. [PMID: 34600133 DOI: 10.1016/j.ijid.2021.09.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/30/2021] [Accepted: 09/26/2021] [Indexed: 11/16/2022] Open
Abstract
This article reports a fatal case of human herpesvirus 6 (HHV-6) myelitis following CD19-targeted chimeric antigen receptor T-cell therapy. Infection from HHV-6 reactivation after haematopoietic stem cell transplant is established, and outside of this population is limited to case reports. The patient developed cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome that responded to corticosteroids both clinically and on imaging. Subsequently, ascending flaccid paralysis developed, leading to neuromuscular respiratory failure and, ultimately, death. Disease progression was refractory to foscarnet and multiple immunomodulating agents. HHV-6 should be considered in patients with encephalitis and myelitis after adoptive T-cell therapy.
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Affiliation(s)
- Guy Handley
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Medicine, Division of Infectious Disease and International Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
| | - Fareed Khawaja
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Divya S Kondapi
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hun J Lee
- Department of Lymphoma-Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gregory P Kaufman
- Department of Lymphoma-Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sattva S Neelapu
- Department of Lymphoma-Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Luis E Fayad
- Department of Lymphoma-Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sudhakar Tummala
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Linda Chi
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paolo Strati
- Department of Lymphoma-Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Victor E Mulanovich
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Heldman MR, Job C, Maalouf J, Morris J, Xie H, Davis C, Stevens-Ayers T, Huang ML, Jerome KR, Fann JR, Zerr DM, Boeckh M, Hill JA. Association of Inherited Chromosomally Integrated Human Herpesvirus 6 with Neurologic Symptoms and Management after Allogeneic Hematopoietic Cell Transplantation. Transplant Cell Ther 2021; 27:795.e1-795.e8. [PMID: 34111575 DOI: 10.1016/j.jtct.2021.05.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/19/2021] [Accepted: 05/31/2021] [Indexed: 11/30/2022]
Abstract
Reactivation of human herpesvirus 6 (HHV-6) after allogeneic hematopoietic cell transplantation (HCT) is associated with neurologic complications, but the impact of donor and/or recipient inherited chromosomally integrated HHV-6 (iciHHV-6) on post-HCT central nervous system (CNS) symptoms and diagnostic and therapeutic interventions is not well understood. The aims of the present study were (1) to compare the cumulative incidence of CNS symptoms in the first 100 days following allogeneic HCT among patients with donor and/or recipient iciHHV-6 (iciHHV-6pos)with that of patients with neither donor nor recipient iciHHV-6 (iciHHV-6neg) and (2) to assess the role of HHV-6 detection in driving potentially unnecessary interventions in iciHHV-6pos patients. We performed a retrospective matched cohort study of 87 iciHHV-6pos and 174 iciHHV-6neg allogeneic HCT recipients. HHV-6 testing was performed at the discretion of healthcare providers, who were unaware of iciHHV-6 status. The cumulative incidence of CNS symptoms was similar in iciHHV-6pos (n = 37; 43%) and iciHHV-6neg HCT recipients (n = 81; 47%; P = .63). HHV-6 plasma testing was performed in similar proportions of iciHHV-6pos (n = 6; 7%) and iciHHV-6neg (9%) patients and was detected in all tested iciHHV-6pos HCTs and 2 (13%) iciHHV-6neg HCTs. This resulted in more frequent HHV-6-targeted antiviral therapy after iciHHV-6pos HCT (odds ratio, 12.8; 95% confidence interval, 1.5 to 108.2) with associated side effects. HHV-6 plasma detection in 2 iciHHV-6pos patients without active CNS symptoms prompted unnecessary lumbar punctures. The cumulative incidence of CNS symptoms was similar after allogeneic HCT involving recipients or donors with and without iciHHV-6. Misattribution of HHV-6 detection as infection after iciHHV-6pos HCT may lead to unnecessary interventions. Testing for iciHHV-6 may improve patient management.
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Affiliation(s)
- Madeleine R Heldman
- Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, Seattle, Washington; Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington.
| | - Cassandra Job
- Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, Seattle, Washington
| | - Joyce Maalouf
- Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, Seattle, Washington
| | - Jessica Morris
- Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, Seattle, Washington
| | - Hu Xie
- Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, Seattle, Washington
| | - Chris Davis
- Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, Seattle, Washington
| | - Terry Stevens-Ayers
- Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, Seattle, Washington
| | - Meei-Li Huang
- Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, Seattle, Washington; Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington
| | - Keith R Jerome
- Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, Seattle, Washington; Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington
| | - Jesse R Fann
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Danielle M Zerr
- Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington
| | - Michael Boeckh
- Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, Seattle, Washington; Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington
| | - Joshua A Hill
- Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, Seattle, Washington; Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington.
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6
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Komaroff AL, Rizzo R, Ecker JL. Human Herpesviruses 6A and 6B in Reproductive Diseases. Front Immunol 2021; 12:648945. [PMID: 33841432 PMCID: PMC8027340 DOI: 10.3389/fimmu.2021.648945] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/09/2021] [Indexed: 11/13/2022] Open
Abstract
Human herpesviruses 6A (HHV-6A) and human herpesvirus 6B (HHV-6B)—collectively, HHV-6A/B—are recently-discovered but ancient human viruses. The vast majority of people acquire one or both viruses, typically very early in life, producing an ineradicable lifelong infection. The viruses have been linked to several neurological, pulmonary and hematological diseases. In early human history, the viruses on multiple occasions infected a germ cell, and integrated their DNA into a human chromosome. As a result, about 1% of humans are born with the full viral genome present in every cell, with uncertain consequences for health. HHV-6A may play a role in 43% of cases of primary unexplained infertility. Both the inherited and acquired viruses may occasionally trigger several of the factors that are important in the pathogenesis of preeclampsia. Transplacental infection occurs in 1-2% of pregnancies, with some evidence suggesting adverse health consequences for the child. While emerging knowledge about these viruses in reproductive diseases is not sufficient to suggest any changes in current practice, we write this review to indicate the need for further research that could prove practice-changing.
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Affiliation(s)
- Anthony L Komaroff
- Division of General Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Roberta Rizzo
- Department of Chemical and Pharmaceutical Sciences, University of Ferrara, Ferrara, Italy
| | - Jeffrey L Ecker
- Department of Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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7
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Handley G, Hasbun R, Okhuysen P. Human herpesvirus 6 and central nervous system disease in oncology patients: A retrospective case series and literature review. J Clin Virol 2021; 136:104740. [PMID: 33548682 DOI: 10.1016/j.jcv.2021.104740] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/18/2021] [Accepted: 01/24/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Human herpesvirus 6 (HHV-6) can reactivate with immunosuppression and cause central nervous system (CNS) dysfunction. Much of the literature describes cases after hematopoietic stem cell transplantation (HSCT), ranging from encephalitis to a post-transplant acute limbic encephalitis syndrome (PALE). Outside of HSCT, studies of HHV-6 encephalitis are limited to case reports. OBJECTIVES This study was designed to review HHV-6 CNS infection, and evaluate all patients admitted to MD Anderson Cancer Center between March 2016 and December 2018 with detectable HHV-6 DNA in the cerebrospinal fluid (CSF). STUDY DESIGN Patients with HHV-6 DNA detected in the CSF using the Viracor or Biofire® Meningitis Encephalitis Panel platforms and no other identified etiology were identified and demographic features, known risk factors, imaging findings, CSF analysis, treatments and patient outcomes were extracted from medical records. RESULTS 725 patients underwent HHV-6 testing during the study timeframe, with 19 cases (2.6 %) of HHV-6 mediated CNS disease identified. Most patients, 13/19 (68 %), had undergone HSCT with median time to presentation of 31 days after transplant. Survival at 240 days after transplant was 62 %. CSF had lymphocyte predominance and nearly all patients had peripheral lymphopenia. Other at risk populations identified included patients who received chimeric antigen receptor (CAR) T-cell therapy and biologic immunotherapy. Notable discordance among testing platforms was found in 5/9 (55 %) instances. CONCLUSIONS In addition to HSCT patients, HHV-6 reactivation leading to CNS disease also occurs in settings such as following adoptive T cell therapy or biologic immunotherapy. Significant diagnostic discordance exists between testing platforms.
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Affiliation(s)
- Guy Handley
- Department of Medicine, Division of Infectious Diseases, McGovern Medical School UT Health, 6431 Fannin, MSB 2.112, Houston, TX, 77030, USA.
| | - Rodrigo Hasbun
- Department of Medicine, Division of Infectious Diseases, McGovern Medical School UT Health, 6431 Fannin, MSB 2.112, Houston, TX, 77030, USA
| | - Pablo Okhuysen
- Department of Infectious Diseases, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1460, Houston, TX, 77030, USA
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8
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Komaroff AL, Pellett PE, Jacobson S. Human Herpesviruses 6A and 6B in Brain Diseases: Association versus Causation. Clin Microbiol Rev 2020; 34:e00143-20. [PMID: 33177186 PMCID: PMC7667666 DOI: 10.1128/cmr.00143-20] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Human herpesvirus 6A (HHV-6A) and human herpesvirus 6B (HHV-6B), collectively termed HHV-6A/B, are neurotropic viruses that permanently infect most humans from an early age. Although most people infected with these viruses appear to suffer no ill effects, the viruses are a well-established cause of encephalitis in immunocompromised patients. In this review, we summarize the evidence that the viruses may also be one trigger for febrile seizures (including febrile status epilepticus) in immunocompetent infants and children, mesial temporal lobe epilepsy, multiple sclerosis (MS), and, possibly, Alzheimer's disease. We propose criteria for linking ubiquitous infectious agents capable of producing lifelong infection to any neurologic disease, and then we examine to what extent these criteria have been met for these viruses and these diseases.
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Affiliation(s)
- Anthony L Komaroff
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Philip E Pellett
- Department of Microbiology and Immunology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Steven Jacobson
- Virology/Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
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9
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Is antiviral therapy against HHV-6B beneficial? Blood 2020; 135:1413-1414. [PMID: 32324868 DOI: 10.1182/blood.2020005448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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10
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Pasca M, Picchioni A, Mazzeo S, Terenzi F, Prestipino E, Fratangelo R, Repice AM, Carlucci G, Massacesi L, Barilaro A. A case of recurrent progressive multifocal leukoencephalopathy after human stem cell transplant, with detection of John Cunningham virus and human herpesvirus 6 on cerebrospinal fluid, treated with Mirtazapine, Olanzapine and Foscarnet. Intractable Rare Dis Res 2019; 8:275-278. [PMID: 31890456 PMCID: PMC6929596 DOI: 10.5582/irdr.2019.01107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We reported the case of a John Cunningham virus (JCV) and human herpesvirus 6 (HHV-6) mediated progressive multifocal leukoencephalopathy (PML) after human stem cell transplant, reactivated 6 months later in absence of immunosuppressive therapy, successfully treated with anti-5HT2A receptors agents and antiviral therapy. Few cases of JCV and HHV-6 coinfection associated PML are described in literature and the role of HHV-6 in the pathogenesis and prognosis of PML is not completely clear. Our case suggests that, in a possible PML, the research of HHV-6 and JCV should be always performed on cerebrospinal fluid (CSF) and on blood samples and in case of detection of HHV-6 DNA a chromosomally integrated human herpesvirus 6(ciHHV-6) should be excluded. Furthermore we recommend to start an appropriate therapy with antiviral and anti-5HT2A receptors agents in case of possible PML due to JCV and HHV-6 coinfection.
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Affiliation(s)
- Matteo Pasca
- Department of Neurological and Psychiatric sciences (NEUROFARBA), University of Florence, Florence, Italy
- Address correspondence to:Dr. Matteo Pasca, Department of Neurological and Psychiatric sciences (NEUROFARBA), University of Florence, Largo Brambilla, 3 - 50134 Florence, Italy. E-mail:
| | - Antonella Picchioni
- Department of Neurological and Psychiatric sciences (NEUROFARBA), University of Florence, Florence, Italy
| | - Salvatore Mazzeo
- Department of Neurological and Psychiatric sciences (NEUROFARBA), University of Florence, Florence, Italy
| | - Federica Terenzi
- Department of Neurological and Psychiatric sciences (NEUROFARBA), University of Florence, Florence, Italy
| | - Elio Prestipino
- Department of Neurological and Psychiatric sciences (NEUROFARBA), University of Florence, Florence, Italy
| | - Roberto Fratangelo
- Department of Neurological and Psychiatric sciences (NEUROFARBA), University of Florence, Florence, Italy
| | - Anna Maria Repice
- Department of Neurological and Psychiatric sciences (NEUROFARBA), University of Florence, Florence, Italy
- Neurological Division II Careggi University Hospital, Florence, Italy
| | - Giovanna Carlucci
- Department of Neurological and Psychiatric sciences (NEUROFARBA), University of Florence, Florence, Italy
- Neurological Division II Careggi University Hospital, Florence, Italy
| | - Luca Massacesi
- Department of Neurological and Psychiatric sciences (NEUROFARBA), University of Florence, Florence, Italy
- Neurological Division II Careggi University Hospital, Florence, Italy
| | - Alessandro Barilaro
- Department of Neurological and Psychiatric sciences (NEUROFARBA), University of Florence, Florence, Italy
- Neurological Division II Careggi University Hospital, Florence, Italy
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Hill JA, Vande Vusse LK, Xie H, Chung EL, Yeung CC, Seo S, Stevens-Ayers T, Fisher CE, Huang ML, Stewart FM, Jerome KR, Zerr DM, Corey L, Leisenring WM, Boeckh M. Human Herpesvirus 6B and Lower Respiratory Tract Disease After Hematopoietic Cell Transplantation. J Clin Oncol 2019; 37:2670-2681. [PMID: 31449472 PMCID: PMC7351330 DOI: 10.1200/jco.19.00908] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2019] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Human herpesvirus 6B (HHV-6B) DNA is frequently detected in bronchoalveolar lavage fluid (BALF) from immunocompromised subjects with lower respiratory tract disease (LRTD). Whether HHV-6B is a pulmonary pathogen is unclear. METHODS We tested BALF for HHV-6B DNA using polymerase chain reaction in allogeneic hematopoietic cell transplantation (HCT) recipients who underwent a BAL for evaluation of LRTD from 1992 to 2015. We used multivariable proportional hazards models to evaluate the association of HHV-6B+ BALF with overall mortality, death from respiratory failure, and the effect of anti-HHV-6B antivirals on these outcomes. We used branched-chain RNA in situ hybridization to detect HHV-6 messenger RNA (U41 and U57 transcripts) in lung tissue. RESULTS We detected HHV-6B+ BALF from 147 of 553 (27%) individuals. Subjects with HHV-6B+ BALF, with or without copathogens, had significantly increased risk of overall mortality (adjusted hazard ratio [aHR], 2.18; 95% CI, 1.41-3.39) and death from respiratory failure (aHR, 2.50; 95% CI, 1.56-4.01) compared with subjects with HHV-6B- BALF. Subjects with HHV-6B+ BALF who received antivirals within 3 days pre-BAL had an approximately 1 log10 lower median HHV-6B BALF viral load, as well as a lower risk of overall mortality (aHR, 0.42; 95% CI, 0.16-1.10), compared with subjects with HHV-6B+ BALF not receiving antivirals. We detected intraparenchymal HHV-6 gene expression by RNA in situ hybridization in lung tissue in all three tested subjects with HHV-6B+ BALF and sufficient tissue RNA preservation. CONCLUSION These data provide evidence that HHV-6B detection in BALF is associated with higher mortality in allogeneic hematopoietic cell transplantation recipients with LRTD. Definitive evidence of causation will require a randomized prevention or treatment trial.
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Affiliation(s)
- Joshua A. Hill
- University of Washington, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Lisa K. Vande Vusse
- University of Washington, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Hu Xie
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Cecilia C.S. Yeung
- University of Washington, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Sachiko Seo
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Cynthia E. Fisher
- University of Washington, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - F. Marc Stewart
- University of Washington, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Keith R. Jerome
- University of Washington, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Danielle M. Zerr
- University of Washington, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Lawrence Corey
- University of Washington, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Michael Boeckh
- University of Washington, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA
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12
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Tamaki H, Ikegame K, Yoshihara S, Kaida K, Yoshihara K, Inoue T, Kato R, Nakata J, Fujioka T, Soma T, Okada M, Ogawa H. Low incidence of HHV‐6 reactivation in haploidentical hematopoietic stem cell transplantation with corticosteroid as graft‐vs‐host disease prophylaxis compared with cord blood transplantation. Transpl Infect Dis 2019; 21:e13073. [DOI: 10.1111/tid.13073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/31/2019] [Accepted: 02/24/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Hiroya Tamaki
- Division of Hematology, Department of Internal Medicine Hyogo College of Medicine Nishinomiya Japan
| | - Kazuhiro Ikegame
- Division of Hematology, Department of Internal Medicine Hyogo College of Medicine Nishinomiya Japan
| | - Satoshi Yoshihara
- Division of Hematology, Department of Internal Medicine Hyogo College of Medicine Nishinomiya Japan
| | - Katsuji Kaida
- Division of Hematology, Department of Internal Medicine Hyogo College of Medicine Nishinomiya Japan
| | - Kyoko Yoshihara
- Division of Hematology, Department of Internal Medicine Hyogo College of Medicine Nishinomiya Japan
| | - Takayuki Inoue
- Division of Hematology, Department of Internal Medicine Hyogo College of Medicine Nishinomiya Japan
| | - Ruri Kato
- Division of Hematology, Department of Internal Medicine Hyogo College of Medicine Nishinomiya Japan
| | - Jun Nakata
- Division of Hematology, Department of Internal Medicine Hyogo College of Medicine Nishinomiya Japan
| | - Tatsuya Fujioka
- Division of Hematology, Department of Internal Medicine Hyogo College of Medicine Nishinomiya Japan
| | - Toshihiro Soma
- Division of Hematology, Department of Internal Medicine Hyogo College of Medicine Nishinomiya Japan
- Laboratory of Cell Transplantation, Institute for Advanced Medical Sciences Hyogo College of Medicine Nishinomiya Japan
| | - Masaya Okada
- Division of Hematology, Department of Internal Medicine Hyogo College of Medicine Nishinomiya Japan
| | - Hiroyasu Ogawa
- Division of Hematology, Department of Internal Medicine Hyogo College of Medicine Nishinomiya Japan
- Laboratory of Cell Transplantation, Institute for Advanced Medical Sciences Hyogo College of Medicine Nishinomiya Japan
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13
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Abidi MZ, Hari P, Chen M, Kim S, Battiwala M, Dahi PB, Diaz MA, Gale RP, Ganguly S, Gergis U, Green J, Hildebrandt G, Hill JA, Komanduri K, Lazarus H, Marks D, Nishihori T, Olsson R, Seo S, Ustun C, Yared J, Yin D, Wingard J, Wirk BM, Auletta J, Lindemans C, Riches M. Virus detection in the cerebrospinal fluid of hematopoietic stem cell transplant recipients is associated with poor patient outcomes: a CIBMTR contemporary longitudinal study. Bone Marrow Transplant 2019; 54:1354-1360. [PMID: 30696997 DOI: 10.1038/s41409-019-0457-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 01/11/2019] [Accepted: 01/17/2019] [Indexed: 12/19/2022]
Abstract
Limited data exist on characteristics of central nervous system viruses (CNS-V) in allogeneic hematopoietic stem cell transplant (HCT) recipients. Between 2007 and 2015, the Center for International Blood and Marrow Transplant Research (CIBMTR) received information on 27,532 patients undergoing HCT. Of these, centers reported 165 HCT recipients with CNS-V detected in cerebrospinal fluid within 6 months after HCT. CNS viruses predominantly included human herpes virus 6 (HHV-6) (73%), followed by Epstein-Barr Virus (10%), cytomegalovirus (3%), varicella zoster virus (3%), herpes simplex virus (3%) and Adenovirus (3%). Median time of viral detection in CNS was 31 days after HCT; and viral detection was earlier in patients with CNS HHV-6. Concurrent viremia occurred in 52% of patients. Cord blood transplant recipients (CBT) accounted for the majority (53%) of patients with CNS-V. Myeloablative conditioning (65%), use of fludarabine (63%), or use of anti-thymocyte globulin (61%) were also predominant. Overall survival from the time of detection of CNS-V was 50% at 6 months and 30% at 5 years. Infections were the leading cause of death (32%). In summary, CBT recipients predominated in the population with CNS-V. Outcomes after CNS-V were poor with significant mortality seen in the first 6 months.
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Affiliation(s)
- Maheen Z Abidi
- Department of Medicine, Division of Infectious Disease, University of Colorado, 12700 E.19th Avenue, Denver, CO, USA.
| | - Parameswaran Hari
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Min Chen
- Department of Medicine, CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Soyoung Kim
- Department of Medicine, CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Minoo Battiwala
- Hematology Branch, National Heart, Lung and Blood Institute, Bethesda, MD, USA
| | - Parastoo Bahrami Dahi
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Miguel Angel Diaz
- Division of Hematopoietic Stem Cell Transplantation, "Nino Jesus" Children Hospital, Madrid, Spain
| | - Robert Peter Gale
- Division of Experimental Medicine, Department of Medicine, Hematology Research Centre, Imperial College London, London, UK
| | - Siddhartha Ganguly
- Department of Medicine, Division of Hematology Oncology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Usama Gergis
- Department of Medical Oncology, Hematologic Malignancies and Bone Marrow Transplant, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Jaime Green
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Gerhard Hildebrandt
- Division of Hematology, Blood, and Marrow Transplantation, University of Kentucky, Lexington, KY, USA
| | - Joshua A Hill
- Department of Medicine, University of Washington, Seattle, Washington; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Krishna Komanduri
- Department of Hematology and Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hillard Lazarus
- Seidman Cancer Center, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - David Marks
- Pediatric Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, UK
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Richard Olsson
- Department of Laboratory Medicine, Division of Therapeutic Immunology, Karolinska Institute, Stockholm, Sweden
| | - Sachiko Seo
- Department of Hematology & Oncology, National Cancer Research Center East, Chiba, Japan
| | - Celalettin Ustun
- Division of Hematology Oncology and Transplantation, Rush University Medical Center, Chicago, IL, USA
| | - Jean Yared
- Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Cancer Center, University of Maryland, Baltimore, MD, USA
| | - Dwight Yin
- Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, USA
| | - John Wingard
- Department of Medicine, Division of Hematology & Oncology, University of Florida, Gainesville, FL, USA
| | - Baldeep Mona Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Jeffrey Auletta
- Divisions of Hematology/Oncology, Bone Marrow Transplantation and Infectious Disease, Nationwide Children's Hospital, Columbus, OH, USA
| | - Caroline Lindemans
- Pediatric Blood and Marrow Transplantation Program, University Medical Center, Utrecht, Netherlands
| | - Marcie Riches
- Division of Hematology/Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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14
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Bartolini L, Libbey JE, Ravizza T, Fujinami RS, Jacobson S, Gaillard WD. Viral Triggers and Inflammatory Mechanisms in Pediatric Epilepsy. Mol Neurobiol 2018; 56:1897-1907. [PMID: 29978423 DOI: 10.1007/s12035-018-1215-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/27/2018] [Indexed: 12/21/2022]
Abstract
Experimental and clinical findings suggest a crucial role for inflammation in the onset of pediatric seizures; this mechanism is not targeted by conventional antiepileptic drugs and may contribute to refractory epilepsy. Several triggers, including infection with neurotropic viruses such as human herpesvirus 6 (HHV-6), other herpesviruses, and picornaviruses, appear to induce activation of the innate and adaptive immune systems, which results in several neuroinflammatory responses, leading to enhanced neuronal excitability, and ultimately contributing to epileptogenesis. This review discusses the proposed mechanisms by which infection with herpesviruses, and particularly with HHV-6, and ensuing inflammation may lead to seizure generation, and later development of epilepsy. We also examine the evidence that links herpesvirus and picornavirus infections with acute seizures and chronic forms of epilepsy. Understanding the mechanisms by which specific viruses may trigger a cascade of alterations in the CNS ultimately leading to epilepsy appears critical for the development of therapeutic agents that may target the virus or inflammatory mechanisms early and prevent progression of epileptogenesis.
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Affiliation(s)
- Luca Bartolini
- Clinical Epilepsy Section, National Institute of Neurological Disorders and Stroke, NIH, Building 10, room 7-5680, 10 Center Drive, Bethesda, MD, 20814, USA. .,Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, NIH, 10 Center Drive, Bethesda, MD, 20892, USA. .,Center for Neuroscience, Children's National Medical Center, George Washington University, 111 Michigan Ave NW, Washington, DC, 20010, USA.
| | - Jane E Libbey
- Department of Pathology, University of Utah School of Medicine, 15 North Medical Drive East, 2600 EEJMRB, Salt Lake City, UT, 84112, USA
| | - Teresa Ravizza
- Neuroscience Department, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Via La Masa 19, 20156, Milan, Italy
| | - Robert S Fujinami
- Department of Pathology, University of Utah School of Medicine, 15 North Medical Drive East, 2600 EEJMRB, Salt Lake City, UT, 84112, USA
| | - Steven Jacobson
- Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, NIH, 10 Center Drive, Bethesda, MD, 20892, USA
| | - William D Gaillard
- Center for Neuroscience, Children's National Medical Center, George Washington University, 111 Michigan Ave NW, Washington, DC, 20010, USA
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15
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Hanson DJ, Hill JA, Koelle DM. Advances in the Characterization of the T-Cell Response to Human Herpesvirus-6. Front Immunol 2018; 9:1454. [PMID: 29988505 PMCID: PMC6026635 DOI: 10.3389/fimmu.2018.01454] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/12/2018] [Indexed: 12/29/2022] Open
Abstract
Human herpesvirus (HHV) 6 is thought to remain clinically latent in most individuals after primary infection and to reactivate to cause disease in persons with severe immunosuppression. In allogeneic hematopoietic stem cell transplant recipients, reactivation of HHV-6 species B is a considerable cause of morbidity and mortality. HHV-6B reactivation is the most frequent cause of infectious meningoencephalitis in this setting and has been associated with a variety of other complications such as graft rejection and acute graft versus host disease. This has inspired efforts to develop HHV-6-targeted immunotherapies. Basic knowledge of HHV-6-specific adaptive immunity is crucial for these endeavors, but remains incomplete. Many studies have focused on specific HHV-6 antigens extrapolated from research on human cytomegalovirus, a genetically related betaherpesvirus. Challenges to the study of HHV-6-specific T-cell immunity include the very low frequency of HHV-6-specific memory T cells in chronically infected humans, the large genome size of HHV-6, and the lack of an animal model. This review will focus on emerging techniques and methodological improvements that are beginning to overcome these barriers. Population-prevalent antigens are now becoming clear for the CD4+ T-cell response, while definition and ranking of CD8+ T-cell antigens and epitopes is at an earlier stage. This review will discuss current knowledge of the T-cell response to HHV-6, new research approaches, and translation to clinical practice.
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Affiliation(s)
- Derek J Hanson
- Department of Medicine, University of Washington, Seattle, WA, United States.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Joshua A Hill
- Department of Medicine, University of Washington, Seattle, WA, United States.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - David M Koelle
- Department of Medicine, University of Washington, Seattle, WA, United States.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States.,Department of Laboratory Medicine, University of Washington, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States.,Benaroya Research Institute, Seattle, WA, United States
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16
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Miura H, Kawamura Y, Hattori F, Tanaka M, Kudo K, Ihira M, Yatsuya H, Takahashi Y, Kojima S, Yoshikawa T. Late-phase human herpesvirus 6B reactivation in hematopoietic stem cell transplant recipients. Transpl Infect Dis 2018; 20:e12916. [PMID: 29797616 DOI: 10.1111/tid.12916] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/17/2018] [Accepted: 05/07/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND We sought to determine whether late-phase human herpesvirus 6B (HHV-6B) infection in hematopoietic stem cell transplant (HSCT) recipients was associated with serious outcomes and mortality. METHODS The occurrence and course of HHV-6B infection was monitored for at least 60 days after transplant using virus isolation and real-time polymerase chain reaction. Risk factors for late-phase HHV-6B infection were examined, and the propensity score was calculated with significant risk factors. The inverse probability-weighted multivariable logistic regression analysis was performed to estimate odds ratios (ORs) and the 95% confidence intervals (95% CI) for mortality. RESULTS Late-phase HHV-6B infection was observed in 12/89 (13.5%) of the HSCT recipients. Older age (OR: 10.3, 95% CI: 2.1/72.9, P = .0027), hematologic malignancy (OR: 10.3, 95% CI: 1.8/97.1, P = .0063), unrelated donor transplantation (OR: 5.3, 95% CI: 1.1/36.0, P = .0345), and sex-mismatched donor transplantation (OR: 6.3, 95% CI: 1.4/39.5, P = .0149) were identified as risk factors for late-phase HHV-6B infection. Fifteen subjects died (17%). Inverse probability-weighted multivariable logistic model analysis revealed that late-phase HHV-6B infection was an independent risk factor for mortality (OR: 4.2, 95% CI: 1.7/11.0, P = .0012). Among 5 of the fatal cases of late-phase HHV-6B infection, viral infection might be associated with severe clinical manifestations. CONCLUSION Late-phase HHV-6B infection in HSCT recipients was associated with worse outcomes. The full spectrum of clinical features of the infection has not been fully elucidated, and therefore, recipients with high-risk factors for late-phase HHV-6B infection should be carefully monitored.
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Affiliation(s)
- Hiroki Miura
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yoshiki Kawamura
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Fumihiko Hattori
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Makito Tanaka
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kazuko Kudo
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Masaru Ihira
- Faculty of Clinical Engineering, Fujita Health University School of Health Sciences, Toyoake, Japan
| | - Hiroshi Yatsuya
- Department of Public Health, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yoshiyuki Takahashi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Seiji Kojima
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tetsushi Yoshikawa
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
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17
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Winestone LE, Punn R, Tamaresis JS, Buckingham J, Pinsky BA, Waggoner JJ, Kharbanda S. High human herpesvirus 6 viral load in pediatric allogeneic hematopoietic stem cell transplant patients is associated with detection in end organs and high mortality. Pediatr Transplant 2018; 22:10.1111/petr.13084. [PMID: 29181879 PMCID: PMC5820136 DOI: 10.1111/petr.13084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2017] [Indexed: 12/27/2022]
Abstract
Human Herpes Virus 6 (HHV-6) reactivation occurs in approximately half of patients following allogeneic hematopoietic stem cell transplant (HSCT). While encephalitis and delayed engraftment are well-documented complications of HHV-6 following HSCT, the extent to which HHV-6 viremia causes disease in children is controversial. We performed a retrospective review of HHV-6 reactivation and possible manifestations in pediatric allogeneic HSCT patients at a single institution. Of 89 children and young adults who underwent allogeneic HSCT over a three-and-a-half-year period, 34 patients reactivated HHV-6 early post-transplant. Unrelated donor stem cell source and lack of antiviral prophylaxis were risk factors for the development of HHV-6 viremia. Viremia correlated with the presence of acute graft-versus-host disease, but not chronic graft-versus-host disease. We identified two subgroups within the viremic patients-a high-risk viremic and tissue-positive group that reactivated HHV-6 and had suspected end-organ disease and a low-risk viremic but asymptomatic group that reactivated HHV-6 but did not exhibit symptoms or signs of end-organ disease. Peak viral load was found to be strongly associated with mortality. Prospective studies in larger numbers of patients are needed to further investigate the role of HHV-6 in causing symptomatic end-organ disease as well as the association of viral load with mortality.
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Affiliation(s)
- Lena E. Winestone
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rajesh Punn
- Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - John S. Tamaresis
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - Julia Buckingham
- Division of Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Benjamin A. Pinsky
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA,Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jesse J. Waggoner
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Sandhya Kharbanda
- Division of Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
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18
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Wood ML, Royle NJ. Chromosomally Integrated Human Herpesvirus 6: Models of Viral Genome Release from the Telomere and Impacts on Human Health. Viruses 2017; 9:E184. [PMID: 28704957 PMCID: PMC5537676 DOI: 10.3390/v9070184] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 06/30/2017] [Accepted: 07/05/2017] [Indexed: 12/11/2022] Open
Abstract
Human herpesvirus 6A and 6B, alongside some other herpesviruses, have the striking capacity to integrate into telomeres, the terminal repeated regions of chromosomes. The chromosomally integrated forms, ciHHV-6A and ciHHV-6B, are proposed to be a state of latency and it has been shown that they can both be inherited if integration occurs in the germ line. The first step in full viral reactivation must be the release of the integrated viral genome from the telomere and here we propose various models of this release involving transcription of the viral genome, replication fork collapse, and t-circle mediated release. In this review, we also discuss the relationship between ciHHV-6 and the telomere carrying the insertion, particularly how the presence and subsequent partial or complete release of the ciHHV-6 genome may affect telomere dynamics and the risk of disease.
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Affiliation(s)
- Michael L Wood
- Department of Genetics, University of Leicester, University Road, Leicester LE1 7RH, UK.
| | - Nicola J Royle
- Department of Genetics, University of Leicester, University Road, Leicester LE1 7RH, UK.
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19
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Greco R, Crucitti L, Noviello M, Racca S, Mannina D, Forcina A, Lorentino F, Valtolina V, Rolla S, Dvir R, Morelli M, Giglio F, Barbanti MC, Lupo Stanghellini MT, Oltolini C, Vago L, Scarpellini P, Assanelli A, Carrabba MG, Marktel S, Bernardi M, Corti C, Clementi M, Peccatori J, Bonini C, Ciceri F. Human Herpesvirus 6 Infection Following Haploidentical Transplantation: Immune Recovery and Outcome. Biol Blood Marrow Transplant 2016; 22:2250-2255. [PMID: 27697585 DOI: 10.1016/j.bbmt.2016.09.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/21/2016] [Indexed: 12/19/2022]
Abstract
Human herpesvirus 6 (HHV-6) is increasingly recognized as a potentially life-threatening pathogen in allogeneic hematopoietic stem cell transplantation (alloSCT). We retrospectively evaluated 54 adult patients who developed positivity to HHV-6 after alloSCT. The median time from alloSCT to HHV-6 reactivation was 34 days. HHV-6 was present in plasma samples from 31 patients, in bone marrow (BM) of 9 patients, in bronchoalveolar lavage fluid and liver or gut biopsy specimens from 33 patients, and in cerebrospinal fluid of 7 patients. Twenty-nine patients developed acute graft-versus-host disease (GVHD), mainly grade III-IV, and 15 had concomitant cytomegalovirus reactivation. The median absolute CD3+ lymphocyte count was 207 cells/µL. We reported the following clinical manifestations: fever in 43 patients, skin rash in 22, hepatitis in 19, diarrhea in 24, encephalitis in 10, BM suppression in 18, and delayed engraftment in 11. Antiviral pharmacologic treatment was administered to 37 patients; nonetheless, the mortality rate was relatively high in this population (overall survival [OS] at 1 year, 38% ± 7%). A better OS was significantly associated with a CD3+ cell count ≥200/µL at the time of HHV-6 reactivation (P = .0002). OS was also positively affected by the absence of acute GVHD grade III-IV (P = .03) and by complete disease remission (P = .03), but was not significantly influenced by steroid administration, time after alloSCT, type of antiviral prophylaxis, plasma viral load, or organ involvement. Although HHV-6 detection typically occurred early after alloSCT, better T cell immune reconstitution seems to have the potential to improve clinical outcomes. Our findings provide new insight into the interplay between HHV-6 and the transplanted immune system.
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Affiliation(s)
- Raffaella Greco
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Maddalena Noviello
- Experimental Hematology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Racca
- Laboratory of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniele Mannina
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Forcina
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Lorentino
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Veronica Valtolina
- Experimental Hematology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Serena Rolla
- Laboratory of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roee Dvir
- Laboratory of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mara Morelli
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Giglio
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Chiara Barbanti
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Chiara Oltolini
- Infectious Disease Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Vago
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Immunogenetics, Leukemia, Genomics, and Immunobiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Scarpellini
- Infectious Disease Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Assanelli
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo G Carrabba
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sarah Marktel
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Bernardi
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Consuelo Corti
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Clementi
- Laboratory of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Jacopo Peccatori
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Bonini
- Experimental Hematology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Ciceri
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
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Ihira M, Yamaki A, Kato Y, Higashimoto Y, Kawamura Y, Yoshikawa T. Cycling probe-based real-time PCR for the detection ofHuman herpesvirus6A and B. J Med Virol 2016; 88:1628-35. [DOI: 10.1002/jmv.24513] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Masaru Ihira
- Faculty of Clinical Engineering; Fujita Health University School of Health Sciences; Toyoake Aichi Japan
| | - Ayumi Yamaki
- ME Center; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Yuri Kato
- Department of Clinical Laboratory; Fujita Health University Hospital; Toyoake Aichi Japan
| | - Yuki Higashimoto
- Department of Clinical Laboratory; Fujita Health University Hospital; Toyoake Aichi Japan
| | - Yoshiki Kawamura
- Department of Pediatrics; Fujita Health University School of Medicine; Toyoake Aichi Japan
| | - Tetsushi Yoshikawa
- Department of Pediatrics; Fujita Health University School of Medicine; Toyoake Aichi Japan
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Detection of Human Herpesvirus 6B (HHV-6B) Reactivation in Hematopoietic Cell Transplant Recipients with Inherited Chromosomally Integrated HHV-6A by Droplet Digital PCR. J Clin Microbiol 2016; 54:1223-7. [PMID: 26888901 DOI: 10.1128/jcm.03275-15] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 01/25/2016] [Indexed: 12/17/2022] Open
Abstract
The presence of inherited chromosomally integrated human herpesvirus 6 (ciHHV-6) in hematopoietic cell transplant (HCT) donors or recipients confounds molecular testing for HHV-6 reactivation, which occurs in 30 to 50% of transplants. Here we describe a multiplex droplet digital PCR clinical diagnostic assay that concurrently distinguishes between HHV-6 species (A or B) and identifies inherited ciHHV-6. By applying this assay to recipient post-HCT plasma and serum samples, we demonstrated reactivation of HHV-6B in 25% (4/16 recipients) of HCT recipients with donor- or recipient-derived inherited ciHHV-6A, underscoring the need for diagnostic testing for HHV-6 infection even in the presence of ciHHV-6.
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Impact of Human Herpesvirus-6 Reactivation on Outcomes of Allogeneic Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2015; 21:2017-22. [DOI: 10.1016/j.bbmt.2015.07.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 07/21/2015] [Indexed: 11/24/2022]
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23
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Virological analysis of inherited chromosomally integrated human herpesvirus-6 in three hematopoietic stem cell transplant patients. Transpl Infect Dis 2015; 17:728-31. [DOI: 10.1111/tid.12419] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 05/24/2015] [Accepted: 07/07/2015] [Indexed: 01/29/2023]
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Analysis of ganciclovir-resistant human herpesvirus 6B clinical isolates using quenching probe PCR methodology. Antimicrob Agents Chemother 2015; 59:2618-24. [PMID: 25691643 DOI: 10.1128/aac.04692-14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 02/11/2015] [Indexed: 11/20/2022] Open
Abstract
Quenching probe PCR (QP-PCR) analysis was used to determine the frequency of ganciclovir (GCV) resistance among clinical isolates of human herpesvirus 6B (HHV-6B) obtained from patients with primary viral infection and viral reactivation. Forty-two HHV-6B clinical isolates were repeatedly recovered from 15 hematopoietic stem cell transplant (HSCT) recipients, and 20 isolates were recovered from 20 exanthem subitum (ES) patients. Of the 15 HSCT recipients, 9 received GCV during the observation period; however, none of the ES patients were treated with GCV. Two established laboratory strains, Z29 and HST, were used as standards in this study. Regions 1 and 2 of the U69 gene of all of the clinical isolates demonstrated the same melting temperature as regions 1 and 2 of the Z29 strain. For region 3, the melting temperatures of all clinical isolates fell between the melting temperature of the plasmid containing the A462D single nucleotide polymorphism (SNP) and the melting temperature of the Z29 strain, and the melting temperatures profiles of all clinical isolates were similar to the melting temperature profile of the Japanese HST strain. As expected, none of the 20 clinical isolates recovered from the ES patients and the 14 isolates recovered from the HSCT recipients who did not receive GCV treatment carried the six known SNPs associated with GCV resistance. Interestingly, these six SNPs were not detected in the 28 clinical isolates recovered from the 9 HSCT recipients who received GCV. Additional sequence analysis of the U69 gene from the 15 representative isolates from the 15 HSCT recipients identified other SNPs. These SNPs were identical to those identified in the HST strain. Therefore, the rate of emergence of GCV-resistant HHV-6B strains appears to be relatively low, even in HSCT recipients treated with GCV.
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Human Herpesvirus-6 Pneumonitis around the Engraftment of Cord Blood Transplantation following Foscarnet Prophylaxis in a Patient with Acute Leukemia. Case Rep Hematol 2015; 2015:949265. [PMID: 25650037 PMCID: PMC4306254 DOI: 10.1155/2015/949265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 12/24/2014] [Indexed: 11/18/2022] Open
Abstract
Human herpesvirus-6 (HHV-6) reactivation is sometimes observed in immunocompromised patients, especially after allogeneic stem cell transplantation. The complications of HHV-6 reactivation in this setting are mainly recognized as HHV-6 encephalitis. We herein report the case of a patient who developed HHV-6 pneumonitis after cord blood transplantation (CBT). A 35-year-old male underwent CBT for T-cell/myeloid mixed phenotype acute leukemia and achieved neutrophil engraftment on day 31. He had received foscarnet as prophylaxis for HHV-6 reactivation. A computed tomography (CT) scan to evaluate the leukemic tumor showed bilateral interstitial pneumonitis on day 33, although he had no respiratory symptoms. The findings of the CT scan were consistent with those of HHV-6 pneumonitis that were reported previously. HHV-6 DNA, but no other pathogens, was detected in his bronchoalveolar lavage (BAL) fluid. The patient was successfully treated with a therapeutic dose of foscarnet. This case indicates that performing a CT scan around the time of neutrophil engraftment can play an important role in detecting the early phase of HHV-6 pneumonia, and BAL should be considered if features consistent with HHV-6 pneumonitis are observed in patients with a risk of HHV-6 reactivation.
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Human herpesvirus 6 is associated with status epilepticus and hyponatremia after umbilical cord blood transplantation. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2014; 25:170-2. [PMID: 25285115 PMCID: PMC4173981 DOI: 10.1155/2014/392720] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This article describes a case involving a 65-year-old man who experienced nonconvulsive status epilepticus after undergoing an allogenic hematopoietic cell transplantation to treat chronic lymphocytic leukemia. The authors describe the diagnostic work-up and treatment of human herpesvirus 6 infection, and discuss other potential causes of nonconvulsive status epilepticus in similar scenarios. Status epilepticus after allogeneic hematopoietic cell transplantation (alloHCT) is rare. The authors report a case involving a 65-year-old man with nonconvulsive status epilepticus 34 days after umbilical cord blood transplantion for chronic lymphocytic leukemia. Cerebrospinal fluid and serum were positive for human herpesvirus 6 (HHV6). Magnetic resonance imaging of the brain showed symmetric T2 hyper-intensity bilaterally in the mesial temporal lobes, and T2 hyperintensi-ties and restricted diffusion of bilateral putamina. Despite aggressive anticonvulsive therapy, his seizures only abated with initiation of ganciclovir therapy. The patient completed six weeks of combination antiviral therapy (ganciclovir and foscarnet). His cognitive function gradually improved and, after prolonged rehabilitation, the patient was discharged home with residual intermittent memory loss but otherwise functional. HHV6 should be considered in the differential diagnosis of nonconvulsive status epilepticus after alloHCT, especially in patients with hyponatremia. Empirical antiviral therapy targeting HHV6 should be administered to these patients.
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Sedlak RH, Cook L, Huang ML, Magaret A, Zerr DM, Boeckh M, Jerome KR. Identification of chromosomally integrated human herpesvirus 6 by droplet digital PCR. Clin Chem 2014; 60:765-72. [PMID: 24594780 DOI: 10.1373/clinchem.2013.217240] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Human herpesvirus 6 (HHV-6) latently infects a majority of adults. In about 1% of the population HHV-6 exists in a chromosomally integrated form (ciHHV-6) that resides in every somatic and germ cell and can be transmitted through the germ line. Patients with ciHHV-6 have been misdiagnosed and unnecessarily treated for active HHV-6 infection, sometimes with important side effects, based on results from quantitative molecular HHV-6 tests. METHODS A droplet digital PCR (ddPCR) assay was developed to identify ciHHV-6 in cellular patient samples by precisely determining the ratio of HHV-6 to cellular DNA. We validated the assay on confirmed ciHHV-6 patient samples and a cell line derived from a ciHHV-6 patient, and we analyzed hematopoietic stem cell transplant patients suspected of having ciHHV-6. We additionally evaluated whether the assay could be applied to stored plasma samples from a study of clinical correlates of HHV-6. RESULTS The ddPCR assay accurately identified ciHHV-6 in cellular samples (buffy coat, peripheral blood mononuclear cells), giving a ratio very close to 1 HHV-6/cell [mean (SD), 1.02 (0.03)] in fluorescence in situ hybridization-confirmed sample). In stored plasma samples, the assay performance was set by design to have 100% sensitivity, which resulted in 82% specificity for ciHHV-6. CONCLUSIONS The possibility of ciHHV-6 is often overlooked in patients with detectable HHV-6 viral loads by quantitative PCR. Our ddPCR test provides rapid and accurate laboratory identification of ciHHV-6 from easily obtained cellular samples. In addition, the assay provides excellent sensitivity and specificity using stored plasma samples, facilitating retrospective analysis of the clinical significance of ciHHV-6.
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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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Affiliation(s)
- Naruhito Otani
- Department of Microbiology; Hyogo College of Medicine; Nishinomiya Hyogo 663-8501 Japan
| | - Toshiomi Okuno
- Department of Microbiology; Hyogo College of Medicine; Nishinomiya Hyogo 663-8501 Japan
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Copy numbers of telomeric repeat sequences of human herpesvirus 6B in clinical isolates: possibility of mixed infections. J Clin Microbiol 2013; 52:419-24. [PMID: 24478470 DOI: 10.1128/jcm.02192-13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In order to determine whether mixed infections of human herpesvirus 6B (HHV-6B) occur in immunocompetent and immunocompromised individuals, we examined the copy numbers of telomeric repeat sequences (TRS) of clinical isolates. In clinical isolates obtained from patients with exanthem subitum caused by primary HHV-6B infection, PCR products with HHV-6B TRS ranging between 400 and 800 bp were amplified. PCR products of various sizes were amplified in four clinical isolates from drug-induced hypersensitivity syndrome (DIHS) patients and 15 isolates from hematopoietic stem cell transplant (HSCT) recipients with HHV-6B reactivation. Based on the sequence analysis of the PCR products, the copy numbers of TRS in DIHS and HSCT patients were between 42 and 82 and 22 and >90, respectively. For two of the HSCT recipients, HHV-6B TRS PCR products of different sizes were detected in several isolates from each patient, which suggests mixed HHV-6B infections. In two of the posttransplant HHV-6B encephalitis patients, the sizes of the TRS nested PCR products amplified from the reactivated virus detected in the central nervous system differed from those of the virus detected in initial isolates from peripheral blood mononuclear cells. Taken together, these results suggest that PCR analysis of TRS copy number is a reliable tool for the discrimination of HHV-6B clinical isolates. Additionally, mixed HHV-6B infections occurred in HSCT recipients, and in some cases, compartmentalization of the HHV-6B strains to the central nervous system versus the blood compartment occurred in posttransplant HHV-6B encephalitis patients.
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Abstract
Human herpesvirus (HHV-) 6A and HHV-6B are two distinct β-herpesviruses which have been associated with various neurological diseases, including encephalitis, meningitis, epilepsy, and multiple sclerosis. Although the reactivation of both viruses is recognized as the cause of some neurological complications in conditions of immunosuppression, their involvement in neuroinflammatory diseases in immunocompetent people is still unclear, and the mechanisms involved have not been completely elucidated. Here, we review the available data providing evidence for the capacity of HHV-6A and -6B to infect the central nervous system and to induce proinflammatory responses by infected cells. We discuss the potential role of both viruses in neuroinflammatory pathologies and the mechanisms which could explain virus-induced neuropathogenesis.
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Affiliation(s)
- Joséphine M. Reynaud
- International Center for Infectiology Research (CIRI), INSERM U1111, CNRS UMR5308, University of Lyon 1, ENS-Lyon, 21 Avenue T. Garnier, 69365 Lyon, France
| | - Branka Horvat
- International Center for Infectiology Research (CIRI), INSERM U1111, CNRS UMR5308, University of Lyon 1, ENS-Lyon, 21 Avenue T. Garnier, 69365 Lyon, France
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Lindahl JK, Woxenius S, Brune M, Andersson R. Human herpesvirus type 6 DNAemia and infection following allogeneic stem cell transplantation with a focus on long-term outcome. ACTA ACUST UNITED AC 2013; 45:557-61. [PMID: 23461659 DOI: 10.3109/00365548.2013.773069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Cases of human herpesvirus type 6 (HHV-6) infection and disease were retrospectively analysed in a cohort of 97 allogeneic haematopoietic stem cell transplantation (allo-SCT) patients in Gothenburg, Sweden (1997-2001). Altogether 54 of 97 (56%) patients were tested for HHV-6. HHV-6 DNAemia was detected in 15 of the tested patients at a median of 76 (range 24-387) days after SCT. Nine of these patients were treated against HHV-6 infection and disease for a total of 11 treatment episodes. The morbidity associated with HHV-6 DNAemia following allo-SCT was in most cases moderate. The overall 1-y survival among the patients with HHV-6 DNAemia was 11/15 (73%) and the 5-y survival was 10/15 (67%), which was not significantly different from the whole cohort.
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Affiliation(s)
- Jenny K Lindahl
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Ihira M, Enomoto Y, Kawamura Y, Nakai H, Sugata K, Asano Y, Tsuzuki M, Emi N, Goto T, Miyamura K, Matsumoto K, Kato K, Takahashi Y, Kojima S, Yoshikawa T. Development of quantitative RT-PCR assays for detection of three classes of HHV-6B gene transcripts. J Med Virol 2012; 84:1388-95. [DOI: 10.1002/jmv.23350] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Cord-blood hematopoietic stem cell transplant confers an increased risk for human herpesvirus-6-associated acute limbic encephalitis: a cohort analysis. Biol Blood Marrow Transplant 2012; 18:1638-48. [PMID: 22564265 DOI: 10.1016/j.bbmt.2012.04.016] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 04/30/2012] [Indexed: 01/18/2023]
Abstract
Human herpesvirus-6 (HHV-6) frequently reactivates after allogeneic hematopoietic stem cell transplantation (HSCT); its most severe manifestation is the syndrome of posttransplantation acute limbic encephalitis (HHV-6-PALE). The epidemiology, risk factors, and characteristics of HHV-6-PALE after unrelated cord-blood transplantation (UCBT) are not well characterized. We analyzed 1344 patients undergoing allogeneic HSCT between March 2003 and March 2010 to identify risk factors and characteristics of HHV-6-PALE. The cohort included 1243 adult-donor HSCT and 101 UCBT recipients. All patients diagnosed with HHV-6-PALE had HHV-6 DNA in cerebrospinal fluid (CSF) specimens in addition to symptoms and studies indicating limbic encephalitis. Nineteen cases (1.4%) of HHV-6-PALE were identified during this study: 10 after UCBT (9.9%) and 9 after adult-donor HSCT (0.7%), for an incidence rate of 1.2 cases/1000 patient-days compared to 0.08 cases/1000 patient-days (P < .001), respectively. Risk factors for HHV-6-PALE on multivariable Cox modeling were UCBT (adjusted hazard ratio [aHR], 20.0; 95% confidence interval [CI], 7.3-55.0; P < .001), time-dependent acute graft-versus-host disease (aGVHD) grades II to IV (aHR, 7.5; 95% CI, 2.8-19.8; P < .001), and adult-mismatched donor (aHR, 4.3; 95% CI, 1.1-17.3; P = .04). Death from HHV-6-PALE occurred in 50% of affected patients undergoing UCBT and no recipients of adult-donor cells. Patients receiving UCBT have increased risk for HHV-6-PALE and greater morbidity from this disease.
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Pustavoitau A, Bhardwaj A, Stevens R. Analytic Review: Neurological Complications of Transplantation. J Intensive Care Med 2011; 26:209-22. [DOI: 10.1177/0885066610389549] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Recipients of solid organ or hematopoietic cell transplants are at risk of life-threatening neurological disorders including encephalopathy, seizures, infections and tumors of the central nervous system, stroke, central pontine myelinolysis, and neuromuscular disorders—often requiring admission to, or occurring in, the intensive care unit (ICU). Many of these complications are linked directly or indirectly to immunosuppressive therapy. However, neurological disorders may also result from graft versus host disease, or be an expression of the underlying disease which prompted transplantation, as well as injury induced during radiation, chemotherapy, surgery, and ICU stay. In rare cases, neuroinfectious pathogens may be transmitted with the transplanted tissue or organ. Diagnosis may be a challenge because clinical symptoms and findings on neuroimaging lack specificity, and a biological specimen or tissue diagnosis is often needed for definitive diagnosis. Management is centered on preventing further neurological injury, etiology-targeted therapy, and balancing the benefits and toxicities of specific immunosuppressive agents.
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Affiliation(s)
- Aliaksei Pustavoitau
- Departments of Anesthesiology Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anish Bhardwaj
- Departments of Neurology and Neurological Surgery, Tufts University School of Medicine, Boston, MA, USA,
| | - Robert Stevens
- Departments of Anesthesiology Critical Care Medicine, Neurology, Neurosurgery, and Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Kawamura Y, Sugata K, Ihira M, Mihara T, Mutoh T, Asano Y, Yoshikawa T. Different characteristics of human herpesvirus 6 encephalitis between primary infection and viral reactivation. J Clin Virol 2011; 51:12-9. [PMID: 21376661 DOI: 10.1016/j.jcv.2011.02.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2010] [Revised: 12/28/2010] [Accepted: 02/07/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pathogenesis of human herpesvirus 6 (HHV-6) encephalitis, in particular difference between HHV-6 encephalitis at the time of primary infection and reactivation remains unclear. OBJECTIVES To elucidate the mechanism of HHV-6 encephalitis at the time of primary infection and reactivation. STUDY DESIGN Twenty-two HHV-6 encephalitis patients at the time of primary infection, 6 febrile convulsion (FC) patients caused by HHV-6 infection, and 14 FC patients without HHV-6 infection (non HHV-6 FC) were enrolled. Additionally, 7 stem cell transplant recipients with HHV-6 encephalitis and eight adult controls were also enrolled in this study. Cerebrospinal fluid (CSF) HHV-6 DNA copy numbers and biomarkers levels were compared. RESULTS Low copy number of CSF HHV-6 DNA was detected in 7 of the 22 patients with HHV-6 encephalitis in primary infection, whereas all seven CSF samples collected from post-transplant HHV-6 encephalitis patients contained high viral DNA copy numbers (P<0.001). CSF concentrations of IL-6 (P=0.032), IL-8 (P=0.014), MMP-9 (P=0.004), and TIMP-1 (P=0.002) were significantly higher in patients with HHV-6 encephalitis in primary infection than non-HHV-6 FC. CSF IL-6 (P=0.008), IL-8 (P=0.015), and IL-10 (P=0.019) concentrations were significantly higher in patients with post-transplant HHV-6 encephalitis than adult controls. CONCLUSION The present study suggests that the characteristics of HHV-6 encephalitis are different between HHV-6 encephalitis at the time of primary infection and reactivation in transplant recipients.
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Affiliation(s)
- Yoshiki Kawamura
- Department of Pediatrics, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 4701192, Japan
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Schmidt-Hieber M, Schwender J, Heinz WJ, Zabelina T, Kühl JS, Mousset S, Schüttrumpf S, Junghanss C, Silling G, Basara N, Neuburger S, Thiel E, Blau IW. Viral encephalitis after allogeneic stem cell transplantation: a rare complication with distinct characteristics of different causative agents. Haematologica 2010; 96:142-9. [PMID: 20851868 DOI: 10.3324/haematol.2010.029876] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Limited data are available on characteristics of viral encephalitis in patients after allogeneic stem cell transplantation. DESIGN AND METHODS We analyzed 2,628 patients after allogeneic stem cell transplantation to identify risk factors and characteristics of viral encephalitis. RESULTS Viral encephalitis occurred in 32 patients (1.2%, 95% confidence interval 0.8%-1.6%) and was associated with the use of OKT-3 or alemtuzumab for T-cell depletion (P < 0.001) and an increased mortality (P = 0.011) in comparison to patients without viral encephalitis. Detected viruses included human herpesvirus-6 (28%), Epstein-Barr virus (19%), herpes simplex virus (13%), JC virus (9%), varicella zoster virus (6%), cytomegalovirus (6%) and adenovirus (3%). More than one virus was identified in 16% of the patients. The median onset time was 106 days after allogeneic stem cell transplantation for the total group of 32 patients, but onset times were shortest in those with human herpesvirus-6 encephalitis and longest in those with JC virus-associated progressive multifocal leukoencephalopathy. The probability of a sustained response to treatment was 63% (95% confidence interval 44%-82%) with a median survival of 94 (95% confidence interval 36-152) days after onset, but significant variation was found when considering different causative viruses. Patients with herpes simplex virus encephalitis had the most favorable outcome with no encephalitis-related deaths. CONCLUSIONS The use of OKT-3 or alemtuzumab for in vivo T-cell depletion is associated with an increased risk of viral encephalitis after allogeneic stem cell transplantation. Different viruses are frequently associated with distinct characteristics such as onset time, response to treatment and outcome.
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Affiliation(s)
- Martin Schmidt-Hieber
- Medizinische Klinik III (Hämatologie, Onkologie and Transfusionsmedizin), Charité Campus Benjamin Franklin, Berlin, Germany.
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39
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Abstract
Human herpesvirus (HHV) 6, the etiologic agent of roseola, is nearly universally acquired during childhood. The virus establishes lifelong infection, including within the central nervous system (CNS), and replicates within several CNS cell types. HHV-6 has been linked to CNS disease during primary infection, including febrile seizures and possibly hippocampal injury. HHV-6 may also be associated with neurologic disease later in life, particularly in transplant patients. Recent reports offer evidence that HHV-6 reactivation may underlie a characteristic limbic encephalitis syndrome following hematopoietic cell transplant; the cardinal features of this syndrome include memory loss, insomnia, electroencephalographic evidence of temporal lobe seizure activity, MRI signal intensity abnormalities of the mesial temporal lobe, and the syndrome of inappropriate release of antidiuretic hormone. HHV-6 DNA is frequently detectable by nucleic acid amplification tests in the cerebrospinal fluid and peripheral blood upon symptom onset, which may provide a screening strategy in high-risk patients. Possible associations of HHV-6 with meningoencephalitis, mesial temporal lobe epilepsy, and multiple sclerosis in apparently immunocompetent hosts are under investigation.
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Affiliation(s)
- Benjamin E Gewurz
- Division of Infectious Diseases, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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40
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Abstract
Although uterine leiomyomata (fibroids) have been the leading indication for hysterectomy in the United States for decades, the epidemiological data on fibroid prevalence and risk factors are limited. Given the hormonal dependence of fibroids, most earlier studies focused on reproductive or hormonal factors. Recent analyses have extended that focus to other areas. We present previously unpublished data on the association between reproductive tract infections and fibroids that highlight the need for more detailed studies. Our review suggests that metabolic, dietary, stress, and environmental factors may also play a role in fibroid development.
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Affiliation(s)
- Shannon K Laughlin
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
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41
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Ljungman P. Molecular monitoring of viral infections after hematopoietic stem cell transplantation. Int J Hematol 2010; 91:596-601. [DOI: 10.1007/s12185-010-0570-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Revised: 04/07/2010] [Accepted: 04/07/2010] [Indexed: 10/19/2022]
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42
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Abstract
Az 1986-ban felfedezett emberi 6-os herpeszvírus A és B változata molekuláris tulajdonságai alapján a legősibb emberi herpeszvírus. A B változat cseppfertőzéssel terjed a tünetmentes vírusürítő felnőttekről a két év alatti kisgyermekekre, akikben alkalmilag exanthema subitum jöhet létre. A vírus a CD4+ macrophagokat, lymphocytákat fertőzi, utóbbiakban élethossziglan lappangás, időnként a nyálmirigyekben vírustermeléssel járó perzisztencia alakul ki. Felnőttkorban ez a változat csontvelő- és szervátültetések kapcsán, immunszuppresszió talaján reaktiválódik, és akár halálos szövődményeket hoz létre. Sclerosis multiplex, idült fáradtság tünetegyüttes, Hodgkin- és nem Hodgkin-lymphomák kialakulásában kofaktor. A CD+-sejteket fertőző és bennük lappangó A változat közvetlen kórokozó képessége nem ismert. A HIV-fertőzést rendkívül erősen transzaktiváljain vitroés betegekben egyaránt. Papillomavírusok által okozott daganatokban is transzaktivátor. Mindkét vírusváltozat kórokozó képessége a megváltozott citokin- és kemokinegyensúlyon alapszik. A két változat elkülönítése szerológiailag nehézkes, erre a savóból vagy a fehérvérsejtekből végzett változatspecifikus PCR alkalmas. A súlyos komplikációk kezelésére, esetleg kemoprofilaxisára ganciclovir, esetleg foscarnet és cidofovir használható.
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Affiliation(s)
- József Ongrádi
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar Közegészségtani Intézet Budapest Nagyvárad tér 4. 1089
| | - Valéria Kövesdi
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar Közegészségtani Intézet Budapest Nagyvárad tér 4. 1089
| | - G. Péter Medveczky
- 2 University of South Florida College of Medicine Department of Molecular Medicine Tampa FL
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Lazarus HM, Laughlin MJ. Viral Infections in Hematopoietic Stem Cell Transplant Recipients. ALLOGENEIC STEM CELL TRANSPLANTATION 2010. [PMCID: PMC7120500 DOI: 10.1007/978-1-59745-478-0_29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Milbradt J, Auerochs S, Korn K, Marschall M. Sensitivity of human herpesvirus 6 and other human herpesviruses to the broad-spectrum antiinfective drug artesunate. J Clin Virol 2009; 46:24-8. [PMID: 19501020 DOI: 10.1016/j.jcv.2009.05.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Antiviral therapy for HHV-6 infection with conventional anti-herpesviral drugs is problematic so novel drugs are required. Artesunate is a well-tolerated drug approved for malaria therapy which possesses antiviral activity. OBJECTIVE The artesunate sensitivity of HHV-6 was analyzed and compared to that of several other human herpesviruses. STUDY DESIGN Cultured human cells were productively infected with strains of HHV-6 or other human herpesviruses to measure artesunate inhibition of viral protein synthesis (Western blot analysis) or viral genome replication (qPCR), and to determine IC(50) values by immunofluorescence or plaque reduction assays. RESULTS Sensitivity of HHV-6 to artesunate was demonstrated with an IC(50) of 3.80+/-1.06microM. This is in a range similar to IC(50) values for HCMV and EBV. Artesunate treatment of HHV-6-infected cells significantly reduced viral early and late protein synthesis that occurred in the absence of drug-induced apoptosis or necrotic cytotoxicity. HHV-6A genome replication was markedly reduced by artesunate. CONCLUSIONS Artesunate possesses anti-HHV-6 activity in vitro and may be useful for treatment of HHV-6 infections.
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Affiliation(s)
- Jens Milbradt
- Institute for Clinical and Molecular Virology, Medical Center Erlangen, University of Erlangen-Nuremberg, Germany.
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45
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Wang LR, Dong LJ, Zhang MJ, Lu DP. Correlations of human herpesvirus 6B and CMV infection with acute GVHD in recipients of allogeneic haematopoietic stem cell transplantation. Bone Marrow Transplant 2008; 42:673-7. [DOI: 10.1038/bmt.2008.238] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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46
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Management of CMV, HHV-6, HHV-7 and Kaposi-sarcoma herpesvirus (HHV-8) infections in patients with hematological malignancies and after SCT. Bone Marrow Transplant 2008; 42:227-40. [PMID: 18587440 DOI: 10.1038/bmt.2008.162] [Citation(s) in RCA: 238] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
These recommendations were prepared by the European Conference on Infections in Leukaemia following a predefined methodology. Literature searches were made to identify studies pertinent to management of CMV, HHV-6, -7 and -8 infections. For CMV, 76 studies were reviewed: 72 published and 4 presented as abstracts. Twenty-nine of these studies were prospective randomized trials. For the other herpesviruses, HHV-6, -7 and -8, no randomized controlled trial has been performed, although data from some studies with other primary endpoints have been used to assess the management of HHV-6 infection. Works presented only as abstracts were used to a very limited extent. The quality of evidence and level of recommendation were graded according to the Center for Disease Control (CDC) criteria.
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Deback C, Agbalika F, Scieux C, Marcelin A, Gautheret-Dejean A, Cherot J, Hermet L, Roger O, Agut H. Detection of human herpesviruses HHV-6, HHV-7 and HHV-8 in whole blood by real-time PCR using the new CMV, HHV-6, 7, 8 R-gene™ kit. J Virol Methods 2008; 149:285-91. [DOI: 10.1016/j.jviromet.2008.01.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2007] [Revised: 01/14/2008] [Accepted: 01/21/2008] [Indexed: 10/22/2022]
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48
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Kitamura K, Asada H, Iida H, Fukumoto T, Kobayashi N, Niizeki H, Morii T, Kimura H, Miyagawa S. Relationship among human herpesvirus 6 reactivation, serum interleukin 10 levels, and rash/graft-versus-host disease after allogeneic stem cell transplantation. J Am Acad Dermatol 2008; 58:802-9. [DOI: 10.1016/j.jaad.2008.01.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Revised: 12/26/2007] [Accepted: 01/10/2008] [Indexed: 10/22/2022]
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49
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Zerr DM. Human herpesvirus 6 and central nervous system disease in hematopoietic cell transplantation. J Clin Virol 2007; 37 Suppl 1:S52-6. [PMID: 17276370 DOI: 10.1016/s1386-6532(06)70012-9] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Human herpesvirus 6 infects virtually all children within the first few years of life and like other herpesviruses, establishes latency after primary infection. In immunocompromised hosts, especially hematopoietic cell transplant (HCT) recipients, HHV-6 has been demonstrated to reactivate frequently. This reactivation has been associated with a number of different clinical endpoints in HCT recipients, including central nervous system (CNS) disease. There have been many detailed descriptions of individual patients with HHV-6-associated encephalitis. In addition, longitudinal observational studies have established a correlation between systemic HHV-6 reactivation and CNS dysfunction. Further research is needed to define optimal diagnostic, prevention, and treatment strategies.
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Affiliation(s)
- Danielle M Zerr
- Children's Hospital and Regional Medical Center and the Department of Pediatrics, University of Washington, Seattle, Washington, USA.
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50
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Pereira CM, de Almeida OP, Corrêa MEP, Costa FF, de Souza CA, Barjas-Castro ML. Detection of human herpesvirus 6 in patients with oral chronic graft-vs-host disease following allogeneic progenitor cell transplantation. Oral Dis 2007; 13:329-34. [PMID: 17448218 DOI: 10.1111/j.1601-0825.2006.01294.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Chronic graft-vs-host disease (cGVHD) is a major cause of morbidity in long-term survivors of allogeneic hematopoietic progenitor cell transplantation. Herpesviruses are involved in the occurrence and progression of various oral diseases. AIM The aim of this study was to investigate the role of human herpesvirus 6 (HHV6) in patients with oral manifestations of cGVHD. MATERIALS AND METHODS Peripheral blood and oral fluids (whole saliva, gingival crevicular fluid and parotid gland saliva) from 19 cGVHD patients, and 28 blood donors were examined for HHV6. Oral tissue samples were collected from 12 cGVHD patients and 12 healthy individuals. Nested polymerase chain reaction was employed to identify the HHV6. RESULTS AND CONCLUSION The virus was detected in whole saliva in 13 cGVHD patients (68%) and in 19 blood donors (67%). HHV6 was not identified in any of the gingival crevicular fluid and parotid gland saliva samples in cGVHD patients. In the control group 14.3% of both, four gingival crevicular fluid and four parotid gland saliva samples were positive. Two oral tissue samples of cGVHD patients were positive for HHV6. These results indicate that patients with oral manifestations of cGVHD and healthy individuals present high and similar incidence of HHV6 in blood and oral fluids. These data do not support the importance of HHV6 in oral lesions of cGVHD.
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Affiliation(s)
- C M Pereira
- Oral Semiology and Oral Pathology, School of Dentistry of Piracicaba, State University of Campinas, São Paulo, Brazil.
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