Cytomegalovirus meningitis in a patient with relapsed acute myeloid leukemia

Co-infections of human herpesviruses (CMV, HHV-6, HHV-7 and EBV) in non-transplant acute leukemia patients undergoing chemotherapy

“…Based on these results, the time of CMV activation could be predicted based on the timing of HHV-6 infection. HHV-6 is known to have immunomodulatory and immunosuppressive effects that could predispose patients to CMV reactivation/infection [7,30]. Although, in a previous study in acute leukemia patients, the association between HHV-6 and CMV was only found in saliva samples but not in blood samples [24].…”

“…β-HHVs were found to transactivated each other; while CMV infection appeared to trigger HHV-6 and/or HHV-7 co-infection and vice versa [6,[35][36][37][38][39]. Recent studies have also shown that the activation of HHV-6 can predispose allo-HSCT recipients for CMV infection, and suggest that HHV-6 infection precedes CMV activation in time [7,[38][39][40][41]. Similarly, in the current study, prior HHV-6 infection was associated with higher rates of CMV activation.…”

“…Furthermore, the use of salvage chemotherapy (relapsed/refractory) was associated with the significant increase in CMV and HHV-6 infections in univariate analysis but not in multivariate analysis in CMV infections. This increase might be due to exposure to more selective suppressive chemotherapy such as fludarabine and the use of high-dose of steroids which depresses CD4 T-lymphocyte leading to a prolonged lymphopenia or T-cell dysfunction [6,7,[28][29][30][31]. However, paradoxical recent data suggest that CMV replication may protect against AML relapse after allo-HSCT [32].…”

“…The median follow-up duration was 7.4 months range (1-36) from the start of chemotherapy. There are 734 blood specimens, (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) samples per patient with a median of seven samples per patient from which all plasma samples were isolated and stored at − 80°C until DNA extraction. The study was approved by the Ethics Committee and Medical Research of Farhat Hached University Hospital of Sousse, ref: IRB registration number assigned by OHRP: IRB00008931 and informed consent was obtained from all participants enrolled in the study.…”

“…Similarly, in these settings, poor data is available concerning the other HHVs which can also lead to severe diseases. Most existing studies consist of retrospective analyses and case series whereas only limited information is available from prospective studies [2,[4][5][6][7][8]. The reported incidence range and outcomes of herpes viral infections among these patients groups are wide and variable due to a number of factors, including the study design, the type of disease, the intensity and duration of T-cell-mediated immune suppression [9].…”