Post-transplant acute limbic encephalitis

Seeley, William W.; Marty, Francisco M.; Holmes, Tim; Upchurch, Katherine S.; Soiffer, Robert J.; Antin, Joseph H.; Baden, Lindsey R.; Bromfield, Edward B

doi:10.1212/01.wnl.0000265591.10200.d7

Cited by 260 publications

(220 citation statements)

References 38 publications

Supporting

Mentioning

208

Contrasting

Unclassified

Order By: Relevance

“…3,36,37 Overt seizures, including generalized seizures and partial seizures, develop in 40-70% of patients. [36][37][38] HHV-6 encephalitis may accompany syndrome of inappropriate antidiuretic hormone. [38][39][40] HHV-6 encephalitis typically shows an MRI signature of hyperintense lesions on T2-weighted, fluid-attenuated inversion recovery imaging and diffusion-weighted imaging of bilateral medial temporal lobes, primarily affecting the hippocampus and amygdala (Figure 1).…”

Section: Disease Associations: We Do Not Know the Precise Disease Assmentioning

confidence: 99%

“…[38][39][40] HHV-6 encephalitis typically shows an MRI signature of hyperintense lesions on T2-weighted, fluid-attenuated inversion recovery imaging and diffusion-weighted imaging of bilateral medial temporal lobes, primarily affecting the hippocampus and amygdala (Figure 1). 3,7,[36][37][38]41,42 Some investigators have termed this finding 'post-transplant acute limbic encephalitis (PALE) 38,40,[42][43][44] and HHV-6 PALE has been diagnosed when the patient has detectable HHV-6 DNA in cerebrospinal fluid in the context of acute-onset altered mental status, amnesia, seizures or other evidence of medial temporal lobe disease involving the limbic system and no other identifiable etiology. 38,42 A recent retrospective study 45 showed, however, not all cases of HHV-6-associated CNS dysfunction meet the criteria for PALE.…”

Section: Disease Associations: We Do Not Know the Precise Disease Assmentioning

confidence: 99%

See 1 more Smart Citation

Human herpesvirus-6 encephalitis after allogeneic hematopoietic cell transplantation: What we do and do not know

Ogata

Fukuda²,

Teshima

2015

Bone Marrow Transplant

104

View full text Add to dashboard Cite

Human herpesvirus-6 (HHV-6) encephalitis following allogeneic hematopoietic cell transplantation is a serious and often fatal complication accompanying reactivation of HHV-6B. Incidence varies among studies, but is reportedly 0-11.6% after bone marrow or PBSC transplantation and 4.9-21.4% after umbilical cord blood transplantation, typically around 2-6 weeks post transplant. Symptoms are characterized by memory loss, loss of consciousness and seizures. Magnetic resonance imaging (MRI) typically shows bilateral signal abnormalities in the limbic system. This complication is considered to represent acute encephalitis caused by direct virally induced damage to the central nervous system, but our understanding of the etiologies and pathogenesis is still limited. The mortality rate attributable to this pathology remains high, and survivors are often left with serious sequelae such as impaired memory and epilepsy. Despite the poor prognosis, no validated treatments or preventative measures have been established. Establishment of preventative strategies represents an important challenge. This article reviews the current knowledge of the clinical features, incidence, pathogenesis and treatment of HHV-6 encephalitis, and discusses issues needing clarification in the future to overcome this serious complication.

show abstract

Section: Disease Associations: We Do Not Know the Precise Disease Assmentioning

confidence: 99%

Section: Disease Associations: We Do Not Know the Precise Disease Assmentioning

confidence: 99%

Human herpesvirus-6 encephalitis after allogeneic hematopoietic cell transplantation: What we do and do not know

Ogata

Fukuda²,

Teshima

2015

Bone Marrow Transplant

104

View full text Add to dashboard Cite

show abstract

“…[19][20][21] HHV-6 encephalitis can result in serious neurological sequelae, such as biphasic seizures and other symptoms of post-transplant acute limbic encephalitis. [22][23][24][25] Symptoms often include confusion, seizures, delirium, aphasia, amnesia, emotional outbursts, hypersexuality, hemiparesis, hemiplegia, ataxia, hyperreflexia, syndrome of inappropriate diuretic hormone secretion and electroencephalography abnormalities. 22,23 HHV-6 encephalitis is also associated with a high rate of long-term sequelae and mortality.…”

Section: Introductionmentioning

confidence: 99%

“…[22][23][24][25] Symptoms often include confusion, seizures, delirium, aphasia, amnesia, emotional outbursts, hypersexuality, hemiparesis, hemiplegia, ataxia, hyperreflexia, syndrome of inappropriate diuretic hormone secretion and electroencephalography abnormalities. 22,23 HHV-6 encephalitis is also associated with a high rate of long-term sequelae and mortality. In a review of post-transplant acute limbic encephalitis associated with HHV-6, Seeley et al 23 found that 5 out of 9 (56%) HHV-6 þ post-transplant acute limbic encephalitis patients died, while 3 out of 4 (75%) of the surviving patients maintained persistent cognitive impairment.…”

Section: Introductionmentioning

confidence: 99%

“…22,23 HHV-6 encephalitis is also associated with a high rate of long-term sequelae and mortality. In a review of post-transplant acute limbic encephalitis associated with HHV-6, Seeley et al 23 found that 5 out of 9 (56%) HHV-6 þ post-transplant acute limbic encephalitis patients died, while 3 out of 4 (75%) of the surviving patients maintained persistent cognitive impairment. In another survey of eight Japanese patients with HHV-6 encephalitis, three died and four out of five patients who survived suffered from permanent neurological disability.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

HHV-6 encephalitis in umbilical cord blood transplantation: a systematic review and meta-analysis

Scheurer

Pritchett

Amirian

et al. 2012

Bone Marrow Transplant

108

View full text Add to dashboard Cite

Reactivation of human herpesvirus-6 (HHV-6) frequently occurs following hematopoietic SCT (HSCT), and has been associated with clinical consequences in many patient populations. HHV-6 reactivation and HHV-6 encephalitis seem to occur more frequently in patients undergoing HSCT with cord blood (CB) as the stem cell source. We have conducted a systematic literature review and meta-analysis to investigate the clinical significance of this correlation. A systematic review of publications indexed in PubMed was performed for HSCT studies published over the past 10 years that fit inclusion criteria. Data on prevalences of HHV-6 reactivation and HHV-6 encephalitis post HSCT were abstracted from 19 papers. Meta-analyses were conducted to calculate combined prevalence estimates. The prevalences of HHV-6 reactivation and encephalitis were compared among CB vs non-CB HSCT. Prevalences of HHV-6 reactivation and HHV-6 encephalitis were significantly higher in patients receiving CB as the stem cell source than in patients receiving another stem cell source (72.0% vs 37.4%, Po0.0001; 8.3% vs 0.50%, Po0.0001, respectively). HHV-6 reactivation and HHV-6 encephalitis are significant complications in the post-HSCT setting, particularly in patients receiving CB as the stem cell source. Thus, patients undergoing umbilical CB transplantation should be closely monitored for HHV-6 reactivation.

show abstract

Emerging Viral Infections of the Central Nervous System

Tyler¹

2009

Arch Neurol

109

View full text Add to dashboard Cite

n this 2-part review, I will focus on emerging virus infections of the central nervous system (CNS). Part 1 will introduce the basic features of emerging infections, including their definition, epidemiology, and the frequency of CNS involvement. Important mechanisms of emergence will be reviewed, including viruses spreading into new host ranges as exemplified by West Nile virus (WNV), Japanese encephalitis (JE) virus, Toscana virus, and enterovirus 71 (EV71). Emerging infections also result from opportunistic spread of viruses into known niches, often resulting from attenuated host resistance to infection. This process is exemplified by transplantassociated cases of viral CNS infection caused by WNV, rabies virus, lymphocytic choriomeningitis, and lymphocytic choriomeningitis-like viruses and by the syndrome of human herpesvirus 6 (HHV6)-associated posttransplantation acute limbic encephalitis. The second part of this review begins with a discussion of JC virus and the occurrence of progressive multifocal leukoencephalopathy in association with novel immunomodulatory therapies and then continues with an overview of the risk of infection introduced by imported animals (eg, monkeypox virus) and examples of emerging diseases caused by enhanced competence of viruses for vectors and the spread of vectors (eg, chikungunya virus) and then concludes with examples of novel viruses causing CNS infection as exemplified by Nipah and Hendra viruses and bat lyssaviruses.

show abstract

Post-transplant acute limbic encephalitis

Cited by 260 publications

References 38 publications

Human herpesvirus-6 encephalitis after allogeneic hematopoietic cell transplantation: What we do and do not know

Human herpesvirus-6 encephalitis after allogeneic hematopoietic cell transplantation: What we do and do not know

HHV-6 encephalitis in umbilical cord blood transplantation: a systematic review and meta-analysis

Emerging Viral Infections of the Central Nervous System

Contact Info

Product

Resources

About