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Ganea OA, Tilișcan C, Streinu-Cercel A, Pițigoi D, Drăgănescu AC, Lazar M, Mihai N, Florea D, Aramă SȘ, Aramă V. Human Herpesvirus 6-A Rare Aetiologic Agent for CNS Infections in Immunocompetent Individuals or an Underestimation? J Clin Med 2024; 13:4660. [PMID: 39200800 PMCID: PMC11355476 DOI: 10.3390/jcm13164660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 08/04/2024] [Accepted: 08/07/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Human herpesvirus 6 (HHV-6) is considered a ubiquitous virus, with many countries reporting a seroprevalence of more than 80-90% among the general population. However, this virus is unique among herpesviruses in its ability to integrate into the genetic material of the host's cells. Thus, there are three ways by which HHV-6 can cause an active infection-primary infection, reactivation of a latent acquired infection, or activation of iciHHV-6 (inherited chromosomally integrated HHV-6). Whole blood quantitative polymerase chain reaction (qPCR) is very useful in distinguishing between iciHHV-6 and primary infection/reactivation. Our aim is to assess the role of HHV-6 in the aetiology of central nervous system (CNS) infections in adults and children, to describe all HHV-6-positive cases in an attempt to determine the susceptible population and to identify potential risk factors that can be linked to HHV-6 meningoencephalitis. Methods: We performed a retrospective study involving patients that were admitted to Prof. Dr. Matei Bals National Institute of Infectious Diseases, Bucharest, Romania, with a diagnosis of meningitis or encephalitis. We only selected the clinical records of patients that had a multiplex PCR Biofire® FilmArray® meningitis/encephalitis panel. Results: We report a 5% HHV-6 positivity in the cerebrospinal fluid (CSF) of patients with CNS infections tested with a commercial multiplex PCR M/E (meningitis/encephalitis) panel. Additionally, 2% to 4% of the total study population (n = 100) had active HHV-6 infections, which denotes 40 to 80% of the HHV-6-positive samples. We did not observe any statistically significant correlation between HHV-6 positivity in the CSF and variables such as age, sex, or comorbidities, including obesity, diabetes, hypertension, immunosuppression, or oncologic disease. Therefore, no risk factors could be linked with HHV-6 positivity in the CSF. Conclusions: although multiplex qualitative PCR is highly useful for providing rapid results and identifying nearly every pathogen that can cause meningitis/encephalitis, we have to be aware of this type of test's limitations. All patients with HHV-6 detectable in their CSF via a multiplex PCR test should also undergo qPCR testing from both CSF and blood to prevent over-diagnosing HHV-6 CNS infections, to avoid unnecessary antiviral treatments, and ensure the accurate identification of the true diagnosis.
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Affiliation(s)
- Oana Alexandra Ganea
- Faculty of General Medicine, Department of Infectious Diseases, “Carol Davila” University of Medicine and Pharmacy, Dionisie Lupu Street No. 37, 010458 Bucharest, Romania
- “Matei Bals” National Institute of Infectious Diseases, Dr. Calistrat Grozovici Street No. 1, 021105 Bucharest, Romania
| | - Cătălin Tilișcan
- Faculty of General Medicine, Department of Infectious Diseases, “Carol Davila” University of Medicine and Pharmacy, Dionisie Lupu Street No. 37, 010458 Bucharest, Romania
- “Matei Bals” National Institute of Infectious Diseases, Dr. Calistrat Grozovici Street No. 1, 021105 Bucharest, Romania
| | - Anca Streinu-Cercel
- Faculty of General Medicine, Department of Infectious Diseases, “Carol Davila” University of Medicine and Pharmacy, Dionisie Lupu Street No. 37, 010458 Bucharest, Romania
- “Matei Bals” National Institute of Infectious Diseases, Dr. Calistrat Grozovici Street No. 1, 021105 Bucharest, Romania
| | - Daniela Pițigoi
- Faculty of General Medicine, Department of Infectious Diseases, “Carol Davila” University of Medicine and Pharmacy, Dionisie Lupu Street No. 37, 010458 Bucharest, Romania
- “Matei Bals” National Institute of Infectious Diseases, Dr. Calistrat Grozovici Street No. 1, 021105 Bucharest, Romania
| | - Anca Cristina Drăgănescu
- “Matei Bals” National Institute of Infectious Diseases, Dr. Calistrat Grozovici Street No. 1, 021105 Bucharest, Romania
| | - Mihai Lazar
- Faculty of General Medicine, Department of Infectious Diseases, “Carol Davila” University of Medicine and Pharmacy, Dionisie Lupu Street No. 37, 010458 Bucharest, Romania
- “Matei Bals” National Institute of Infectious Diseases, Dr. Calistrat Grozovici Street No. 1, 021105 Bucharest, Romania
| | - Nicoleta Mihai
- Faculty of General Medicine, Department of Infectious Diseases, “Carol Davila” University of Medicine and Pharmacy, Dionisie Lupu Street No. 37, 010458 Bucharest, Romania
- “Matei Bals” National Institute of Infectious Diseases, Dr. Calistrat Grozovici Street No. 1, 021105 Bucharest, Romania
| | - Dragoș Florea
- Faculty of General Medicine, Department of Infectious Diseases, “Carol Davila” University of Medicine and Pharmacy, Dionisie Lupu Street No. 37, 010458 Bucharest, Romania
- “Matei Bals” National Institute of Infectious Diseases, Dr. Calistrat Grozovici Street No. 1, 021105 Bucharest, Romania
| | - Sorin Ștefan Aramă
- Faculty of General Medicine, Department of Infectious Diseases, “Carol Davila” University of Medicine and Pharmacy, Dionisie Lupu Street No. 37, 010458 Bucharest, Romania
- “Matei Bals” National Institute of Infectious Diseases, Dr. Calistrat Grozovici Street No. 1, 021105 Bucharest, Romania
| | - Victoria Aramă
- Faculty of General Medicine, Department of Infectious Diseases, “Carol Davila” University of Medicine and Pharmacy, Dionisie Lupu Street No. 37, 010458 Bucharest, Romania
- “Matei Bals” National Institute of Infectious Diseases, Dr. Calistrat Grozovici Street No. 1, 021105 Bucharest, Romania
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Sunnerhagen T, Widén J, Handhal S, Özkaya Şahin G. A retrospective observational study of 1000 consecutive patients tested with the FilmArray® Meningitis/Encephalitis panel: clinical diagnosis at discharge and microbiological findings. Sci Rep 2024; 14:4015. [PMID: 38369552 PMCID: PMC10874959 DOI: 10.1038/s41598-024-54621-9] [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: 10/14/2023] [Accepted: 02/14/2024] [Indexed: 02/20/2024] Open
Abstract
FilmArray® Meningitis/Encephalitis panel (FAME-p) is used to diagnose central nervous system (CNS) infections. In this study, we investigated performance of FAME-p compared to comparator assays (CA), and for the first time, clinical diagnosis at discharge (CDD). 1000 consecutive patients with a cerebrospinal fluid (CSF) sample analyzed with FAME-p were identified. As CA, culture, polymerase chain reaction and cryptococcal antigen test were used. Medical records of patients were obtained. A CDD of CNS infection was made in 139 of 1000 CSF samples. FAME-p was positive in 66 samples with 44 viral and 22 bacterial agents. Thirteen FAME-p findings were not confirmed by CA, with four discrepant results remaining after comparison with the CDD. Positive percentage agreement (PPA) calculated against CA was 100%. Negative percentage agreement (NPA) calculated against CA was 94.4-99.8% for Haemophilus influenzae, Listeria monocytogenes, Streptococcus agalactiae, S. pneumoniae and varicella-zoster virus (VZV). NPA calculated against CDD was higher (compared to CA) for L. monocytogenes, S. agalactiae and VZV (100%), and lower for Escherichia coli, enterovirus and herpes simplex virus 2 (50-83.3%). NPA of FAME-p for human herpes virus 6 was difficult to interpret. Eighty-four cases received diagnosis of CNS-infection despite negative FAME-p. The four most common non-infectious etiologies were primary headache disorders, cranial nerve palsies, neuroinflammatory disorders and seizure. Although FAME-p shows good performance in diagnosis of CNS infections, result of FAME-p should be interpreted carefully. Considering infectious diseases not covered by FAME-p as well as non-infectious differential diagnoses is important in this context.
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Affiliation(s)
- Torgny Sunnerhagen
- Clinical Microbiology, Infection Prevention and Control, Office for Medical Services, Region Skåne, Lund, Sweden.
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
| | - Johan Widén
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Clinic of Infectious Diseases, Skåne University Hospital, Lund, Sweden
| | - Sahar Handhal
- Clinical Microbiology, Infection Prevention and Control, Office for Medical Services, Region Skåne, Lund, Sweden
| | - Gülşen Özkaya Şahin
- Clinical Microbiology, Infection Prevention and Control, Office for Medical Services, Region Skåne, Lund, Sweden
- Division of Medical Microbiology, Department of Laboratory Medicine Lund, Medical Faculty, Lund University, Lund, Sweden
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