Human Herpesvirus 6 Detection during the Evaluation of Sepsis in Infants Using the FilmArray Meningitis/Encephalitis Panel

Dantuluri, Keerti; Konvinse, Katherine C.; Crook, Jennifer; Thomsen, Isaac; Banerjee, Ritu

doi:10.1016/j.jpeds.2020.03.023

Cited by 10 publications

(8 citation statements)

References 11 publications

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“…Increasing use of PCR-based pathogen detection panels in newborns may lead to more always frequent diagnoses of HHV-6 and interpretation of this finding could be challenging to interpret [ 73 ]. Prevention strategies …”

Section: Herpes Virusmentioning

confidence: 99%

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Pregnancy and viral infections: Mechanisms of fetal damage, diagnosis and prevention of neonatal adverse outcomes from cytomegalovirus to SARS-CoV-2 and Zika virus

Auriti

Rose

Santisi

et al. 2021

Biochimica et Biophysica Acta (BBA) - Molecular Basis of Diseas

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Section: Herpes Virusmentioning

confidence: 99%

“…Intravenous ganciclovir is feasible to decrease viral load but treatment for HHV-6 is appropriate only in patients who are either immunocompromised, have a high viral load (without a ciHHV-6), or present with a severe disease [ 73 ].…”

Section: Herpes Virusmentioning

confidence: 99%

Pregnancy and viral infections: Mechanisms of fetal damage, diagnosis and prevention of neonatal adverse outcomes from cytomegalovirus to SARS-CoV-2 and Zika virus

Auriti

Rose

Santisi

et al. 2021

Biochimica et Biophysica Acta (BBA) - Molecular Basis of Diseas

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“…With the advent of new technologies like the FilmArray (BioFire) panel, there has been an uptick in rates of HHV-6 detection in standardized viral screening. The preponderance of cases are asymptomatic, are not associated with encephalitis, and are most likely due to ciHHV-6 [5]. Without an ability to delineate ciHHV-6 status or viral load, concerns arise over the propensity to attribute a CNS condition to HHV-6 when the panel is simply detecting ciHHV-6 DNA.…”

Section: Discussionmentioning

confidence: 99%

“…Without an ability to delineate ciHHV-6 status or viral load, concerns arise over the propensity to attribute a CNS condition to HHV-6 when the panel is simply detecting ciHHV-6 DNA. A positive test has been shown to usually be due to either integration within vertically transferred chromosomes or due to subclinical reactivation of latent HHV-6 virus [5,9,10]. Additional diagnostic testing modalities such as viral load or HHV-6 DNA qPCR tests on CSF and blood may be needed to confirm clinical significance [5,[9][10][11].…”

Section: Discussionmentioning

confidence: 99%

“…Human herpesvirus-6 (HHV-6) is a DNA virus that demonstrates near-universal infection in childhood, affecting more than 80% of children by two years of age [1][2][3][4][5][6][7][8][9][10]. With a varied range of infections, HHV-6 has been shown to induce an asymptomatic disease state in a majority of those affected, and infrequently cause febrile seizures, encephalitis, or meningitis in some [1].…”

Section: Introductionmentioning

confidence: 99%

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Incidental Detection of Human Herpesvirus-6 in Cerebrospinal Fluid Analysis: To Treat or Not to Treat?

Kharbat¹,

Lakshmi-Narasimhan²,

Bhaskaran³

et al. 2022

Cureus

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Human herpesvirus-6 (HHV-6) is a ubiquitous beta herpes virus which can result in meningitis/ meningoencephalitis in humans. FilmArray meningitis/encephalitis panel (BioFire Diagnostics, Salt Lake City, UT) is employed in medical centers for the establishment of a central nervous system (CNS) infection, and HHV-6 is often positive. However, establishing HHV-6 as a cause of meningitis or encephalitis is difficult at the present time, as a polymerase chain reaction (PCR) test alone does not establish the etiology of the CNS infection. HHV-6 can be transmitted in a Mendelian fashion by integrating into the human genome (ciHHV-6 or chromosomally integrated HHV-6). We present a case of a 34-week gestational age neonate in the neonatal intensive care unit (NICU) who tested positive for HHV-6 through a panel screening, presumably due to ciHHV-6 infection. Knowledge and understanding of this phenomenon is essential in preventing misdiagnosis of active HHV-6 infection and subsequent unnecessary antiviral treatment.

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Severe herpes virus 6 interstitial pneumonia in an infant with three variants in genes predisposing to lung disease

Rose

Auriti

Lozzi

et al. 2021

Journal of Medical Virology

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Infections due to human herpesvirus 6 (HHV‐6) are frequent during early childhood. Usually, they have a favorable clinical course. Conversely, HHV‐6 congenital infections occur in about 1% of neonates and may present with more severe clinical pictures. HHV‐6 can be found in lung tissues and bronchoalveolar lavage (BAL) samples from patients with pneumonia and in immunocompromised patients can cause mild to severe pneumonia. In neonates, the role of HHV‐6 in the genesis of severe pneumonia is poorly defined still now. We describe a healthy infant with a late‐onset (15 days of life) severe interstitial pneumonia and heavy HHV‐6 genome load, persistently detected in its BAL fluid. The baby underwent high‐frequency oscillatory ventilation, hydroxychloroquine, steroids, and ganciclovir for 6 weeks and at 9 months she died. Next‐generation sequencing of genes known to cause neonatal respiratory insufficiency revealed the presence of a “probably pathogenetic” heterozygous variant in the autosomal recessive DRC1 gene, a heterozygous variant of unknown significance (VUS) in the autosomal recessive RSPH9 gene, and a heterozygous VUS in the autosomal recessive MUC5B gene. HHV‐6 infection should be considered in the differential diagnosis of late‐onset severe respiratory distress in neonates and the co‐occurrence of genetic predisposing factors or modifiers should be tested by specific molecular techniques. The intensity of HHV‐6 genome load in BAL fluid could be an indicator of the response to antiviral therapy.

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Human Herpesvirus 6 Detection during the Evaluation of Sepsis in Infants Using the FilmArray Meningitis/Encephalitis Panel

Cited by 10 publications

References 11 publications

Pregnancy and viral infections: Mechanisms of fetal damage, diagnosis and prevention of neonatal adverse outcomes from cytomegalovirus to SARS-CoV-2 and Zika virus

Pregnancy and viral infections: Mechanisms of fetal damage, diagnosis and prevention of neonatal adverse outcomes from cytomegalovirus to SARS-CoV-2 and Zika virus

Incidental Detection of Human Herpesvirus-6 in Cerebrospinal Fluid Analysis: To Treat or Not to Treat?

Severe herpes virus 6 interstitial pneumonia in an infant with three variants in genes predisposing to lung disease

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