Severe Meningoencephalitis Caused by Human Herpesvirus 6 Type B in an Immunocompetent Woman Treated with Ganciclovir

Birnbaum, Tobias; Padovan, Claudio S.; Sporer, Bernd; Rupprecht, Tobias A.; Ausserer, Harald; Jaeger, Gundula; Pfister, H.-W.

doi:10.1086/427943

Cited by 75 publications

(55 citation statements)

References 15 publications

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“…There are a remarkable number of cases of encephalitis in immunocompetent adults attributed to variant A, 6 in all (4,13,26,29,30,39), as opposed to one attributed to variant B (5,28). As previously discussed, HHV-6B, not HHV-6A, is responsible for primary infection in childhood, whereas either variant A or B can be integrated into human chromosomes.…”

Section: Discussionmentioning

confidence: 88%

“…Turning to older individuals in whom primary infection is extremely unlikely, there are a few case reports describing, in all, 11 immunocompetent adults and 1 teenager. All had clinically defined encephalitis and HHV-6 DNA in their CSF (4,5,13,21,26,29,30,33,39), and in each case, the diagnosis was given as HHV-6 encephalitis but viral integration had not been considered. Viral DNA load in CSF was measured in 7 patients; low level HHV-6 DNA was found in 2 of these but in both primary infection was excluded (29,30) suggesting viral reactivation.…”

Section: Discussionmentioning

confidence: 99%

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Human Herpesvirus 6 DNA Levels in Cerebrospinal Fluid Due to Primary Infection Differ from Those Due to Chromosomal Viral Integration and Have Implications for Diagnosis of Encephalitis

et al. 2007

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The prevalence and concentration of human herpesvirus 6 (HHV-6) DNA in the cerebrospinal fluid (CSF) of the immunocompetent in primary infection was compared with that in viral chromosomal integration. Samples from 510 individuals with suspected encephalitis, 200 young children and 310 older children and/or adults, and 12 other patients were tested. HHV-6 DNA concentration (log 10 copies/ml) was measured in CSF, serum, and whole blood using PCR. Serum HHV-6 immunoglobulin G antibody was measured by indirect immunofluorescence. Primary infection was defined by antibody seroconversion and/or a low concentration of HHV-6 DNA (<3.0 log 10 copies/ml) in a seronegative serum. Chromosomal integration was defined by a high concentration of viral DNA in serum (>3.5 log 10 copies/ml) or whole blood (>6.0 log 10 copies/ml). The prevalences of CSF HHV-6 DNA in primary infection and chromosomal integration were 2.5% and 2.0%, respectively, in the young children (<2 years) and 0% and 1.3%, respectively, in the older children and/or adults. The mean concentration of CSF HHV-6 DNA in 9 children with primary infection (2.4 log 10 copies/ml) was significantly lower than that of 21 patients with viral chromosomal integration (4.0 log 10 copies/ml). Only HHV-6B DNA was found in primary infection, whereas in viral integration, 4 patients had HHV-6A and 17 patients HHV-6B. Apart from primary infection, chromosomal integration is the most likely cause of HHV-6 DNA in the CSF of the immunocompetent. Our results show that any diagnosis of HHV-6 encephalitis or other type of active central nervous system infection should not be made without first excluding chromosomal HHV-6 integration by measuring DNA load in CSF, serum, and/or whole blood.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Human Herpesvirus 6 DNA Levels in Cerebrospinal Fluid Due to Primary Infection Differ from Those Due to Chromosomal Viral Integration and Have Implications for Diagnosis of Encephalitis

et al. 2007

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“…The classic manifestations of HHV-6 infection in immunocompetent children are roseola infantum (also known as exanthema subitum, and sixth disease) and acute febrile illnesses with or without a rash [3]. Encephalitis of variable severity has been associated with HHV-6 infection in immunocompetent patients [10,11]. As most people over 2 years of age are seropositive for HHV-6, a positive result cannot be interpreted.…”

Section: Discussionmentioning

confidence: 99%

Co-infection with Mycoplasma pneumoniae and Human Herpesvirus 6 (HHV-6) in an Immunocompetent Child with Meningoencephalitis: a Random Association?

et al. 2007

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Encephalitis can represent a complication of both Mycoplasma and Human Herpesvirus type 6 infections and, although uncommon, is associated with significant morbidity and mortality. We describe a 13-year-old girl with fever, headache and mental changes with a pattern of concomitant Mycoplasma and Human Herpesvirus-6 infection. The hypothetical relationship between this dual infection and the central nervous system disease is discussed.

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“…The weight of evidence indicates that HHV6 is a causative agent in immune-competent adults, as IgM to the virus is often found in such circumstances [73,74]. Both strains of HHV6 are also strongly implicated in the pathogenesis of idiopathic encephalitis [72,75].…”

Section: Human Herpes Virusmentioning

confidence: 99%

The Putative Role of Viruses, Bacteria, and Chronic Fungal Biotoxin Exposure in the Genesis of Intractable Fatigue Accompanied by Cognitive and Physical Disability

Morris¹,

Berk

Walder

et al. 2015

Mol Neurobiol

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Patients who present with severe intractable apparently idiopathic fatigue accompanied by profound physical and or cognitive disability present a significant therapeutic challenge. The effect of psychological counseling is limited, with significant but very slight improvements in psychometric measures of fatigue and disability but no improvement on scientific measures of physical impairment compared to controls. Similarly, exercise regimes either produce significant, but practically unimportant, benefit or provoke symptom exacerbation. Many such patients are afforded the exclusionary, non-specific diagnosis of chronic fatigue syndrome if rudimentary testing fails to discover the cause of their symptoms. More sophisticated investigations often reveal the presence of a range of pathogens capable of establishing life-long infections with sophisticated immune evasion strategies, including Parvoviruses, HHV6, variants of Epstein-Barr, Cytomegalovirus, Mycoplasma, and Borrelia burgdorferi. Other patients have a history of chronic fungal or other biotoxin exposure. Herein, we explain the epigenetic factors that may render such individuals susceptible to the chronic pathology induced by such agents, how such agents induce pathology, and, indeed, how such pathology can persist and even amplify even when infections have cleared or when biotoxin exposure has ceased. The presence of active, reactivated, or even latent Herpes virus could be a potential source of intractable fatigue accompanied by profound physical and or cognitive disability in some patients, and the same may be true of persistent Parvovirus B12 and mycoplasma infection. A history of chronic mold exposure is a feasible explanation for such symptoms, as is the presence of B. burgdorferi. The complex tropism, life cycles, genetic variability, and low titer of many of these pathogens makes their detection in blood a challenge. Examination of lymphoid tissue or CSF in such circumstances may be warranted.

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Severe Meningoencephalitis Caused by Human Herpesvirus 6 Type B in an Immunocompetent Woman Treated with Ganciclovir

Cited by 75 publications

References 15 publications

Human Herpesvirus 6 DNA Levels in Cerebrospinal Fluid Due to Primary Infection Differ from Those Due to Chromosomal Viral Integration and Have Implications for Diagnosis of Encephalitis

Human Herpesvirus 6 DNA Levels in Cerebrospinal Fluid Due to Primary Infection Differ from Those Due to Chromosomal Viral Integration and Have Implications for Diagnosis of Encephalitis

Co-infection with Mycoplasma pneumoniae and Human Herpesvirus 6 (HHV-6) in an Immunocompetent Child with Meningoencephalitis: a Random Association?

The Putative Role of Viruses, Bacteria, and Chronic Fungal Biotoxin Exposure in the Genesis of Intractable Fatigue Accompanied by Cognitive and Physical Disability

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