Encephalitis Caused by Human Herpesvirus-6 in a Liver Transplant Recipient

Montejo, Miguel; Fernández, José R.; Testillano, M.; Valdivieso, A.; Aguirrebengoa, Koldo; Varas, Carmen; Olaizola, Alberto; Urbina, J. Ortiz de

doi:10.1159/000066172

Cited by 35 publications

(30 citation statements)

References 11 publications

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“…Clinical manifestations of HHV-6 reactivation or reinfection in SOT recipients are similar to those described in BMT patients. These include fever and/or rash as the most frequently seen disease manifestation of active HHV-6 infection (150,363,384,449,451), followed by encephalitis or encephalopathy (291,323,363,384), hepatitis (150,384,427), graft dysfunction or rejection (2,15,168,231), bone marrow suppression (362,363), and pneumonitis (362). Table 2 provides a summary of prospective studies in SOT patients.…”

Section: Clinical Manifestations Of Hhv-6 Infectionmentioning

confidence: 99%

Update on Human Herpesvirus 6 Biology, Clinical Features, and Therapy

2005

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Human herpesvirus 6 (HHV-6) is a betaherpesvirus that is closely related to human cytomegalovirus. It was discovered in 1986, and HHV-6 literature has expanded considerably in the past 10 years. We here present an up-to-date and complete overview of the recent developments concerning HHV-6 biological features, clinical associations, and therapeutic approaches. HHV-6 gene expression regulation and gene products have been systematically characterized, and the multiple interactions between HHV-6 and the host immune system have been explored. Moreover, the discovery of the cellular receptor for HHV-6, CD46, has shed a new light on HHV-6 cell tropism. Furthermore, the in vitro interactions between HHV-6 and other viruses, particularly human immunodeficiency virus, and their relevance for the in vivo situation are discussed, as well as the transactivating capacities of several HHV-6 proteins. The insight into the clinical spectrum of HHV-6 is still evolving and, apart from being recognized as a major pathogen in transplant recipients (as exemplified by the rising number of prospective clinical studies), its role in central nervous system disease has become increasingly apparent. Finally, we present an overview of therapeutic options for HHV-6 therapy (including modes of action and resistance mechanisms)

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Section: Clinical Manifestations Of Hhv-6 Infectionmentioning

confidence: 99%

Update on Human Herpesvirus 6 Biology, Clinical Features, and Therapy

2005

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“…These have been classified as either direct or indirect effects of HHV-6. The direct clinical manifestations due to HHV-6 include a febrile illness with or without rash, myelosuppression, hepatitis, pneumonitis and neurological diseases [33,[36][37][38] . The indirect effects attributed to HHV-6 include an exacerbation of cytomegalovirus (CMV) disease, an increased severity of hepatitis C virus (HCV) recurrence, an increased risk of other opportunistic infections, allograft dysfunction, and acute cellular rejection (Table 1) [33,36,[39][40][41][42][43][44][45] .…”

Section: Clinical Syndromes Associated With Hhv-6 Infection After LIVmentioning

confidence: 99%

“…Neurological illness: Encephalitis due to HHV-6 infection has been reported in two liver transplant recipients [38,51] . In another report, central nervous system complications such as mental status changes of unidentified etiology were more likely to occur in liver transplant recipients who had HHV-6 infection [44] .…”

Section: Myelosuppression and Pneumonitismentioning

confidence: 99%

“…Fever and rash [36] Increased incidence and severity of cytomegalovirus disease [31,40,41] Hepatitis [33,36,49] Earlier and more severe recurrence of hepatitis C virus [42] Myelosuppression [37] Higher incidence of fungal infections [44] Pneumonitis [37] Higher incidence of opportunistic Infection [36] Neurologic illness [38,44,51] Higher incidence of allograft rejection [33,36,45,53] …”

Section: Hhv-6 Indirect Effectsmentioning

confidence: 99%

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Human herpesvirus 6 infections after liver transplantation

Massih¹,

Razonable²

2009

WJG

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“…1,2 Many investigators have studied the clinical features of HHV-6 infection in liver transplant recipients, using viral isolation, [3][4][5][6][7][8][9] antigenemia assay, [10][11][12][13][14] serological analysis, 15,16 and molecular analysis such as real-time polymerase chain reaction (PCR). [17][18][19][20][21][22] Several clinical features, including fever, 5,6,8,10 encephalitis, 7,23 CMV disease, 15,17,18 fungal infection, 7 graft dysfunction, 10,11,22 and hepatitis C virus (HCV) recurrence 9,19 after transplantation, have been suggested as clinical manifestations due to HHV-6 infection. However, the precise clinical features of HHV-6 reactivation remain unknown because evaluating active HHV-6 infection in transplant recipients is difficult.…”

mentioning

confidence: 99%

Human herpesvirus 6 infection in adult living related liver transplant recipients

et al. 2007

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To analyze human herpesvirus 6 (HHV-6) infection in adult living related liver transplantation, we performed a virological analysis, including viral isolation, serological assay, and real-time polymerase chain reaction, of serially collected blood samples from 67 recipients. In addition, cytokine levels were measured to determine their role in viral reactivation. HHV-6 was isolated from only 4 recipients (6.0%), and viral DNA was detected in 15 (22.4%) of the 67 recipients. A significant increase in HHV-6 immunoglobulin G antibody titers was observed in 19 (28.4%) of the 67 recipients. Finally, 26 recipients (38.8%) had HHV-6 reactivation 2-6 weeks after transplantation. HHV-6 associated clinical features were analyzed in the 17 recipients presenting with either viremia or DNAemia. Two recipients with viremia and 3 recipients with DNAemia had unexplained fever at the time of viral infection. An increase in aminotransferase levels was observed in 2 recipients with viremia and 3 recipients with DNAemia. Recipients with liver cirrhosis caused by hepatitis B virus or hepatitis C virus infection as the underlying disease were more likely to have HHV-6 infection (P ϭ 0.025). Mortality at the last follow-up in recipients with HHV-6 reactivation was significantly higher than in those without viral reactivation (P ϭ 0.0118). Plasma interleukin-6 levels were significantly higher in the recipients with HHV-6 viremia than in the recipients without viremia at 4 weeks post-transplant (P ϭ 0.0411). Moreover, tumor necrosis factor ␣ levels were also higher in recipients with HHV-6 viremia (P Ͻ 0.0001) or reactivation (P ϭ 0.0011) than in recipients without viremia or reactivation 4 weeks post-transplant.

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Encephalitis Caused by Human Herpesvirus-6 in a Liver Transplant Recipient

Cited by 35 publications

References 11 publications

Update on Human Herpesvirus 6 Biology, Clinical Features, and Therapy

Update on Human Herpesvirus 6 Biology, Clinical Features, and Therapy

Human herpesvirus 6 infections after liver transplantation

Human herpesvirus 6 infection in adult living related liver transplant recipients

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