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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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Hautala M, Arvila J, Pokka T, Mikkonen K, Koskela U, Helander H, Glumoff V, Rantala H, Tapiainen T. Respiratory viruses and febrile response in children with febrile seizures: A cohort study and embedded case-control study. Seizure 2020; 84:69-77. [PMID: 33285363 DOI: 10.1016/j.seizure.2020.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE There are limited data on the pathogen-related and host-related factors in the pathogenesis of febrile seizures (FS). We designed a controlled study to compare the role of different respiratory viruses and febrile response in FS. METHODS In a prospective cohort study of 1899 pediatric emergency room patients aged 6 months-6 years with a positive respiratory virus multiplex PCR, we identified 225 patients with FSs. We first compared the distribution of respiratory viruses in age-stratified patients with FSs with that in other patients. In an embedded case-control study, we compared the febrile response in patients with FSs with that in the controls matched for age, season and the same respiratory virus. RESULTS The relative risk for FS was the highest for coronavirus OC43, 229E, and NL63 infections [RR: 3.2, 95 % confidence interval (CI): 1.4-7.2) and influenza A and B [RR: 2.5, 95 % CI: 1.4-4.7] as compared to those with other respiratory viral infections. The patients with FSs had a stronger febrile response of 39.2 °C (difference: 0.8 °C, 95 % CI: 0.5-1.2) later during hospitalization after acute care than the controls matched for the same respiratory virus. CONCLUSIONS Influenza and coronaviruses caused relatively more FS-related emergency room visits than other respiratory viruses. Furthermore, the febrile response was stronger in the patients with FSs than in the controls matched for the same respiratory virus. The results suggest that the pathomechanism of FSs includes modifiable pathogen-related and host-related factors with possible potential in the prevention of FSs.
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MESH Headings
- Adenovirus Infections, Human/epidemiology
- Adenovirus Infections, Human/virology
- Case-Control Studies
- Child
- Child, Preschool
- Cohort Studies
- Coronavirus 229E, Human
- Coronavirus Infections/epidemiology
- Coronavirus Infections/virology
- Coronavirus NL63, Human
- Coronavirus OC43, Human
- Emergency Service, Hospital
- Enterovirus Infections/epidemiology
- Enterovirus Infections/virology
- Female
- Fever/physiopathology
- Finland/epidemiology
- Humans
- Infant
- Inflammation
- Influenza A virus
- Influenza B virus
- Influenza, Human/epidemiology
- Influenza, Human/virology
- Male
- Multiplex Polymerase Chain Reaction
- Paramyxoviridae Infections/epidemiology
- Paramyxoviridae Infections/virology
- Picornaviridae Infections/epidemiology
- Picornaviridae Infections/virology
- Prospective Studies
- Respiratory Syncytial Virus Infections/epidemiology
- Respiratory Syncytial Virus Infections/virology
- Respiratory Tract Infections/epidemiology
- Respiratory Tract Infections/physiopathology
- Respiratory Tract Infections/virology
- Rhinovirus
- Risk
- Seizures, Febrile/epidemiology
- Seizures, Febrile/virology
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Affiliation(s)
- Maria Hautala
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), University of Oulu, Oulu, Finland; Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland.
| | - Jukka Arvila
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), University of Oulu, Oulu, Finland; Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
| | - Tytti Pokka
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), University of Oulu, Oulu, Finland; Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
| | - Kirsi Mikkonen
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), University of Oulu, Oulu, Finland; Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland; Epilepsia Helsinki, Division of Child neurology, Children's Hospital, and Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ulla Koskela
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), University of Oulu, Oulu, Finland; Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
| | - Heli Helander
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), University of Oulu, Oulu, Finland; Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
| | - Virpi Glumoff
- Research Unit of Biomedicine, University of Oulu, Oulu, Finland
| | - Heikki Rantala
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), University of Oulu, Oulu, Finland; Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
| | - Terhi Tapiainen
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), University of Oulu, Oulu, Finland; Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland; Biocenter Oulu, University of Oulu, Finland
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Atakla HG, Noudohounsi ACWH, Barry LF, Noudohounsi MMUD, Legba LDG, Souare IS, Kaba F, Houinato DS. COVID-19 infection in known epileptic and non-epileptic children: what is the place of chloroquine sulfate? (a case report). Pan Afr Med J 2020; 37:177. [PMID: 33447332 PMCID: PMC7778175 DOI: 10.11604/pamj.2020.37.177.26066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/13/2020] [Indexed: 11/23/2022] Open
Abstract
The coronavirus 19 (COVID-19) disease, which was declared in China in December 2019, very early on became a pandemic, claiming more than 28 million victims worldwide to date. Its impact on the central nervous system is still poorly understood. The objective of this work is to assess the involvement of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in the aggravation of seizures in children known to have epilepsy and in the epileptogenesis of children hitherto seizure-free. Prior to conducting this work, we had obtained informed consent from patients and parents. We report the cases of three (3) patients, one known epileptic and the other two apparently healthy, who presented a febrile seizure in a context of COVID-19 infection. The aggravation of the epileptic seizure was indicative of a SARS-CoV-2 infection in the first patient, while the seizure occurred after induction of chloroquine sulfate treatment in the 2 other patients. Although our current concern is to limit the spread of the disease to COVID-19, it is crucial to address its possible complications. Notably, the worsening of seizures in children with epilepsy and the occurrence of first seizures in children without epilepsy following drug treatment. Equipping our COVID-19 patient management facilities with electroencephalogram (EEG) equipment could facilitate continuous electroencephalographic monitoring of children for proper management.
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Affiliation(s)
| | | | | | | | | | - Ibrahima Sory Souare
- Neurosurgery Department, Ignace Deen University Hospital Center, Conakry, Guinea
| | - Fatoumata Kaba
- Neurosurgery Department, Ignace Deen University Hospital Center, Conakry, Guinea
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Carman KB, Calik M, Karal Y, Isikay S, Kocak O, Ozcelik A, Yazar AS, Nuhoglu C, Sag C, Kilic O, Dinleyici M, Lacinel Gurlevik S, Yimenicioglu S, Ekici A, Perk P, Tosun A, Isik I, Yarar C, Arslantas D, Dinleyici EC. Viral etiological causes of febrile seizures for respiratory pathogens (EFES Study). Hum Vaccin Immunother 2018; 15:496-502. [PMID: 30235060 PMCID: PMC6422444 DOI: 10.1080/21645515.2018.1526588] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 08/30/2018] [Accepted: 09/15/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Febrile seizure is the most common childhood neurological disorder, is an important health problem with potential short- and long-term complications, also leading to economic burden and increased parental anxiety about fevers and seizures occurring in their children. There are no routine recommendation to detect etiological causes of FS for neurological perspective, further knowledge about the etiological causes of FS in children will support preventive measures and follow-up strategies. The aim of this study is to evaluate the percentage of respiratory viruses in children with FS. METHODS This prospective multicenter study, entitled "Viral etiological causes of febrile seizures for respiratory pathogens (EFES Study)" examined representative populations in eight different cities in Turkey between March 1, 2016 and April 1, 2017. Nasopharyngeal swabs were taken from all children at presentation. A respiratory multiplex array was performed to detect for influenza A and B; respiratory syncytial virus A and B; human parainfluenza virus 1-2-3 and 4; human coronavirus 229E and OC43; human rhinovirus; human enterovirus; human adenovirus; human bocavirus; human metapneumovirus. RESULTS During the study period, at least one virus was detected in 82.7% (144/174) of children with FS. The most frequently detected virus was adenovirus, followed by influenza A and influenza B. Detection of more than one virus was present in 58.3% of the children with FS, and the most common co-existence was the presence of adenovirus and influenza B. In children younger than 12 months, Coronavirus OC43 was the most common, while influenza A was most frequently observed in children older than 48 months (p < 0.05). Human bocavirus was common in children who experienced complex FS, while respiratory syncytial virus (RSV) A was more common in children who experienced simple FS. Influenza B virus was the most common virus identified in children who were experiencing their first incidence of FS (p < 0.05). CONCLUSIONS This study indicates that respiratory viruses are important in the etiology of FS in children. The results show that antibiotics must be prescribed carefully in children with FS since the majority of cases are related to viral causes. Widespread use of the existing quadrivalent influenza vaccine might be useful for the prevention of FS related to the flu. Further vaccine candidates for potential respiratory pathogens, including RSV, might be helpful for the prevention of FS.
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Affiliation(s)
- Kursat Bora Carman
- Faculty of Medicine, Department of Pediatric Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Mustafa Calik
- Faculty of Medicine, Department of Pediatric Neurology, Harran University, Sanliurfa, Turkey
| | - Yasemin Karal
- Faculty of Medicine, Department of Pediatric Neurology, Trakya University, Edirne, Turkey
| | - Sedat Isikay
- Faculty of Medicine, Department of Pediatric Neurology, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Ozan Kocak
- Department of Pediatric Neurology, Samsun Education and Research Hospital, Samsun, Turkey
| | - Aysima Ozcelik
- Faculty of Medicine, Department of Pediatric Neurology, Gaziantep University, Gaziantep, Turkey
| | - Ahmet Sami Yazar
- Department of Pediatrics, Umraniye Education and Research Hospital, Istanbul, Turkey
| | - Cagatay Nuhoglu
- Department of Pediatrics, Haydarapasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Cigdem Sag
- Department of Pediatrics, Haydarapasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Omer Kilic
- Faculty of Medicine, Pediatric Infectious Disease Unit, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Meltem Dinleyici
- Faculty of Medicine, Department of Social Pediatrics, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Sibel Lacinel Gurlevik
- Faculty of Medicine, Department of Pediatric Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Sevgi Yimenicioglu
- Department of Pediatric Neurology, Eskisehir Maternity and Children Hospital, Eskisehir, Turkey
| | - Arzu Ekici
- Department of Pediatric Neurology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Peren Perk
- Faculty of Medicine, Department of Pediatric Neurology, Gaziantep University, Gaziantep, Turkey
| | - Ayse Tosun
- Faculty of Medicine, Department of Pediatric Neurology, Adnan Menderes University, Aydin, Turkey
| | - Ilhan Isik
- Department of Pediatric Neurology, Sanliurfa Children’s Hospital, Sanliurfa, Turkey
| | - Coskun Yarar
- Faculty of Medicine, Department of Pediatric Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Didem Arslantas
- Faculty of Medicine, Department of Public Health, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Ener Cagri Dinleyici
- Faculty of Medicine, Department of Pediatrics, Eskisehir Osmangazi University, Eskisehir, Turkey
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Waggoner J, Heath CJ, Ndenga B, Mutuku F, Sahoo MK, Mohamed-Hadley A, Vulule J, Mukoko D, Desiree LaBeaud A, Pinsky BA. Development of a Real-Time Reverse Transcription Polymerase Chain Reaction for O'nyong-nyong Virus and Evaluation with Clinical and Mosquito Specimens from Kenya. Am J Trop Med Hyg 2017; 97:121-124. [PMID: 28719301 PMCID: PMC5508918 DOI: 10.4269/ajtmh.17-0027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/08/2017] [Indexed: 11/07/2022] Open
Abstract
O'nyong-nyong virus (ONNV), an alphavirus closely related to chikungunya virus (CHIKV), has been the documented cause of two large outbreaks in east Africa; however, little is known about the contribution of ONNV to cases of acute febrile illness during interepidemic periods. An ONNV real-time reverse transcription polymerase chain reaction (rRT-PCR) was developed and evaluated using clinical and mosquito pool samples. The ONNV rRT-PCR linear range extended from 8.0 to 2.0 log10 copies/μL, and the lower limit of 95% detection was 22.4 copies/μL. No cases of ONNV infection were identified in serum from 385 Kenyan children who presented with an acute febrile illness. Additionally, ONNV was not detected in 120 mosquito pools collected in coastal and western Kenya. The ONNV rRT-PCR demonstrated good analytical sensitivity when performed in monoplex or as a component of an ONNV-CHIKV duplex assay. This assay should provide a useful diagnostic for the detection of ONNV in surveillance studies.
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Affiliation(s)
- Jesse Waggoner
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Claire Jane Heath
- Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | | | | | - Malaya K. Sahoo
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Alisha Mohamed-Hadley
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - John Vulule
- Kenya Medical Research Institute, Kisumu, Kenya
| | | | - A. Desiree LaBeaud
- Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Benjamin A. Pinsky
- Department of Pathology, Stanford University School of Medicine, Stanford, California
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
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Tamai M, Kobayashi N, Shimada K, Oka N, Takahashi M, Tanuma A, Tanemoto T, Namba H, Saito Y, Wada Y, Okamoto A, Ida H, Kondo K. Increased interleukin-1β and basic fibroblast growth factor levels in the cerebrospinal fluid during human herpesvirus-6B (HHV-6B) encephalitis. Biochem Biophys Res Commun 2017; 486:706-711. [PMID: 28342868 DOI: 10.1016/j.bbrc.2017.03.102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/21/2017] [Indexed: 11/18/2022]
Abstract
Human herpesvirus 6B (HHV-6B) causes exanthema subitum in infants and is known to be mildly pathogenic. However, HHV-6B infection can induce febrile seizures in a high percentage of patients, and in rare cases, result in encephalitis. We detected higher levels of interleukin (IL)-1β and basic fibroblast growth factor (bFGF) in the cerebrospinal fluid (CFS) of patients with HHV-6B encephalitis when compared to those in patients with non-HHV-6B-induced febrile seizures. In vitro, IL-1β and bFGF enhanced HHV-6B gene expression in infected U373 astrocytes during the initial and maintenance phases of infection, respectively. These findings indicated that IL-1β and bFGF contribute to HHV-6B growth and the onset of encephalitis.
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MESH Headings
- Astrocytes/metabolism
- Astrocytes/virology
- Case-Control Studies
- Cell Line
- Child, Preschool
- DNA, Viral/cerebrospinal fluid
- DNA, Viral/genetics
- Encephalitis, Viral/cerebrospinal fluid
- Encephalitis, Viral/genetics
- Encephalitis, Viral/pathology
- Encephalitis, Viral/virology
- Female
- Fibroblast Growth Factors/cerebrospinal fluid
- Fibroblast Growth Factors/genetics
- Gene Expression
- Herpesvirus 6, Human/genetics
- Herpesvirus 6, Human/growth & development
- Herpesvirus 6, Human/pathogenicity
- Host-Pathogen Interactions
- Humans
- Infant
- Interleukin-1beta/cerebrospinal fluid
- Interleukin-1beta/genetics
- Male
- RNA, Messenger/cerebrospinal fluid
- RNA, Messenger/genetics
- Seizures, Febrile/cerebrospinal fluid
- Seizures, Febrile/genetics
- Seizures, Febrile/pathology
- Seizures, Febrile/virology
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Affiliation(s)
- Masato Tamai
- Department of Virology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan; Department of Pediatrics, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Nobuyuki Kobayashi
- Department of Virology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan.
| | - Kazuya Shimada
- Department of Virology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Naomi Oka
- Department of Virology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Mayumi Takahashi
- Department of Virology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Akiko Tanuma
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Tomohiro Tanemoto
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan; Department of General Medical Science, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan
| | - Hiroyuki Namba
- Department of Pediatrics, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Yoshihiro Saito
- Department of Pediatrics, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Yasuyuki Wada
- Department of Pediatrics, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Aikou Okamoto
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Hiroyuki Ida
- Department of Pediatrics, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Kazuhiro Kondo
- Department of Virology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
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7
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Ozkan M, Tuygun N, Erkek N, Aksoy A, Yildiz YT. Neurologic manifestations of novel influenza A (H1N1) virus infection in childhood. Pediatr Neurol 2011; 45:72-6. [PMID: 21763945 DOI: 10.1016/j.pediatrneurol.2011.02.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 02/28/2011] [Indexed: 11/17/2022]
Abstract
The neurologic manifestations and prognoses of a novel influenza A (H1N1) virus infection in previously healthy children were evaluated. Nose and throat swabs were retrieved from all patients who met the criteria of influenza-like illness. A real time reverse-transcriptase polymerase chain reaction assay was used to confirm the novel influenza A (H1N1) virus. This viral infection was evident in 240 children between October 10 and December 22, 2009. Neurologic findings were evident in 17 (7.08%) patients, aged between 4 months and 8 years. Nine were boys. Five patients manifested simple febrile seizures, seven manifested complex febrile seizures or additional afebrile seizures, and three manifested encephalopathy. Febrile status epilepticus and flaccid paralysis were diagnosed in one patient each. All were treated with oseltamivir. Fifteen of 17 patients demonstrated complete recovery. One undergoing follow-up with a diagnosis of Guillain-Barré syndrome manifested sequelae. One patient died because of septic shock and disseminated intravascular coagulation. We suggest that neurologic manifestations occur quite often in children aged less than 5 years with novel influenza A (H1N1) virus infection. Most infections were benign, although a severe course is possible, and sequelae may be encountered.
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Affiliation(s)
- Mehpare Ozkan
- Department of Pediatric Neurology, Dr. Sami Ulus Children's Health and Diseases Training and Research Hospital, Ankara, Turkey.
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8
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Nakamura M, Yamanaka G, Kawashima H, Watanabe Y, Ioi H, Kashiwagi Y, Takekuma K, Hoshika A, Hayakawa M, Suzuki S. Clinical application of rapid assay of interleukin-6 in influenza-associated encephalopathy. Dis Markers 2009; 21:199-202. [PMID: 16403955 PMCID: PMC3851426 DOI: 10.1155/2005/671609] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The characteristics of influenza-associated encephalopathy is the high mortality and nimble progress with coma which appears in general cases within 48 hours. Most of patients show no abnormalities in the standard blood checks on admission or in early stage. In this study we investigated if a rapid assay of interleukin (IL)-6 is useful in influenza-associated encephalopathy in early stages. The levels of IL-6 in patients with influenza-associated encephalopathy did not show any significant difference compared with those in patients with febrile convulsion and rotavirus-associated convulsion. However the levels of IL-6 in severe cases were significantly higher than those of mild cases with influenza-associated encephalopathy. Consequently the rapid assay of serum IL-6 is useful to evaluate and decide the therapies.
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Affiliation(s)
| | - Gaku Yamanaka
- Department of PaediatricsTokyo Medical UniversityJapan
| | - Hisashi Kawashima
- Department of PaediatricsTokyo Medical UniversityJapan
- *Hisashi Kawashima:
| | | | - Hiroaki Ioi
- Department of PaediatricsTokyo Medical UniversityJapan
| | | | | | | | - Mizuho Hayakawa
- Department of Central Clinical LaboratoryTokyo Medical UniversityJapan
| | - Shigeru Suzuki
- Department of Central Clinical LaboratoryTokyo Medical UniversityJapan
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9
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Abstract
OBJECTIVES To examine the role of viruses in febrile seizures (FS) by comparing the relative risk (RR) of developing FS with common viral infections and subsequent risk of recurrence. METHODS We matched the medical records of all children admitted with FS over 5 years and the contemporary records for all admissions for febrile illnesses associated with influenza, adenovirus, parainfluenza, respiratory syncytial virus (RSV) and rotavirus to calculate the RR of FS following these viral infections. For patients admitted for a first FS, we carried multivariate analysis for type of viral infection, age of onset, family history, complex FS features and maximum temperature during the episode, to identify the risk factors for recurrence. RESULTS There were 923 admissions for FS, of which 565 were for first seizures. The five most common viruses in FS were influenza (163/923, 17.6%), adenovirus (63/923, 6.8%), parainfluenza (55/923, 6%), RSV (25/923, 2.7%) and rotavirus (12/923, 1.3%). Incidences of FS in febrile illnesses due to these viruses were 20.8% (163/785) for influenza, 20.6% (55/267) for parainfluenza, 18.4% (63/343) for adenovirus, 5.3% (25/468) for RSV and 4.3% (12/280) for rotavirus. Complex FS occurred in 20.6% (n = 191) and the risk of developing complex FS was similar for the five viruses. Overall recurrence rate was 20.5% and was not predicted by type of viral infection. CONCLUSION The risk of developing FS is similar with influenza, adenovirus or parainfluenza and is higher than with RSV or rotavirus. Type of viral infection is not important in predicting complex features or future recurrences.
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Affiliation(s)
- Brian Chung
- Division of Neurodevelopmental Paediatrics, Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
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10
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Mizuguchi M, Yamanouchi H, Ichiyama T, Shiomi M. Acute encephalopathy associated with influenza and other viral infections. Acta Neurol Scand Suppl 2007; 186:45-56. [PMID: 17784537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Acute encephalopathy is the most serious complication of pediatric viral infections, such as influenza and exanthem subitum. It occurs worldwide, but is most prevalent in East Asia, and every year several hundreds of Japanese children are affected by influenza-associated encephalopathy. Mortality has recently declined, but is still high. Many survivors are left with motor and intellectual disabilities, and some with epilepsy. This article reviews various syndromes of acute encephalopathy by classifying them into three major categories. The first group caused by metabolic derangement consists of various inherited metabolic disorders and the classical Reye syndrome. Salicylate is a risk factor of the latter condition. The second group, characterized by a systemic cytokine storm and vasogenic brain edema, includes Reye-like syndrome, hemorrhagic shock and encephalopathy syndrome, and acute necrotizing encephalopathy. Non-steroidal anti-inflammatory drugs, such as diclofenac sodium and mephenamic acid, may aggravate these syndromes. Severe cases are complicated by multiple organ failure and disseminated intravascular coagulation. Mortality is high, although methylprednisolone pulse therapy may be beneficial in some cases. The third group, characterized by localized edema of the cerebral cortex, has recently been termed acute encephalopathy with febrile convulsive status epilepticus, and includes hemiconvulsion-hemiplegia syndrome and acute infantile encephalopathy predominantly affecting the frontal lobes. Theophylline is a risk factor of these syndromes. The pathogenesis is yet to be clarified, but an increasing body of evidence points to excitotoxicity and delayed neuronal death.
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Affiliation(s)
- M Mizuguchi
- Department of Pediatrics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
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Hara K, Tanabe T, Aomatsu T, Inoue N, Tamaki H, Okamoto N, Okasora K, Morimoto T, Tamai H. Febrile seizures associated with influenza A. Brain Dev 2007; 29:30-8. [PMID: 16859852 DOI: 10.1016/j.braindev.2006.05.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2005] [Revised: 05/18/2006] [Accepted: 05/29/2006] [Indexed: 11/17/2022]
Abstract
To clarify the clinical impact of influenza A on the development of febrile seizures (FS), consecutive FS patients brought to our hospital between October 2003 and September 2004 were prospectively surveyed. Patients infected with influenza A (influenza A patients) and those uninfected with influenza (non-influenza patients) were compared with regard to clinical characteristics of FS. Influenza infection was determined by rapid antigen test and/or serologically. Associations of influenza A with atypical findings of FS, including partial seizures, prolonged seizures, multiple seizures during the same illness, and 30-min or longer prolonged postictal impairment of consciousness (PPIC), were analyzed by multiple logistic regression. A total of 215 patients (47 influenza A and 168 non-influenza patients) were enrolled in the study. Age was significantly higher in the influenza A group (39.85+/-22.16 months vs. 27.51+/-17.14 months, P<0.001). Of 42 patients aged 48 months or older, which corresponded to the 80th percentile for age, 15 (35.7%) were influenza A patients, with a significantly higher incidence of such patients than in the subgroup of patients aged 47 months or younger (32/173, 18.5%) (P=0.015). On multiple logistic regression analysis, influenza A was independently associated with PPIC (odds ratio: 4.44, 95% confidence interval: 1.52-12.95, P=0.006), but not with other atypical findings. The positive association of influenza A with PPIC suggests that influenza may affect state of consciousness at the same time that it induces seizures with fever.
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Affiliation(s)
- Keita Hara
- Division of Pediatrics, Hirakata City Hospital, 2-14-1 Kinyahonmachi, Hirakata, Osaka, Japan.
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12
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Abstract
The aims of the present study are to identify predisposing factors of febrile seizures in influenza A infection and to clarify the special characteristics of febrile seizures in children with influenza A infection. Between January and July 2005, children hospitalized because of febrile seizures and subsequently confirmed influenza A infection were enrolled as subjects. Age-matched control subjects were those admitted as a result of influenza A infection but no febrile seizures (control 1) and children who developed febrile seizures with negative viral studies (control 2). Significant factors for the development of febrile seizures include: history of febrile seizures, family history of seizure disorders, and coexisting gastroenteritis. Independent risk factor for febrile seizures was history of febrile seizures (odds ratio 7.58, 95% confidence interval CI 1.48 to 38.84, P = 0.015). When compared with children who developed febrile seizures with negative virus studies, children who developed febrile seizures in influenza A infection had a significantly higher maximum body temperature, shorter duration of fever before seizure onset, and more frequent occurrence of partial seizures. Current episode represented first seizure in 26.5% of children infected with influenza A as compared with 50% of children whose virus studies were negative (P = 0.04). The findings suggest that effective vaccination may prevent development of febrile seizures, especially in those patients with past history of febrile seizures. Rapid diagnostic testing for influenza infection in the management of complex febrile seizures, especially during influenza season, is cost-effective.
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MESH Headings
- Child
- Child, Hospitalized/statistics & numerical data
- Child, Preschool
- Epilepsies, Partial/epidemiology
- Epilepsies, Partial/prevention & control
- Epilepsies, Partial/virology
- Female
- Fever/epidemiology
- Fever/prevention & control
- Fever/virology
- Humans
- Infant
- Influenza A virus
- Influenza Vaccines
- Influenza, Human/complications
- Influenza, Human/epidemiology
- Influenza, Human/prevention & control
- Male
- Risk Factors
- Seizures, Febrile/epidemiology
- Seizures, Febrile/prevention & control
- Seizures, Febrile/virology
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Affiliation(s)
- Karen L Kwong
- Department of Pediatrics, Tuen Mun Hospital, Hong Kong.
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Abstract
During a 29-month period, 11 (12%) of 92 hospitalized patients with influenza B virus infection presented neurologic manifestations, which included febrile seizure in 4 cases and encephalopathy/encephalitis in 7 cases. Without appropriate antiviral therapy, recovery was uneventful in all but 1 patient, who had neurologic sequelae of quadriplegia and developmental delay.
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MESH Headings
- Child
- Child, Preschool
- Encephalitis, Viral/epidemiology
- Encephalitis, Viral/etiology
- Encephalitis, Viral/virology
- Female
- Hospitalization
- Humans
- Infant
- Influenza B virus/pathogenicity
- Influenza, Human/complications
- Influenza, Human/epidemiology
- Influenza, Human/virology
- Male
- Nervous System Diseases/epidemiology
- Nervous System Diseases/etiology
- Nervous System Diseases/virology
- Seizures, Febrile/epidemiology
- Seizures, Febrile/etiology
- Seizures, Febrile/virology
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Affiliation(s)
- Chien-Hui Lin
- Division of Infectious Diseases, Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan
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14
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Abstract
The role of viral infection in the etiology of febrile seizures is a relatively neglected field of neurologic research. A National Institutes of Health Consensus Conference (1981) omitted reference to causes of infections and the role of fever in febrile seizures, and emphasized outcome and anticonvulsant treatment. In an earlier review of the world literature (1924-1964), except for roseola infantum, viral infections as a cause of febrile seizures were rarely diagnosed. The present review includes reports of viruses most commonly associated with febrile seizures in the last decade, especially human herpesvirus-6 and influenza. The specificity and neurotropic properties of some viruses in the febrile seizure mechanism, a possible encephalitic or encephalopathic pathology, and the essential role of fever and height of the body temperature as a measure of the febrile seizure threshold are discussed. Cytokine and immune response to infection, and a genetic susceptibility to febrile seizures are additional etiologic factors. Future research should emphasize early detection of causative viruses, the nature of viral neurotropism, and the role of cytokines in fever induction. Trials of antiviral agents and vaccines, with attention to safety concerns, and more effective antipyretics would address the febrile seizure mechanism more specifically than anticonvulsant therapies.
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Affiliation(s)
- J Gordon Millichap
- Division of Neurology, Children's Memorial Hospital, Northwestern University Medical School, Chicago, Illinois 60614, USA.
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Kawada JI, Kimura H, Kamachi Y, Nishikawa K, Taniguchi M, Nagaoka K, Kurahashi H, Kojima S, Morishima T. Analysis of gene-expression profiles by oligonucleotide microarray in children with influenza. J Gen Virol 2006; 87:1677-1683. [PMID: 16690933 DOI: 10.1099/vir.0.81670-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
In order to clarify the mechanism of the host response to influenza virus, gene-expression profiles of peripheral blood obtained from paediatric patients with influenza were investigated by oligonucleotide microarray. In the acute phase of influenza, 200 genes were upregulated and 20 genes were downregulated compared with their expression in the convalescent phase. Interferon-regulated genes, such as interferon-induced protein with tetratricopeptide repeats 2 (IFIT2) and vipirin, were strongly upregulated in the acute phase. Gene ontology analysis showed that immune response genes were highly overrepresented among the upregulated genes. Gene-expression profiles of influenza patients with and without febrile convulsion were also studied. In patients with febrile convulsion, 22 genes were upregulated and five were downregulated compared with their expression in patients without febrile convulsion. These results should help to clarify the pathogenesis of influenza and its neurological complications.
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Affiliation(s)
- Jun-Ichi Kawada
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Kimura
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiro Kamachi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuo Nishikawa
- Department of Pediatrics, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Mariko Taniguchi
- Division of Molecular Genetics, Institute for Comprehensive Medical Science, Fujita Health University, Toyoake, Japan
| | - Kayuri Nagaoka
- Development Center for Targeted and Minimally Invasive Diagnosis and Treatment, Fujita Health University, Toyoake, Japan
- Division of Molecular Genetics, Institute for Comprehensive Medical Science, Fujita Health University, Toyoake, Japan
| | - Hiroki Kurahashi
- Development Center for Targeted and Minimally Invasive Diagnosis and Treatment, Fujita Health University, Toyoake, Japan
- Division of Molecular Genetics, Institute for Comprehensive Medical Science, Fujita Health University, Toyoake, Japan
| | - Seiji Kojima
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tsuneo Morishima
- Department of Pediatrics, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
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Gamkrelidze N, Butsashvili M, Barabadze K, Kamkamidze G. Rare recurrence of seizures in children with episodes of febrile seizures associated with herpesvirus 6 infection. Georgian Med News 2006:88-90. [PMID: 16783075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Human herpesvirus 6 (HHV-6) is one of the recently discovered herpesviruses. Primary HHV-6 infection is a causative agent of roseola infantum and is frequently associated with nonspecific febrile seizures in children under the age of 3 years. The goal of our study was the investigation of HHV-6 infection in children with febrile seizures and to evaluate consequent seizures after the first episodes of febrile seizures associated vs. not associated with primary herpesvirus 6 infection during 12 months time period. 25 children with (study group) and 25 without (control group) HHV-6 infection have been investigated. Laboratory investigations included detection of anti-HHV-6 specific IgM and IgG antibodies by ELISA and of HHV-6 DNA by polymerase chain reaction ("home-made" PCR as well as Chemicon Light Diagnostics Oligo-Detect Assay). The clinical severity of the febrile seizures was not statistically different between the study and control groups. The recurrence rate was higher in the study group. Our study shows that s first febrile seizure associated with the primary HHV-6 infection corresponds to the reduced risk of development of recurrent seizures.
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Affiliation(s)
- N Gamkrelidze
- Research Institute of Pediatrics; REA Research and Rehabilitation Center, Tbilisi, Georgia
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Mihara T, Mutoh T, Yoshikawa T, Yano S, Asano Y, Yamamoto H. Postinfectious Myeloradiculoneuropathy With Cranial Nerve Involvements Associated With Human Herpesvirus 7 Infection. ACTA ACUST UNITED AC 2005; 62:1755-7. [PMID: 16286551 DOI: 10.1001/archneur.62.11.1755] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Infection with human herpesvirus 7 (HHV-7) generally results in a febrile illness with accompanying exanthema subitum. OBJECTIVES To ascertain and describe the role of HHV-7 in a case of acute myeloradiculoneuropathy. PATIENT A previously healthy young man with complaints of motor weakness, dysphasia, and nasal voice. METHODS Serological examinations were performed with the patient's serum. We also examined virus genome DNA in cerebrospinal fluid by regular and real-time polymerase chain reaction. Moreover, we checked the antiganglioside antibody level in the patient's serum samples by the immunoblot analysis. RESULTS Serological studies revealed significant change in titers of antibodies against cytomegalovirus, Epstein-Barr virus, and HHV-7, but only HHV-7 genome was detected in the cerebrospinal fluid, with its disappearance after therapy. No antiganglioside antibody was detected in the patient's serum. CONCLUSION The unique clinical picture of the present patient might be closely related to the reactivation of HHV-7 in the nervous system.
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Affiliation(s)
- Takateru Mihara
- Department of Neurology, Fujita Health University School of Medicine, Aichi, Japan
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19
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Kawada JI, Kimura H, Ito Y, Hara S, Iriyama M, Yoshikawa T, Morishima T. Systemic cytokine responses in patients with influenza-associated encephalopathy. J Infect Dis 2003; 188:690-8. [PMID: 12934185 DOI: 10.1086/377101] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2002] [Accepted: 04/01/2002] [Indexed: 11/04/2022] Open
Abstract
Influenza-associated encephalopathy, a severe neurologic complication of influenza, is being reported more frequently in Japan. We investigated the transcription of cytokine genes in peripheral blood leukocytes and compared patients with influenza and with encephalopathy or febrile convulsions and patients with influenza but without neurologic complications. A quantitative polymerase chain reaction (PCR) revealed that transcription of the interleukin (IL)-6, IL-10, and tumor necrosis factor-alpha genes was up-regulated to a greater extent in patients with encephalopathy than in those without neurologic complications. Plasma IL-6 levels also were higher in patients with encephalopathy, although the difference was marginal. Viral RNA in throat swabs was quantified using a real-time quantitative PCR. The virus load was similar among patients with encephalopathy or febrile convulsions or without neurologic complications. Furthermore, virus load was not correlated with either the transcription of cytokine genes or plasma cytokine concentrations. These results suggest that influenza-associated encephalopathy might be a consequence of systemic immune responses.
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Affiliation(s)
- Jun-ichi Kawada
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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Kawada JI, Kimura H, Hara S, Ito Y, Kawashima H, Okuno T, Morishima T. Absence of associations between influenza-associated encephalopathy and human herpesvirus 6 or human herpesvirus 7. Pediatr Infect Dis J 2003; 22:115-9. [PMID: 12586973 DOI: 10.1097/01.inf.0000050364.08131.48] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Influenza-associated encephalopathy is a severe complication of influenza virus infection, but its pathogenesis is unknown. It was recently suggested that the neurologic complications of influenza, including encephalopathy, are associated with human herpesvirus 6 (HHV-6) and human herpesvirus 7 (HHV-7). AIM To confirm or refute the association between influenza-associated encephalopathy and HHV-6 or HHV-7. METHODS Cerebrospinal fluid and serum from 25 patients with central nervous system complications of influenza (18 patients with encephalopathy and 7 patients with febrile convulsions) were investigated. The specimens were examined by real time polymerase chain reaction (PCR) and nested PCR for HHV-6 and HHV-7 DNA. RESULTS In the cerebrospinal fluid samples neither HHV-6 DNA nor HHV-7 DNA was detected by real time PCR or nested PCR. HHV-6 DNA was detected in a single serum sample from a patient with febrile convulsions. CONCLUSION In our study there was no association with HHV-6 or HHV-7 in most patients with central nervous system complications of influenza.
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MESH Headings
- Age Distribution
- Case-Control Studies
- Child
- Child, Preschool
- DNA, Viral/analysis
- Encephalitis, Viral/complications
- Encephalitis, Viral/virology
- Female
- Herpesviridae Infections/complications
- Herpesviridae Infections/virology
- Herpesvirus 6, Human/isolation & purification
- Herpesvirus 7, Human/isolation & purification
- Humans
- Incidence
- Influenza, Human/complications
- Influenza, Human/diagnosis
- Japan/epidemiology
- Male
- Polymerase Chain Reaction
- Risk Factors
- Seizures, Febrile/complications
- Seizures, Febrile/virology
- Sex Distribution
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Affiliation(s)
- Jun-Ichi Kawada
- Department of Pediatrics, Nagoya University School of Medicine, Japan
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Abstract
AIMS To examine the relation between enteroviral infection, especially group A coxsackieviral infection, and acute febrile illness over two summers using tissue culture and polymerase chain reaction (PCR). METHODS Throat swabs were collected from 246 children from June to August 1997 and 1998. RESULTS Enteroviruses were isolated from 33/246 samples and 35 other viruses were isolated. Enteroviral genomes were detected in 54/178 samples from which no virus was isolated. Of 41 enteroviral genotypes identified by sequence analysis of PCR products, 38 were group A coxsackieviruses, which are usually difficult to isolate using tissue culture. CONCLUSION Results indicate that viral detection and identification based on PCR is useful in the diagnosis of group A coxsackieviral infection.
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Affiliation(s)
- M Hosoya
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan.
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23
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Abstract
OBJECTIVES To compare the incidence of febrile seizures in children hospitalized for influenza A infection with parainfluenza and adenovirus infection and to examine the hypothesis that children hospitalized for influenza A (variant Sydney/H3N2) during the 1998 season in Hong Kong had more frequent and refractory seizures when compared with other respiratory viruses, including the A/Wuhan H3N2 variant that was present in the previous year. METHODS Medical records of children between 6 months and 5 years of age admitted for influenza A infection in 1998 were reviewed. For comparison, records of children of the same age group with influenza A infection in 1997, and with parainfluenza and adenovirus infections between 1996 and 1998 were reviewed. Children who were afebrile or who had an underlying neurologic disorder were excluded. RESULTS Of children hospitalized for influenza A in 1998 and 1997, 54/272 (19.9%) and 27/144 (18.8%) had febrile seizures, respectively. The overall incidence of febrile seizures associated with influenza A (19.5%) was higher than that in children hospitalized for parainfluenza (18/148; 12.2%) and adenovirus (18/199; 9%) infection, respectively. In children who had febrile seizures, repeated seizures were more commonly associated with influenza A infection than with parainfluenza or adenovirus infection (23/81 [28%] vs 3/36 [8.3%], odds ratio [OR] 4.3, 95% confidence interval: 1.2 to 15.4). Alternatively, children with influenza A infection had a higher incidence (23/416, 5.5%) of multiple seizures during the same illness than those with adenovirus or parainfluenza infection (3/347, 0.86%; OR 6.7, 95% confidence interval: 2.0-22.5.) The increased incidence of febrile seizures associated with influenza A was not attributable to differences in age, gender, or family history of febrile seizure. Multivariate analysis, adjusted for peak temperature and duration of fever, showed that hospitalized children infected with infection A had a higher risk of febrile seizures than those who were infected with parainfluenza or adenovirus (OR 1.97). Influenza A infection was a significant cause of febrile seizure admissions. Of 250 and 249 children admitted to Queen Mary Hospital for febrile seizures in 1997 and 1998, respectively, influenza A infection accounted for 27 (10.8%) admissions in 1997 and 54 (21.7%) in 1998. During months of peak influenza activity, it accounted for up to 35% to 44% of febrile seizure admissions. In contrast, parainfluenza, adenovirus, respiratory syncytial virus, and influenza B had a smaller contribution to hospitalizations for febrile seizures, together accounting for only 25/250 (10%) admissions in 1997 and 16/249 (6.4%) in 1998. CONCLUSION The influenza A Sydney variant (H3N2) was not associated with an increased risk of febrile seizures when compared with the previous influenza A Wuhan variant (H3N2) or H1N1 viruses. However, in hospitalized children, influenza A is associated with a higher incidence of febrile seizures and of repeated seizures in the same febrile episode than are adenovirus or parainfluenza infections. The pathogenesis of these observations warrants additional studies. Complex febrile seizures, particularly multiple febrile seizures at the time of presentation, have been thought to carry an adverse long-term prognosis because of its association with a higher incidence of epilepsy. Repeated febrile seizures alone, particularly if associated with influenza A infection, may not be as worrisome as children with complex febrile seizures because of other causes, which requires additional investigation. This may subsequently have an impact on reducing the burden of evaluation in a subset of children with complex febrile seizures.
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Affiliation(s)
- S S Chiu
- Department of Pediatrics, University of Hong Kong, Hong Kong SAR, China.
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Abstract
Human herpesvirus-6 (HHV-6) is the causative agent of the common childhood infectious disease, exanthem subitum. After the virus was recently isolated from humans, it was found to be closely related to human cytomegalovirus (CMV), and was thus classified within the beta subgroup of human herpesviruses. HHV-6 possesses neurotropism in vitro, and it has been suggested that primary infection can cause complications of the central nervous system (CNS), including febrile seizures and encephalitis/encephalopathy. There is also speculation that the direct invasion of the virus into the CNS may play an important role in causing these neurological complications. Moreover, there are several reports which have suggested an association between HHV-6 and a variety of neurological disorders in adults. This paper will briefly review our virological understanding of the virus, and summarize recent findings regarding HHV-6 as an etiologic agent for CNS infection.
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Affiliation(s)
- T Yoshikawa
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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25
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Suga S, Suzuki K, Ihira M, Yoshikawa T, Kajita Y, Ozaki T, Iida K, Saito Y, Asano Y. Clinical characteristics of febrile convulsions during primary HHV-6 infection. Arch Dis Child 2000; 82:62-6. [PMID: 10630916 PMCID: PMC1718177 DOI: 10.1136/adc.82.1.62] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To clarify clinical characteristics of children with febrile convulsions during primary human herpesvirus 6 (HHV-6) infection. SUBJECTS AND METHODS The clinical characteristics of first febrile convulsion were compared between those with and without primary HHV-6 infection in 105 children. HHV-6 infection was verified by culture or acute/convalescent anti-HHV-6 antibody titres. RESULTS Primary infection with HHV-6 was seen in 21 of 105 patients with febrile convulsions (3 upper respiratory infection, 1 lower respiratory infection, and 17 exanthem subitum). 13 of 23 patients < 1 year, 19 of 79 patients with first febrile convulsion, and 2 of 15 with second convulsion were infected with HHV-6. The median age of patients with first febrile convulsion and HHV-6 was significantly lower than those without infection. The frequency of clustering seizures, long lasting seizures, partial seizures, and postictal paralysis was significantly higher among those with primary HHV-6 infection than among those without. The frequency of atypical seizures in 19 patients with first febrile convulsion associated with primary infection was significantly higher than in 60 patients without primary infection. The frequency in infants younger than 1 year of age was also significantly higher than that in 10 age matched infants without primary infection. CONCLUSIONS These findings suggest that primary infection with HHV-6 is frequently associated with febrile convulsions in infants and young children and that it often results in the development of a more severe form of convulsions, such as partial seizures, prolonged seizures, and repeated seizures, and might be a risk factor for subsequent development of epilepsy.
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Affiliation(s)
- S Suga
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan
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27
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Bergström T. [Recently discovered herpes viruses explain the etiology of well-known diseases]. Tidsskr Nor Laegeforen 1999; 119:4463-6. [PMID: 10827485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Three new members of the family of human herpesviruses (HHVs) have been identified in less than a decade, HHV 6 7 and 8. HHV-6 and HHV-7, both infecting T-lymphocytes and phylogenetically related to cytomegalovirus, were identified as causative agents of exanthema subitum. In addition, HHV-6 has been reported to manifest central nervous system tropism and to be frequently detected in normal brain tissue, but has also been associated with febrile seizures. HHV-7 has been suggested to be involved in the development of pityriasis rosea, but has also been found to occur in normal dermal tissue. HHV-8, related to Epstein-Barr virus and infecting B-lymphocytes, was the first herpesvirus to be identified with molecular techniques. Recent research has been focused on the involvement of proteins expressed by HHV-8 in the pathogenesis of two rare tumours, Kaposi's sarcoma and body-cavity B-cell lymphomas.
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Affiliation(s)
- T Bergström
- Virologiska laboratoriet Sahlgrenska Universitetssjukhuset, Göteborg.
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28
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Abstract
The frequency was studied with which human herpesviruses types 6 and 7 (HHV-6 and HHV-7) occur in the cerebrospinal fluid (CSF) of patients with febrile seizures and matched control patients. CSF samples were prospectively collected from a case series of patients with febrile seizures and from age-, sex-, and race-matched control patients without febrile seizures, all of whom were evaluated in the emergency department of an urban, tertiary care, pediatric medical center. Using polymerase chain reaction, the samples were examined for the presence of viral DNA from HHV-6, HHV-7, herpes simplex viruses types 1 and 2 (HSV-1 and HSV-2), and cytomegalovirus (CMV). CSF from a subset of both groups was also examined for RNA from enteroviruses. During the 7-month, 2-week collection period, a total of 174 patients were evaluated for fever and seizures. Of these, 23 (13.2%) met the study criteria. Their mean age was 1.4 +/- 0.7 years. Sixteen (70%) of the 23 were male. The 23 patients were matched to 21 control subjects. None of the samples from the patients or control subjects had polymerase chain reaction evidence of HHV-6, HHV-7, HSV-1, or HSV-2. All samples from the patients were negative for CMV. One control subject was positive for CMV. The 10 patients and seven control subjects tested for enteroviral RNA were negative. Neither HHV-6 nor HHV-7 appears to be present in the CSF of patients with febrile seizures. What role, if any, they have in the pathogenesis of febrile seizures merits further study.
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Affiliation(s)
- S J Teach
- Department of Pediatrics, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC 20010, USA
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29
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Abstract
Influenza A is an uncommon but well-recognized cause of viral encephalitis in childhood, occurring most commonly during community influenza outbreaks. The authors report four cases of influenza A encephalitis that occurred during an Australian epidemic in 1997-1998. Choreoathetosis during the acute phase of infection or basal ganglia involvement on neuroimaging was observed in three of the four patients. These findings in pediatric encephalitis are suggestive of influenza A infection and may guide investigation and early diagnosis.
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Affiliation(s)
- M M Ryan
- Department of Neurology, Royal Alexandra Hospital for Children, Sydney, NSW, Australia
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Bergström T. [HHV 6,7 and 8. Recently discovered herpesviruses explain the etiology of well-known diseases]. Lakartidningen 1999; 96:3161-5. [PMID: 10423975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Three new members of the family of human herpesviruses (HHVs) have been identified in less than a decade, HHV 67 and 8. HHV-6 and HHV-7, both infecting T-lymphocytes and phylogenetically related to cytomegalovirus, were identified as causative agents of exanthema subitum. In addition, HHV-6 has been reported to manifest central nervous system tropism and to be frequently detected in normal brain tissue, but has also been associated with febrile seizures. HHV-7 has been suggested to be involved in the development of pityriasis rosea, but has also been found to occur in normal dermal tissue. HHV-8, related to Epstein-Barr virus and infecting B-lymphocytes, was the first herpesvirus to be identified with molecular techniques. Recent research has been focused on the involvement of proteins expressed by HHV-8 in the pathogenesis of two rare tumours, Kaposi's sarcoma and body-cavity B-cell lymphomas.
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MESH Headings
- Adult
- Child
- Exanthema Subitum/diagnosis
- Exanthema Subitum/pathology
- Exanthema Subitum/virology
- Fever/virology
- Herpesviridae Infections/diagnosis
- Herpesviridae Infections/pathology
- Herpesvirus 6, Human/classification
- Herpesvirus 6, Human/isolation & purification
- Herpesvirus 7, Human/classification
- Herpesvirus 7, Human/isolation & purification
- Herpesvirus 8, Human/classification
- Herpesvirus 8, Human/isolation & purification
- Humans
- Infant
- Lymphoma, B-Cell/chemically induced
- Lymphoma, B-Cell/diagnosis
- Multiple Sclerosis/diagnosis
- Multiple Sclerosis/virology
- Pityriasis Rosea/diagnosis
- Pityriasis Rosea/pathology
- Pityriasis Rosea/virology
- Sarcoma, Kaposi/diagnosis
- Sarcoma, Kaposi/pathology
- Sarcoma, Kaposi/virology
- Seizures, Febrile/diagnosis
- Seizures, Febrile/virology
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Affiliation(s)
- T Bergström
- Virologiska laboratoriet, Sahlgrenska Universitetssjukhuset/Sahlgrenska, Göteborg.
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Hukin J, Farrell K, MacWilliam LM, Colbourne M, Waida E, Tan R, Mroz L, Thomas E. Case-control study of primary human herpesvirus 6 infection in children with febrile seizures. Pediatrics 1998; 101:E3. [PMID: 9445513 DOI: 10.1542/peds.101.2.e3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Human herpesvirus 6 (HHV-6) has been demonstrated to be the causative agent in roseola infantum. It has been suggested that HHV-6 may have neurotropic properties and be involved in the pathogenesis of febrile seizures in infants. We describe a case-control study to examine the hypothesis that acute HHV-6 infection occurs more commonly in children with febrile seizures than in controls. METHODS Patients presenting with a first or second febrile seizure between 6 months and 2 years of age were entered in the study. Control patients did not have a seizure but had similar inclusion and exclusion criteria. Specimens were obtained for HHV-6 viral serology and polymerase chain reaction in the acute stage and approximately 2 weeks later. A diagnosis of HHV-6 infection was based on HHV-6-specific IgM and IgG serology and HHV-6 polymerase chain reaction of peripheral blood mononuclear cells and saliva. RESULTS Eighty-six patients (45 with febrile seizures; 41 controls) were enrolled. The HHV-6 infection status could be determined in only 68 patients (35 with febrile seizures; 33 controls). Acute HHV-6 infection was identified in 15 of 35 febrile seizure patients and in 15 of 33 controls. Evidence of past HHV-6 infection was demonstrated in 13 febrile seizure patients and in 8 controls. CONCLUSIONS The incidence of primary HHV-6 infection is similar in patients with febrile seizures and age-matched controls. HHV-6 does not seem to be a major factor in the pathogenesis of first and second febrile seizures.
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MESH Headings
- Acute Disease
- Antibodies, Viral/analysis
- Antigens, Viral/immunology
- Capsid Proteins
- Case-Control Studies
- Cerebrospinal Fluid/virology
- Child, Preschool
- Cytomegalovirus/immunology
- DNA Primers/chemistry
- DNA, Viral/analysis
- Enzyme-Linked Immunosorbent Assay
- Female
- Fever/complications
- Fluorescent Antibody Technique, Indirect
- Herpesviridae Infections/complications
- Herpesviridae Infections/diagnosis
- Herpesviridae Infections/virology
- Herpesvirus 1, Human/immunology
- Herpesvirus 6, Human/genetics
- Herpesvirus 6, Human/isolation & purification
- Humans
- Incidence
- Infant
- Male
- Polymerase Chain Reaction
- Seizures, Febrile/complications
- Seizures, Febrile/diagnosis
- Seizures, Febrile/virology
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Affiliation(s)
- J Hukin
- Division of Pediatric Neurology, University of British Columbia and British Columbia's Children's Hospital, Vancouver, British Columbia
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Clark DA, Kidd IM, Collingham KE, Tarlow M, Ayeni T, Riordan A, Griffiths PD, Emery VC, Pillay D. Diagnosis of primary human herpesvirus 6 and 7 infections in febrile infants by polymerase chain reaction. Arch Dis Child 1997; 77:42-5. [PMID: 9279150 PMCID: PMC1717251 DOI: 10.1136/adc.77.1.42] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Primary human herpesvirus 6 (HHV-6) and 7 (HHV-7) infections were identified in febrile children by qualitative and quantitative polymerase chain reaction (PCR) assays. Diagnosis was based on the differential detection of viral DNA in peripheral blood mononuclear cells (PBMC), but not in saliva. Six of 41 febrile infants, but none of seven non-febrile controls, were identified with primary infections (three HHV-6, three HHV-7). These children had significantly higher viral loads in PBMC (HHV-6, median 24213 genomes/10(6) PBMC; HHV-7, median 6,040,000 genomes/10(6) PBMC) than DNA-aemic, saliva PCR positive children (HHV-6, median 1606 genomes/10(6) PBMC, p < 0.01; HHV-7, median 7089 genomes/ 10(6) PBMC, p < 0.05). Viral DNA was detected in serum by PCR in only 50% of primary infections. All three children with primary HHV-7 infection had febrile convulsions. Thus PCR, including quantitative assays, may identify primary HHV-6 and HHV-7 infections when an appropriate combination of clinical specimens is used.
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Affiliation(s)
- D A Clark
- Department of Virology, Royal Free Hospital School of Medicine, London
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Affiliation(s)
- X L Pang
- Department of Pediatrics, Hospital La Paz, Universidad Autonoma de Madrid, Spain
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Abstract
HHV-6 is ubiquitous in the community, appears to be acquired early in life, and has been proved to cause the clinical syndrome of exanthem subitum, and rarely to cause encephalitis. Like other herpesviruses, HHV-6 is capable of establishing latent infection and reactivating under a variety of stimuli. Improved diagnostic techniques have led to increased recognition of HHV-6 in the presence of many diseases, but much of the evidence for an aetiological role is inconclusive. There is accruing evidence for possible pathological roles in the immunocompromised host, but the evidence is less convincing for the range of associations otherwise listed for the normal host at the present time.
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Affiliation(s)
- C A Jones
- Department of Immunology and Infectious Diseases, Royal Alexandra Hospital for Children, Camperdown, Australia
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Westarp ME, Kleiser B, Bechinger D, Kornhuber HH. Three or more infantile febrile seizures and HHV-6. J Neurovirol 1995; 1:321. [PMID: 9222371 DOI: 10.3109/13550289509114029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Abstract
We evaluated febrile convulsions prospectively in 42 children to investigate the association between acute human herpesvirus-6 (HHV-6) infection and first-time febrile convulsions, using both virologic and serologic methods. Eight children had primary HHV-6 infection documented by viral culture and an additional three by acute- and convalescent-phase serologic studies. These findings indicate that acute HHV-6 infection is a frequent cause of febrile convulsions in young children.
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Affiliation(s)
- S R Barone
- Department of Pediatrics, North Shore University Hospital-Cornell University Medical College, Manhasset, NY 11030, USA
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Abstract
Twenty two cases of human herpesvirus 7 (HHV-7) infection are described. HHV-7 infection occurred later than human herpesvirus 6 (HHV-6) infection and induced exanthem subitum in 47.1% of the children. HHV-7 infection was associated with exanthem subitum and the other symptoms that were observed in HHV-6 infection.
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Affiliation(s)
- S Torigoe
- Shingu Municipal Hospital, Wakayama, Japan
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