1/48. PCR in meningoencephalitis diagnosis.polymerase chain reaction (PCR) detection of a stretch of nucleic acid sequence of microbial origin from a clinical sample is not always diagnostic of disease unless the identified agent is a strict pathogen or its growth is documented. We describe here a case of acute meningoencephalitis in a 21-y-old man, in whom no pathogen was isolated by traditional bacterial or viral culture. Standard dna PCR performed on the cerebrospinal fluid (CSF) identified the presence of 3 infectious agents: HHV-6, HHV-7 and mycoplasma pneumoniae. Additional PCRs performed on CSF fractions along with gene transcript analysis proved the bystander role of the 2 herpesviruses and indicated M. pneumoniae as the relevant replicating agent, most likely playing to be a pathogenic role. Until this useful analysis becomes routine, clinicians should deal carefully with dna PCR results, especially when assessing the aetiological role of agents, such as herpesviruses, which are known to undergo latency.- - - - - - - - - - ranking = 1keywords = herpesvirus (Clic here for more details about this article) |
2/48. Fatal adult case of severe lymphocytopenia associated with reactivation of human herpesvirus 6.It has been suggested that immunosuppression associated with human herpesvirus 6 (HHV-6) infection is a result of functional impairment or direct destruction of immunological cells. The ability of the virus to infect and destroy lymphocytes may cause progressive immunodeficiency in an infant with primary HHV-6 infection. An adult patient is described who had a fatal cytomegalovirus (CMV) infection due to severe and prolonged lymphocyte depletion associated with HHV-6 reactivation. The HHV-6 antibody titers were increased significantly after reactivation, and the virus was isolated from his peripheral blood mononuclear cells. The quantity of both HHV-6 and CMV dna was determined by using real-time PCR in plasma samples collected serially. HHV-6 DNAemia persisted for 1 month, which started just 1 week after the onset of lymphocytopenia. In contrast to HHV-6, CMV DNAemia was detected in the terminal phase of the illness. Thus, HHV-6 reactivation may have been the cause of the severe lymphocyte depletion and fatal CMV infection.- - - - - - - - - - ranking = 2.5keywords = herpesvirus (Clic here for more details about this article) |
3/48. Human herpesvirus 6-associated hemophagocytic syndrome in a healthy adult.Virus-associated hemophagocytic syndrome is a fulminant disorder associated with systemic viral infection and characterized pathologically by multiple-organ infiltration of hemophagocytic histiocytes into the lymphoreticular tissues. This is the first report of a previously healthy adult in whom Human herpesvirus 6 reactivation induced this syndrome with severe hemodynamic and respiratory distress.- - - - - - - - - - ranking = 2.5keywords = herpesvirus (Clic here for more details about this article) |
4/48. Case report: primary human herpesvirus-6 associated with an afebrile seizure in a 3-week-old infant.We describe a 3-week-old male infant with an afebrile seizure in whom serologic and polymerase chain reaction (PCR) findings support concomitant primary human herpesvirus 6 (HHV-6) infection. Although HHV-6 infection has been associated with first-time febrile seizures and encephalitis in both immunocompetent and immunocompromised hosts, it has not been associated previously with afebrile seizures in healthy infants. This report provides additional evidence of the neuropathogenic potential of HHV-6.- - - - - - - - - - ranking = 2.5keywords = herpesvirus (Clic here for more details about this article) |
5/48. Influenza encephalopathy associated with infection with human herpesvirus 6 and/or human herpesvirus 7.Influenza-associated encephalopathy is often reported in young Japanese children, but its pathogenesis is unknown. Although influenza virus can be demonstrated by throat culture for patients with encephalopathy, cultures of samples of cerebrospinal fluids (CSF) do not yield the virus. Eight patients with encephalopathy or complicated febrile convulsions had influenza virus infection diagnosed by means of culture, polymerase chain reaction (PCR), or rapid diagnosis using throat swabs. In all 8 cases, the results of PCR testing of CSF specimens for influenza virus were negative. On the other hand, human herpesvirus 6 (HHV-6) dna was demonstrated in CSF specimens obtained from 2 of 8 patients. In 3 of 8 patients, the presence of human herpesvirus 7 (HHV-7) dna was demonstrated in CSF specimens. Some cases of influenza-associated encephalopathy reported in japan may be attributable to a dual infection with influenza virus and HHV-6, -7, or both. Another possibility is that latent HHV-6 or HHV-7 in the brain is reactivated by influenza, causing encephalopathy or febrile convulsions.- - - - - - - - - - ranking = 5keywords = herpesvirus (Clic here for more details about this article) |
6/48. Case report: human herpesvirus 7 associated fatal encephalitis in a peripheral blood stem cell transplant recipient.Previous studies have suggested a neuroinvasive and neuropersistent potential of human herpesvirus 7 (HHV-7). In this report, a case of fatal encephalitis is described and its association with HHV-7 infection is discussed. An 8-year-old girl received a peripheral blood stem cell transplant for relapsed acute lymphoblastic leukaemia. The post-transplant period was uneventful and a course of intrathecal chemotherapy was given on Day-30. On Day-41, she developed acute encephalopathy with diplopia and nystagmus. She ran a rapid downhill course and succumbed despite antiviral treatment. The only positive pathological finding was the multiple microscopic foci of haemorrhage associated with neuronal degeneration detected in the brain stem. All microbiological investigations were negative, except for the presence of HHV-7 dna in cerebrospinal fluid and brain stem tissue samples.- - - - - - - - - - ranking = 2.5keywords = herpesvirus (Clic here for more details about this article) |
7/48. Herpesvirus-6 encephalitis complicated by Wernicke-korsakoff syndrome in a pediatric recipient of unrelated cord blood transplantation.A 10-year-old girl with M2 acute myeloid leukemia underwent an unrelated cord blood transplantation in refractory first relapse. On day 13, after 48 hours with fever, she showed a measles-like rash, and on day 15, she began experiencing neurologic symptoms (headache, tremors, weakness, nystagmus, mild confusion, speaking, taste, and behavior disturbances, and focal seizures). She also had amnesia for recent events with disability to learn, mimicking Wernicke-korsakoff syndrome. Computed tomography of the brain and cerebrospinal fluid (CSF) and electroencephalogram were nonspecific. We found human herpesvirus 6 (HHV-6) dna in CSF and cytomegalovirus in bronchoalveolar lavage using polymerase chain reaction techniques. Treatment with ganciclovir and foscarnet was effective, with total resolution of symptoms.- - - - - - - - - - ranking = 0.5keywords = herpesvirus (Clic here for more details about this article) |
8/48. Severe amnesia associated with human herpesvirus 6 encephalitis after bone marrow transplantation.BACKGROUND: Human herpesvirus 6 (HHV-6) appears to have a predilection for immunocompromised patients and has been implicated as a cause of posttransplant encephalitis. However, the pathogenesis, as well as the appropriate means of diagnosis and treatment of HHV-6 encephalitis is unclear. METHOD: We describe a case of a 20-year-old male university student with anemia who presented with an acute, severe amnesia 1 month after bone marrow transplantation. His illness was subsequently attributed to HHV-6 encephalitis. RESULTS: cerebrospinal fluid analysis was consistent with encephalitis and polymerase chain reaction confirmed the presence of HHV-6 dna in both cerebrospinal fluid and serum. No other herpes virus particles were detected. MRI showed bilateral hippocampal involvement. Treatment with acyclovir resulted in a decrease in serum HHV-6 dna to undetectable levels, coincident with improvement of both memory and lesions on MRI. CONCLUSIONS: This case provides strong clinical and radiological evidence of the reversibility of this disease process and supports the recommendations for empiric treatment of post transplant patients with laboratory evidence of HHV-6 infection, culture or polymerase chain reaction, plus clinical symptoms compatible with HHV-6 infection.- - - - - - - - - - ranking = 2.5keywords = herpesvirus (Clic here for more details about this article) |
9/48. Human herpesvirus 6 infection mimicking juvenile myelomonocytic leukemia in an infant.in vitro cell culture studies of bone marrow and peripheral blood progenitor cells from patients with juvenile myclomonocytic leukemia (JMML) consistently show spontaneous proliferation and selective hypersensitivity to granulocyte-macrophage colony-stimulating factor (GM-CSF). This GM-CSF hypersensitivity dose-response assay has become a component of the international diagnostic criteria for JMML. The authors report a 2-week-old boy with perinatal human herpesvirus 6 (HHV-6) infection in whom in vitro bone marrow culture studies suggested the diagnosis of JMML by showing increased spontaneous proliferation, inhibition of this growth by anti-GM-CSF antibodies, and hypersensitivity to GM-CSF. polymerase chain reaction viral studies from whole blood dna and the shell vial viral culture assay were both positive for HHV-6. The patient's condition improved with expectant treatment, with an eventual return to normal blood counts and resolution of hepatosplenomegaly. This case of perinatal HHV-6 infection shows that viruses can initially mimic the in vitro culture results found in patients with JMML. It also illustrates that patients suspected of having JMML should be observed if there are no signs of progressive disease and concurrent features suggestive of viral infection.- - - - - - - - - - ranking = 2.5keywords = herpesvirus (Clic here for more details about this article) |
10/48. Human herpesvirus 6 meningoencephalitis successfully treated with ganciclovir in a patient who underwent allogeneic bone marrow transplantation from an HLA-identical sibling.Human herpesvirus 6 (HHV-6) has recently been recognized as an important pathogen in immunocompromised hosts, such as patients who have undergone allogeneic bone marrow transplantation (allo-BMT). Here we report a case of HHV-6 meningoencephalitis in a patient who underwent allo-BMT from an HLA-identical sibling. The patient suffered from headache, high fever, tremor, and disorientation on day 35 after allo-BMT. Findings at magnetic resonance imaging, electroencephalography, and routine cerebrospinal fluid (CSF) examination suggested the presence of viral meningoencephalitis. We diagnosed HHV-6 meningoencephalitis by means of polymerase chain reaction (PCR) analysis of a CSF specimen. Successful treatment was achieved with ganciclovir. Because HHV-6 encephalitis has a potentially fatal and fulminant course, it is necessary that HHV-6 encephalitis be recognized as one of the central nervous system complications that can follow allo-BMT. PCR analysis for HHV-6 in the CSF specimen is necessary for appropriate diagnosis and treatment.- - - - - - - - - - ranking = 2.5keywords = herpesvirus (Clic here for more details about this article) |
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