A report of human herpesvirus 6-associated encephalitis in a solid organ transplant recipient and a review of previously published cases

Abstract

Human herpesvirus 6 (HHV-6) is a common pathogen among children, classically presenting as fever and rash that resolve without specific therapy (exanthem subitum or roseola infantum). Also identified as a pathogen in hematopoietic cell transplant and solid organ transplant (SOT) recipients, it has been recognized as a cause of limbic encephalitis, characterized by confusion and amnesia, with magnetic resonance imaging findings of T2 hyperintensity of the amygdala and hippocampus. We report a case of limbic encephalitis associated with HHV-6 infection in a liver transplant recipient, and we review previously reported cases of HHV-6 encephalitis in SOT recipients.

Detection of HHV-6 in over a thousand samples: New types of infection revealed by an analysis of positive results

“…The virus is believed to be implicated in central nervous system diseases with seizures in immunocompetent patients 2 and encephalitis in immunocompromised adults. 3,4 It has also been involved in pneumonitis in solid organs 5 and bone marrow transplant recipients 1 and in delayed engraftment in stem cell transplant recipients. 6 However, the role of HHV-6 in human disease remains to be fully specified.…”

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

“…Current serology assays have a high sensitivity and specificity to the presence of the VP2 structural protein of parvovirus in blood compartments [102]. In similar vein, B19 DNA can readily be detected by PCR following culture of PMBCs extracted from infected people [103]. However, there is a caveat, as B19 DNA can be detected in tissue by PCR, when examination of any blood compartment is negative [102].…”

“…The specificity and sensitivity of recent serology assays for the presence of IgG and IgM antibodies to HHV6 in the blood compartment are high [102], and the presence of HHV6 can readily be detected by nested polymerase chain reaction (PCR) following culture of peripheral mononuclear blood cells extracted from an infected patient. The most recent assays can discriminate between DNA from actively replicating HHV6A and that from chromosomally integrated virus [103]. However, due to the neurotropism of the virus, a negative result for either serology or PCR carried out in any blood compartment cannot rule out the presence of HHV6A or HHV6B in the brain [96].…”

Betaherpesviruses in Adult Liver Transplant Recipients

“…Patients could be treated with intravenous ganciclovir (2.5 mg/kg daily) for 3-6 weeks, cidofovir 5mg/kg once weekly for 2 consecutive weeks or intravenous foscarnet (40 mg/kg every 12 hours) for 3-4 weeks (Vinnard et al, 2009). However, in patients with renal failure, dose must be adjusted to avoid toxicity in the patients.…”