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Raouf MME, Ouf NM, Elsorady MAS, Ghoneim FM. Human herpesvirus-6 in hematopoietic stem cell transplant recipients: a prospective cohort study in Egypt. Virol J 2023; 20:20. [PMID: 36739398 PMCID: PMC9899109 DOI: 10.1186/s12985-023-01980-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 01/28/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Immunocompromised patients face reactivation of latent viruses that increase the risk of morbidity. AIM The study aimed to detect human herpes virus 6 (HHV-6) reactivation among allogeneic (allo) and autologous (auto) hematopoietic stem cell transplant (HSCT) recipients and to correlate potentially attributed clinical manifestations to HHV-6 DNA plasma level. METHODS A prospective study included all (forty) patients undergoing allo and auto-HSCT from Jan 2020 till June 2022. Plasma samples were collected for HHV-6 serology, and for HHV-6 quantitative PCR at post-transplantation weeks 2, 4, 6. Demographic and clinical data were recorded. RESULTS Out of 40 peripheral blood stem cell transplant (PBSCT) recipients, 34 (85%) were HHV-6 IgG positive pre-HSCT. Of which, fourteen patients (14/34, 41.2%) showed positive HHV-6 DNaemia. HHV-6 DNAemia (15/40, 37.5%) was significantly higher among allo (8/12, 66.7%) versus auto (7/28, 25%) HSCT recipients (p = 0.030). Patients with HHV-6 DNAemia developed fever, delayed engraftment and bone marrow suppression in 6/15, 40%, thrombocytopenia (5/15, 33.3%), rash and pneumonitis (2/15, 13.3%), acute GVHD (aGVHD) (1/15, 6.7%). HHV-6 DNAemia ranged from 101 to 102,000 copies/mL. Univariate analysis identified conditioning with busulfan-cyclophosphamide as a significant risk (p = 0.043), while receiving BEAM protocol was a protective factor (p = 0.045). In multivariate analysis, receiving BEAM protocol retained significance (p = 0.040). CONCLUSION Frequent HHV-6 reactivation was detected after HSCT, especially in allo-HSCT recipients with clinical manifestations which could not be otherwise explained. To our best knowledge this is the first study of HHV6 reactivation in HSCT recipients from Egypt. Raising awareness for HHV-6 reactivation manifestations and screening in HSCT recipients could be lifesaving.
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Affiliation(s)
- May Moheb Eldin Raouf
- Medical Microbiology and Immunology Department, Faculty of Medicine, Alexandria University, 0 Khartoum Square, Azarita, Alexandria, Egypt.
| | - Nancy Mohammed Ouf
- grid.7155.60000 0001 2260 6941Medical Microbiology and Immunology Department, Faculty of Medicine, Alexandria University, 0 Khartoum Square, Azarita, Alexandria, Egypt
| | - Manal Abdel Sattar Elsorady
- grid.7155.60000 0001 2260 6941Internal Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Faika Mahmoud Ghoneim
- grid.7155.60000 0001 2260 6941Medical Microbiology and Immunology Department, Faculty of Medicine, Alexandria University, 0 Khartoum Square, Azarita, Alexandria, Egypt
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Risk factors and outcome of concurrent and sequential multiviral cytomegalovirus, Epstein-Barr virus, BK virus, adenovirus and other viral reactivations in transplantation. Curr Opin Infect Dis 2022; 35:536-544. [PMID: 36255049 DOI: 10.1097/qco.0000000000000888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE OF REVIEW Reactivation of viral infections occurs frequently in immunosuppressed populations, particularly in solid organ (SOT) or allogeneic haematopoietic cell (HCT) transplant patients. Concurrent and sequential multivirus infections are common, yet risk factors and outcomes remain unclear. This review aims to identify the patients vulnerable to multivirus infections and characterize the impact of increased viral burden to formulate prevention and treatment strategies. RECENT FINDINGS Incidences of up to 89% in SOT and 36% in HCT have been reported for two viruses, and 32% in SOT and 28% in HCT for at least three viruses. Risk factors appear related to an increased burden of immunosuppression, with most viral coinfections occurring within 12 months of transplantation. Direct viral complications such as cytomegalovirus disease are more frequent in coinfected patients, with documented prolonged duration of viraemia, higher viral load and increased end-organ disease. Graft dysfunction, acute rejection and graft-vs.-host disease (GVHD) have also been associated. Increased mortality is reported in the HCT population. SUMMARY Multivirus infections occur in a significant proportion of transplant patients and is linked to immunosuppressive burden. There is increasing evidence that this leads to worse graft and patient outcomes. Further prospective studies are required to further comprehensively characterise viral epidemiology, mechanisms and treatment strategies to ameliorate this risk.
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Abstract
AbstractHuman herpes virus 6 (HHV-6) is a ubiquitous and most common pathogen that affects humans. Human herpes virus 6B (HHV-6B) is a wide spread human herpesvirus that infects most people when they are children, establishes latent infections in the central nervous system (CNS), especially in the hippocampus and amygdala, and induces neurologic diseases. HHV-6 can establish a latent infection and be reactivated by various stimuli. Recently, viral genomic DNA of HHV-6B has been detected in surgically removed brain tissues of intractable epilepsy patients, suggesting the involvement of HHV-6B in the pathogenesis of epilepsy. Temporal lobe epilepsy (TLE) has been shown to be closely related with HHV-6B. TLE patients with HHV-6B in their brains suffer from reiterative attacks of febrile seizures and hippocampal sclerosis. However, the mechanisms underlying the contribution of this virus to the development of TLE remains unknown. The direct damage and immune activation caused by the virus are involved in the process of neuron damage, abnormal neural circuit formation and glial cell proliferation. In addition, some cytokines like interleukin-17A (IL-17A), nuclear factor-kappa B (NF-κb), transforming growth factor-β (TGF-β), mitogen-activated protein kinase (MAPK) and phospholipase A2 are up-regulated and involved in the pathological process of TLE. More studies are needed to clarify the mechanisms underlying the link between HHV-6B and epilepsy, and identify biomarkers to recognize different patient groups for anti-inflammatory or immunomodulatory therapies.
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Balsat M, Pillet S, Tavernier E, Cacheux V, Escuret V, Moluçon-Chabrot C, Augeul-Meunier K, Mirand A, Regagnon C, Tinquaut F, Bousser V, Oriol M, Guyotat D, Salles G, Bay JO, Pozzetto B, Cornillon J. Human herpesvirus 6 infection after autologous stem cell transplantation: A multicenter prospective study in adult patients. J Infect 2019; 79:36-42. [PMID: 31075291 DOI: 10.1016/j.jinf.2019.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 01/26/2019] [Accepted: 05/04/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES to prospectively evaluate the incidence and the clinical relevance on hematopoietic reconstitution of HHV-6 infection in autologous hematopoietic stem cell transplantation (ASCT) recipients. METHODS HHV-6 DNA load was measured in whole blood specimens once during the 7 days before stem cell re-infusion and once a week after transplantation until hematopoietic recovery. Active HHV-6 infection was defined by 2 consecutive positive DNA loads. RESULTS from July 2012 to February 2015, 196 adult patients undergoing ASCT were enrolled. Twenty-two (11.2%) patients developed active HHV-6 infection with a cumulative incidence of 19% at 40 days after transplantation. The onset of active HHV-6 infection occurred with a median of 13 days after stem cell re-infusion. HHV-6 infection was associated with an increased frequency of non-infectious complications (OR = 5.05; 95%CI 1.78-14.32; P < 0.001). Moreover, the severity of these non-infectious complications was higher in recipients exhibiting HHV-6 infection (OR = 4.62; 95%CI 1.32-16.2; p < 0.01). Delayed neutrophils 10 (IQR: 8-14) vs 8 (IQR: 6-11) days and platelets recoveries 15 (IQR: 11.8-18.5) vs 8 (IQR: 4-14) days were observed in patients with active HHV-6 infection compared to non-infected ones. CONCLUSIONS in this study, 11.2% ASCT recipients presented active HHV-6 infection associated with significantly delayed hematologic reconstitution.
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Affiliation(s)
- Marie Balsat
- Hematology Department, Institut de Cancérologie Lucien Neuwirth, 108, bis avenue Albert Raymond, 42270 Saint-Priest-en-Jarez, France; Hematology Department, Hospices Civils de Lyon, Pavillon Marcel Bérard, Centre Hospitalier Lyon Sud, 165 chemin du Grand Revoyet, Centre Hospitalier Lyon Sud, 69495 Pierre Bénite, France.
| | - Sylvie Pillet
- CHU de Saint-Etienne, Laboratory of Infectious Agents and Hygiene, avenue Albert Raymond, 42270 Saint-Priest-en-jarez, France
| | - Emmanuelle Tavernier
- Hematology Department, Institut de Cancérologie Lucien Neuwirth, 108, bis avenue Albert Raymond, 42270 Saint-Priest-en-Jarez, France
| | - Victoria Cacheux
- Hematology Department, CHU Clermont-Ferrand, 1, rue Lucie Aubrac, 63100 Clermont-Ferrand, France
| | - Vanessa Escuret
- Hospices Civils de Lyon, GHN, Laboratoire de Virologie F-69317, Lyon, France
| | - Cécile Moluçon-Chabrot
- Hematology Department, CHU Clermont-Ferrand, 1, rue Lucie Aubrac, 63100 Clermont-Ferrand, France
| | - Karine Augeul-Meunier
- Hematology Department, Institut de Cancérologie Lucien Neuwirth, 108, bis avenue Albert Raymond, 42270 Saint-Priest-en-Jarez, France
| | - Audrey Mirand
- CHU Clermont-Ferrand, Laboratory of Virology, F-63003 Clermont-Ferrand, France
| | - Christel Regagnon
- CHU Clermont-Ferrand, Laboratory of Virology, F-63003 Clermont-Ferrand, France
| | - Fabien Tinquaut
- Institut de Cancérologie Lucien Neuwirth, Centre Hygée, Chemin de la Marandière, 42270 Saint-Priest-en-Jarez, France
| | - Véronique Bousser
- Institut de Cancérologie Lucien Neuwirth, Centre Hygée, Chemin de la Marandière, 42270 Saint-Priest-en-Jarez, France
| | - Mathieu Oriol
- Institut de Cancérologie Lucien Neuwirth, Centre Hygée, Chemin de la Marandière, 42270 Saint-Priest-en-Jarez, France
| | - Denis Guyotat
- Hematology Department, Institut de Cancérologie Lucien Neuwirth, 108, bis avenue Albert Raymond, 42270 Saint-Priest-en-Jarez, France
| | - Gilles Salles
- Hematology Department, Hospices Civils de Lyon, Pavillon Marcel Bérard, Centre Hospitalier Lyon Sud, 165 chemin du Grand Revoyet, Centre Hospitalier Lyon Sud, 69495 Pierre Bénite, France
| | - Jacques-Olivier Bay
- Hospices Civils de Lyon, GHN, Laboratoire de Virologie F-69317, Lyon, France
| | - Bruno Pozzetto
- CHU de Saint-Etienne, Laboratory of Infectious Agents and Hygiene, avenue Albert Raymond, 42270 Saint-Priest-en-jarez, France
| | - Jérôme Cornillon
- Hematology Department, Institut de Cancérologie Lucien Neuwirth, 108, bis avenue Albert Raymond, 42270 Saint-Priest-en-Jarez, France
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Shargian-Alon L, Yahav D, Rozovski U, Dovrat S, Amitai I, Sela-Navon M, Pasvolsky O, Raanani P, Yeshurun M. Human herpes virus 6 reactivation following autologous hematopoietic cell transplantation - a single-center experience. Leuk Lymphoma 2019; 60:2230-2236. [PMID: 30773083 DOI: 10.1080/10428194.2019.1576869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Data regarding presentation and management of human herpes virus 6 (HHV-6) reactivation among autologous hematopoietic cell transplantation (HCT) recipients are limited. We retrospectively reviewed medical charts of all autologous HCT patients tested for HHV-6 reactivation due to suspected clinical presentation between 1/2012 and 8/2017. Among 328 autologous HCT recipients, 44 patients were tested for HHV-6 reactivation. Thirty patients tested positive; 29 (97%) had sustained fever, six (20%) had rash and four (13%) had pneumonia. Median C-reactive protein was significantly lower in HHV-6 positive patients compared to negative patients (3.6 (range, 0.4-11) vs. 9.6 (range, 3.2-30) mg/dL, respectively, p = .004). Ganciclovir formulations were administrated in 29 (97%) patients with median time to fever resolution of one (range, 1-2) day. HHV-6 should be considered as an important cause of post engraftment fever in autologous HCT. Larger studies are warranted to evaluate incidence of HHV-6 reactivation and optimal treatment regimen.
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Affiliation(s)
- Liat Shargian-Alon
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center , Petah-Tikva , Israel.,Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Dafna Yahav
- Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel.,Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital , Petah-Tikva , Israel
| | - Uri Rozovski
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center , Petah-Tikva , Israel.,Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Sara Dovrat
- Central Virology Laboratory, Israel Ministry of Health, Chaim Sheba Medical Center , Tel-Hashomer , Israel
| | - Irina Amitai
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center , Petah-Tikva , Israel.,Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Michal Sela-Navon
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center , Petah-Tikva , Israel
| | - Oren Pasvolsky
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center , Petah-Tikva , Israel.,Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Pia Raanani
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center , Petah-Tikva , Israel.,Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Moshe Yeshurun
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center , Petah-Tikva , Israel.,Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
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Genomic Integration of HHV-6 Mimicking Viral Reactivation after Autologous Stem Cell Transplantation. Mediterr J Hematol Infect Dis 2018. [PMID: 29531650 PMCID: PMC5841938 DOI: 10.4084/mjhid.2018.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The monitoring of Human Herpesvirus 6 (HHV-6) after allogeneic stem cell transplantation has proven to be useful in preventing life-threatening complications; however, the pathogenic role of HHV-6 after autologous transplantation is not well-characterized, although viral reactivation might be responsible for significant complications even after this type of transplant. Here we report, for the first time to our knowledge, the case of a patient with chromosomally integrated HHV-6 (ciHHV-6), presenting with high titers of HHV-6 DNA copies after autologous transplantation, mimicking HHV-6 reactivation. The presence of viral DNA in the follicle bulb confirmed the ciHHV-6 and allowed for the discontinuation of the antiviral treatment. Due to the increasing awareness of HHV-6 potential pathogenicity and the fact that ciHHV-6 is expected in 1–2% of the population, such a case might be helpful in recognizing ci HHV-6, thus avoiding unnecessary and potentially toxic antiviral therapy once the viral genomic integration is confirmed.
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7
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Marchesi F, Pimpinelli F, Ensoli F, Mengarelli A. Cytomegalovirus infection in hematologic malignancy settings other than the allogeneic transplant. Hematol Oncol 2017; 36:381-391. [DOI: 10.1002/hon.2453] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/28/2017] [Accepted: 06/05/2017] [Indexed: 12/13/2022]
Affiliation(s)
- F. Marchesi
- Hematology and Stem Cell Transplant Unit; Regina Elena National Cancer Institute; Rome Italy
| | - F. Pimpinelli
- Molecular Virology, Pathology and Microbiology Laboratory; San Gallicano Dermatological Institute; Rome Italy
| | - F. Ensoli
- Molecular Virology, Pathology and Microbiology Laboratory; San Gallicano Dermatological Institute; Rome Italy
| | - A. Mengarelli
- Hematology and Stem Cell Transplant Unit; Regina Elena National Cancer Institute; Rome Italy
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8
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Colombier MA, Amorim S, Salmona M, Thieblemont C, Legoff J, Lafaurie M. HHV-6 reactivation as a cause of fever in autologous hematopoietic stem cell transplant recipients. J Infect 2017; 75:155-159. [PMID: 28551368 DOI: 10.1016/j.jinf.2017.05.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 03/30/2017] [Accepted: 05/17/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVES We report the biological and clinical impacts possibly associated with HHV-6 reactivation in autologous hematopoietic stem cell transplant (AHSCT) recipients after intensive chemotherapy regimen for lymphoma. METHODS We retrospectively reviewed clinical, biological, radiological, treatment and outcomes of patients with positive HHV-6 DNA in whole blood following autologous hematopoietic stem cell transplantation. RESULTS Blood HHV-6 reactivation was reported in 27 (8.5%) patients among 316 AHSCT recipients after high dose therapy for lymphoma. Thirteen (4.1%) patients were symptomatic with fever (100%), diarrhea (61.5%), skin rash (46.1%), and pneumonia (23.1%). Antiviral treatment was administered in 9 (69%) patients and outcome was favorable in all cases. CONCLUSION Our study suggests a possible pathogenic role of HHV-6 in AHSCT recipients and suggests an impact of antiviral treatments on viral replication and clinical signs resolution.
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Affiliation(s)
- M A Colombier
- Department of Infectious Diseases, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - S Amorim
- Department of Hemato-Oncology, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - M Salmona
- Microbiology Laboratory, Inserm U941, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - C Thieblemont
- Department of Hemato-Oncology, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - J Legoff
- Microbiology Laboratory, Inserm U941, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - M Lafaurie
- Department of Infectious Diseases, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.
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Ongrádi J, Ablashi DV, Yoshikawa T, Stercz B, Ogata M. Roseolovirus-associated encephalitis in immunocompetent and immunocompromised individuals. J Neurovirol 2017; 23:1-19. [PMID: 27538995 PMCID: PMC5329081 DOI: 10.1007/s13365-016-0473-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 06/15/2016] [Accepted: 07/17/2016] [Indexed: 01/26/2023]
Abstract
The roseoloviruses, human herpesvirus (HHV)-6A, HHV-6B, and HHV-7, can cause severe encephalitis or encephalopathy. In immunocompetent children, primary HHV-6B infection is occasionally accompanied by diverse clinical forms of encephalitis. Roseolovirus coinfections with heterologous viruses and delayed primary HHV-7 infection in immunocompetent adults result in very severe neurological and generalized symptoms. Recovery from neurological sequelae is slow and sometimes incomplete. In immunocompromised patients with underlying hematological malignancies and transplantation, frequent single or simultaneous reactivation of roseoloviruses elicit severe, lethal organ dysfunctions, including damages in the limbic system, brain stem, and hippocampus. Most cases have been due to HHV-6B with HHV-6A accounting for 2-3%. The most severe manifestation of HHV-6B reactivation is post-transplantation limbic encephalitis. Seizures, cognitive problems, and abnormal EEG are common. Major risk factors for HHV-6B-associated encephalitis include unrelated cord blood cell transplantation and repeated hematopoietic stem cell transplantation. Rare genetic disorders, male gender, certain HLA constellation, and immune tolerance to replicating HHV-6 in persons carrying chromosomally integrated HHV-6 might also predispose an individual to roseolovirus-associated brain damage. At this time, little is known about the risk factors for HHV-7-associated encephalitis. Intrathecal glial cell destruction due to virus replication, overexpression of proinflammatory cytokines, and viral mimicry of chemokines all contribute to brain dysfunction. High virus load in the cerebrospinal fluid, hippocampal astrogliosis, and viral protein expression in HHV-6B-associated cases and multiple microscopic neuronal degeneration in HHV-7-associated cases are typical laboratory findings. Early empirical therapy with ganciclovir or foscarnet might save the life of a patient with roseolovirus-associated encephalitis.
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Affiliation(s)
- Joseph Ongrádi
- Institute of Medical Microbiology, Semmelweis University, Nagyvárad tér 4, Budapest, 1089, Hungary.
| | - Dharam V Ablashi
- HHV-6 Foundation, 1482 East Valley Road, Santa Barbara, CA, 93101, USA
| | - Tetsushi Yoshikawa
- Department of Pediatrics, Fujita Health University School of Medicine, 1-98, Kotsukake-cho, Dengakugakolo, Toyoake, Aichi, 470-1192, Japan
| | - Balázs Stercz
- Institute of Medical Microbiology, Semmelweis University, Nagyvárad tér 4, Budapest, 1089, Hungary
| | - Masao Ogata
- Department of Medical Oncology and Hematology, Oita University Hospital, Hasama-machi, Yufu City, 879-5593, Japan
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Human Herpesvirus 6 replication predicts Cytomegalovirus reactivation after allogeneic stem cell transplantation from haploidentical donor. J Clin Virol 2016; 84:24-26. [PMID: 27669362 DOI: 10.1016/j.jcv.2016.09.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 08/16/2016] [Accepted: 09/19/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Since HHV-6 reactivation after transplant has been reported to increase the risk of CMV infection, we tested this hypothesis in the HLA-haploidentical hematopoietic stem cell transplantation setting. STUDY DESIGN From February 2011 to October 2015, 75 patients received hematopoietic stem cell transplantation using a T-cell replete graft from a HLA-haploidentical donor at our Institution. RESULTS Interestingly, 87% of HHV-6 reactivations were followed by a CMV reactivation, at a median of 15days between the two viruses. Incidence of CMV reactivation was 14.5-fold higher in those patients with prior HHV-6 reactivation vs. those without it (p-value<0.001). CONCLUSION The present results suggest that HHV-6 can be considered as a predicting indicator of cellular immunosuppression preceding the onset of CMV infection.
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Inazawa N, Hori T, Nojima M, Saito M, Igarashi K, Yamamoto M, Shimizu N, Yoto Y, Tsutsumi H. Virus reactivations after autologous hematopoietic stem cell transplantation detected by multiplex PCR assay. J Med Virol 2016; 89:358-362. [PMID: 27364410 DOI: 10.1002/jmv.24621] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2016] [Indexed: 11/05/2022]
Abstract
Several studies have indicated that viral reactivations following allogeneic hematopoietic stem cell transplantation (allo-HSCT) are frequent, but viral reactivations after autologous HSCT (auto-HSCT) have not been investigated in detail. We performed multiplex polymerase chain reaction (PCR) assay to examine multiple viral reactivations simultaneously in 24 patients undergoing auto-HSCT between September 2010 and December 2012. Weekly whole blood samples were collected from pre- to 42 days post-HSCT, and tested for the following 13 viruses; herpes simplex virus 1 (HSV-1), HSV-2, varicella-zoster virus (VZV), Epstein-Barr virus (EBV), cytomegalovirus (CMV), human herpesvirus 6 (HHV-6), HHV-7, HHV-8, adeno virus (ADV), BK virus (BKV), JC virus (JCV), parvovirus B19 (B19V), and hepatitis B virus (HBV). Fifteen (63%) patients had at least one type of viral reactivation. HHV6 (n = 10; 41.7%) was most frequently detected followed by EBV (n = 7; 29.2%). HHV-6 peaked on day 21 after HSCT and promptly declined. In addition, HBV, CMV, HHV7, and B19V were each detected in one patient. HHV6 reactivation was detected in almost half the auto-HSCT patients, which was similar to the incidence in allo-HSCT patients. The incidence of EBV was unexpectedly high. Viral infections in patients undergoing auto-HSCT were higher than previously reported in other studies. Although there were no particular complications of viral infection, we should pay attention to possible viral reactivations in auto-HSCT patients. J. Med. Virol. 89:358-362, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Natsuko Inazawa
- Department of Pediatrics, JCHO Sapporo Hokushin Hospital, Sapporo, Japan
| | - Tsukasa Hori
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masanori Nojima
- The Institute of Medical Science Hospital, Tokyo University, Tokyo, Japan
| | - Makoto Saito
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Keita Igarashi
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masaki Yamamoto
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Norio Shimizu
- Department of Virology Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuko Yoto
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiroyuki Tsutsumi
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
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Dzieciatkowski T, Tomaszewska A, Przybylski M, Rusicka P, Basak GW, Jedrzejczak WW, Wroblewska M, Halaburda K. Analysis of the shedding of three β-herpesviruses DNA in Polish patients subjected to allogeneic hematopoietic stem cell transplantation: Six-year follow up. J Clin Virol 2016; 76:30-5. [PMID: 26809130 DOI: 10.1016/j.jcv.2016.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 10/25/2015] [Accepted: 01/07/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Infections with human β-herpesviruses are common worldwide and are still frequent in patients after hematopoietic stem cell transplantation. Some data suggest that HHV-6 and HHV-7 could take part in CMV reactivation from latency and/or progression of CMV disease in immunosupressed patients. OBJECTIVES The aims of this study were: (1) to summarise retrospectively the results of β-herpesviruses DNA detection in a large group of adult allogeneic haematopoietic stem cell transplant recipients; and (2) to find a potential correlation between viruses belonging to this subfamily. STUDY DESIGN AlloHSCT recipients (N=142) were examined in the early post-transplant period (median=89 days). The presence of CMV, HHV-6 and HHV-7 was confirmed through detection and quantification of viral DNA, isolated from 1679 sera samples. RESULTS CMV DNA alone was detected in 23.9% of patients, while single HHV-6 and HHV-7 were detected in 14.8% and 9.9% of individuals, respectively. The reactivation of more than one virus was identified in 31% of analysed patients. In cases of concurrent infection, HHV-7 was detected at the same time as HHV-6, and both of them were usually reactivated before CMV. The kinetics of virus reactivation and measured viral load may suggest a potential role of HHV-6 and HHV-7 as co-factors in CMV reactivation. CONCLUSIONS The observed kinetics of virus reactivation may strongly suggest a potential role of HHV-6 and/or HHV-7 as co-factors of CMV reactivation. The co-infection with these β-herpesviruses could predispose patients after hematopoietic stem cell transplantation to a longer and more severe CMV infection.
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Affiliation(s)
- Tomasz Dzieciatkowski
- Department of Microbiology, Central Clinical Hospital in Warsaw, 1A Banacha Str., 02-097 Warsaw, Poland; Chair and Department of Medical Microbiology, Medical University of Warsaw, 5 Chalubinskiego Str., 02-004 Warsaw, Poland
| | - Agnieszka Tomaszewska
- Department of Haematopoietic Stem Cell Transplantation, Institute of Haematology and Transfusion Medicine, 14 Gandhi Str., 02-776 Warsaw, Poland.
| | - Maciej Przybylski
- Department of Microbiology, Central Clinical Hospital in Warsaw, 1A Banacha Str., 02-097 Warsaw, Poland; Chair and Department of Medical Microbiology, Medical University of Warsaw, 5 Chalubinskiego Str., 02-004 Warsaw, Poland
| | - Patrycja Rusicka
- Department of Haematology, Oncology and Internal Medicine, Medical University of Warsaw, 1A Banacha Str., 02-097 Warsaw, Poland
| | - Grzegorz W Basak
- Department of Haematology, Oncology and Internal Medicine, Medical University of Warsaw, 1A Banacha Str., 02-097 Warsaw, Poland
| | - Wieslaw W Jedrzejczak
- Department of Haematology, Oncology and Internal Medicine, Medical University of Warsaw, 1A Banacha Str., 02-097 Warsaw, Poland
| | - Marta Wroblewska
- Department of Microbiology, Central Clinical Hospital in Warsaw, 1A Banacha Str., 02-097 Warsaw, Poland; Department of Dental Microbiology, Medical University of Warsaw, 1A Banacha Str., 02-097 Warsaw, Poland; Infection Control Unit, Institute of Haematology and Transfusion Medicine, 14 Gandhi Str., 02-776 Warsaw, Poland
| | - Kazimierz Halaburda
- Department of Haematopoietic Stem Cell Transplantation, Institute of Haematology and Transfusion Medicine, 14 Gandhi Str., 02-776 Warsaw, Poland
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13
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Chapenko S, Roga S, Skuja S, Rasa S, Cistjakovs M, Svirskis S, Zaserska Z, Groma V, Murovska M. Detection frequency of human herpesviruses-6A, -6B, and -7 genomic sequences in central nervous system DNA samples from post-mortem individuals with unspecified encephalopathy. J Neurovirol 2016; 22:488-97. [PMID: 26727906 DOI: 10.1007/s13365-015-0417-0] [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: 09/02/2015] [Revised: 11/25/2015] [Accepted: 12/09/2015] [Indexed: 12/22/2022]
Abstract
In this autopsy-based study, human herpesvirus-6 (HHV-6) and -7 (HHV-7) genomic sequence frequency, HHV-6 variants, HHV-6 load and the expression of HHV-6 antigens in brain samples from the individuals, with and without unspecified encephalopathy (controls), using nested and real-time polymerase chain reactions, restriction endonuclease, and immunohistochemical analysis were examined. GraphPad Prism 6.0 Mann-Whitney nonparametric and chi-square test and Fisher's exact test were used for statistical analysis. The encephalopathy diagnoses were shown by magnetic resonance imaging made during their lifetime and macro- and microscopically studied autopsy tissue materials. Widespread HHV-6 and/or HHV-7 positivity was detected in the brain tissue of various individuals with encephalopathy, as well as in controls (51/57, 89.4 % and 35/51, 68.6 %, respectively; p = 0.009). Significantly higher detection frequency of single HHV-6 and concurrent HHV-6 + HHV-7 DNA was found in pia mater meninges, frontal lobe, temporal lobe, and olfactory tract DNAs in individuals with encephalopathy compared to the control group. HHV-6 load and higher frequency of the viral load >10 copies/10(6) cells significantly differed in samples from individuals with and without encephalopathy. The expression of HHV-6 antigens was revealed in different neural cell types with strong predominance in the encephalopathy group. In all HHV-6-positive autopsy samples of individuals with and without encephalopathy, HHV-6B was revealed. Significantly higher detection frequency of beta-herpesvirus DNA, more often detected HHV-6 load >10 copies/10(6) cells, as well as the expression of HHV-6 antigens in different brain tissue samples from individuals with encephalopathy in comparison with control group indicate on potential involvement of these viruses in encephalopathy development.
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Affiliation(s)
- Svetlana Chapenko
- August Kirchenstein Institute of Microbiology and Virology, Riga Stradins University, Ratsupites iela 5, Riga, Latvia.
| | - Silvija Roga
- Study Department, Riga Stradins University, Riga, Latvia.,Pathology Department, Riga 1st Hospital, Riga, Latvia
| | - Sandra Skuja
- Institute of Anatomy and Anthropology, Riga Stradins University, Riga, Latvia
| | - Santa Rasa
- August Kirchenstein Institute of Microbiology and Virology, Riga Stradins University, Ratsupites iela 5, Riga, Latvia
| | - Maksims Cistjakovs
- August Kirchenstein Institute of Microbiology and Virology, Riga Stradins University, Ratsupites iela 5, Riga, Latvia
| | - Simons Svirskis
- August Kirchenstein Institute of Microbiology and Virology, Riga Stradins University, Ratsupites iela 5, Riga, Latvia
| | - Zane Zaserska
- August Kirchenstein Institute of Microbiology and Virology, Riga Stradins University, Ratsupites iela 5, Riga, Latvia
| | - Valerija Groma
- Institute of Anatomy and Anthropology, Riga Stradins University, Riga, Latvia
| | - Modra Murovska
- August Kirchenstein Institute of Microbiology and Virology, Riga Stradins University, Ratsupites iela 5, Riga, Latvia
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14
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Ueda MYH, Alvarenga PG, Real JM, Moreira EDS, Watanabe A, Passos-Castilho AM, Vescovi M, Novis Y, Rocha V, Seber A, Oliveira JSR, Rodrigues CA, Granato CFH. Optimisation of a quantitative polymerase chain reaction-based strategy for the detection and quantification of human herpesvirus 6 DNA in patients undergoing allogeneic haematopoietic stem cell transplantation. Mem Inst Oswaldo Cruz 2015; 110:461-7. [PMID: 26038958 PMCID: PMC4501408 DOI: 10.1590/0074-02760150004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 05/07/2015] [Indexed: 12/19/2022] Open
Abstract
Human herpesvirus 6 (HHV-6) may cause severe complications after haematopoietic stem
cell transplantation (HSCT). Monitoring this virus and providing precise, rapid and
early diagnosis of related clinical diseases, constitute essential measures to
improve outcomes. A prospective survey on the incidence and clinical features of
HHV-6 infections after HSCT has not yet been conducted in Brazilian patients and the
impact of this infection on HSCT outcome remains unclear. A rapid test based on
real-time quantitative polymerase chain reaction (qPCR) has been optimised to screen
and quantify clinical samples for HHV-6. The detection step was based on reaction
with TaqMan® hydrolysis probes. A set of previously described primers and
probes have been tested to evaluate efficiency, sensitivity and reproducibility. The
target efficiency range was 91.4% with linearity ranging from 10-106
copies/reaction and a limit of detection of five copies/reaction or 250 copies/mL of
plasma. The qPCR assay developed in the present study was simple, rapid and
sensitive, allowing the detection of a wide range of HHV-6 loads. In conclusion, this
test may be useful as a practical tool to help elucidate the clinical relevance of
HHV-6 infection and reactivation in different scenarios and to determine the need for
surveillance.
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Affiliation(s)
| | | | - Juliana M Real
- Centro de Oncologia, Instituto de Ensino e Pesquisa, Hospital Sírio Libanês, São Paulo, SP, Brasil
| | | | | | | | | | - Yana Novis
- Centro de Oncologia, Instituto de Ensino e Pesquisa, Hospital Sírio Libanês, São Paulo, SP, Brasil
| | - Vanderson Rocha
- Centro de Oncologia, Instituto de Ensino e Pesquisa, Hospital Sírio Libanês, São Paulo, SP, Brasil
| | - Adriana Seber
- Instituto de Oncologia Pediátrica, São Paulo, SP, Brasil
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15
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Inhibitors of nucleotidyltransferase superfamily enzymes suppress herpes simplex virus replication. Antimicrob Agents Chemother 2014; 58:7451-61. [PMID: 25267681 DOI: 10.1128/aac.03875-14] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Herpesviruses are large double-stranded DNA viruses that cause serious human diseases. Herpesvirus DNA replication depends on multiple processes typically catalyzed by nucleotidyltransferase superfamily (NTS) enzymes. Therefore, we investigated whether inhibitors of NTS enzymes would suppress replication of herpes simplex virus 1 (HSV-1) and HSV-2. Eight of 42 NTS inhibitors suppressed HSV-1 and/or HSV-2 replication by >10-fold at 5 μM, with suppression at 50 μM reaching ∼1 million-fold. Five compounds in two chemical families inhibited HSV replication in Vero and human foreskin fibroblast cells as well as the approved drug acyclovir did. The compounds had 50% effective concentration values as low as 0.22 μM with negligible cytotoxicity in the assays employed. The inhibitors suppressed accumulation of viral genomes and infectious particles and blocked events in the viral replication cycle before and during viral DNA replication. Acyclovir-resistant mutants of HSV-1 and HSV-2 remained highly sensitive to the NTS inhibitors. Five of six NTS inhibitors of the HSVs also blocked replication of another herpesvirus pathogen, human cytomegalovirus. Therefore, NTS enzyme inhibitors are promising candidates for new herpesvirus treatments that may have broad efficacy against members of the herpesvirus family.
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16
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17
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Ablashi D, Agut H, Alvarez-Lafuente R, Clark DA, Dewhurst S, DiLuca D, Flamand L, Frenkel N, Gallo R, Gompels UA, Höllsberg P, Jacobson S, Luppi M, Lusso P, Malnati M, Medveczky P, Mori Y, Pellett PE, Pritchett JC, Yamanishi K, Yoshikawa T. Classification of HHV-6A and HHV-6B as distinct viruses. Arch Virol 2014; 159:863-70. [PMID: 24193951 PMCID: PMC4750402 DOI: 10.1007/s00705-013-1902-5] [Citation(s) in RCA: 235] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 10/18/2013] [Indexed: 12/18/2022]
Abstract
Shortly after the discovery of human herpesvirus 6 (HHV-6), two distinct variants, HHV-6A and HHV-6B, were identified. In 2012, the International Committee on Taxonomy of Viruses (ICTV) classified HHV-6A and HHV-6B as separate viruses. This review outlines several of the documented epidemiological, biological, and immunological distinctions between HHV-6A and HHV-6B, which support the ICTV classification. The utilization of virus-specific clinical and laboratory assays for distinguishing HHV-6A and HHV-6B is now required for further classification. For clarity in biological and clinical distinctions between HHV-6A and HHV-6B, scientists and physicians are herein urged, where possible, to differentiate carefully between HHV-6A and HHV-6B in all future publications.
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18
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Tomaszewska A, Kryśko A, Dzieciątkowski T, Przybylski M, Basak GW, Hałaburda K, Piekarska K, Sulowska A, Nasiłowska-Adamska B, Młynarczyk G, Jędrzejczak WW, Mariańska B. Co-infections with cytomegalovirus and human herpesvirus type 7 in adult Polish allogeneic haematopoietic stem cell transplant recipients. Arch Immunol Ther Exp (Warsz) 2013; 62:77-80. [PMID: 23955532 PMCID: PMC3898125 DOI: 10.1007/s00005-013-0252-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 08/05/2013] [Indexed: 11/29/2022]
Abstract
Human herpesvirus 7 (HHV-7) is widespread around the world and may also be a possible cofactor for cytomegalovirus (CMV) infection in haematopoietic stem cell transplant (HSCT) recipients. In case of viral diseases where specific treatment is available, real-time PCR assays constitute reliable diagnostic tools enabling timely initiation of appropriate therapy and rapid assessment of the efficacy of antiviral treatment strategies. The presence of CMV and HHV-7 was confirmed by the detection of viral DNA isolated from 1,027 plasma samples. A group of 69 allogeneic HSCT (alloHSCT) recipients was examined in early post-transplant period using quantitative real-time PCR methods. Within the study period, 62 % of patients had at least once CMV DNA-emia, while HHV-7 DNA was found in 43 % of subjects. Co-infection between these β-herpesviruses was detected in the plasma samples collected from 18 patients (26 %). Patients with concomitant HHV-7 DNA-emia had significantly higher number of CMV DNA copies compared with those without HHV-7 infection (1986 vs. 432 copies/ml, p < 0.001) but there was no difference in duration of CMV DNA-emia between these groups. On the other hand, while the load of HHV-7 DNA was comparable between patients with CMV DNA-emia and without CMV DNA-emia, the duration of HHV-7 DNA-emia was significantly longer in the first group (38.5 vs. 14 days, p < 0.001). HHV-7 DNA-emia is very frequently detected in Polish alloHSCT recipients. In those, who have subsequent CMV reactivation, the coexistence of the viruses may negatively affect the kinetics of infection with either of them. Therefore the investigation of concomitant HHV-7 DNA-emia could affect the prognosis of post-transplant patients suffering from CMV reactivation.
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Affiliation(s)
- Agnieszka Tomaszewska
- Department of Haematopoetic Stem Cell Transplantation, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
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