HHV-6 and septic shock: Tenuous proof of causation

Epstein, David G.; Deresinski, Stan

doi:10.1111/ajt.14983

Cited by 9 publications

(4 citation statements)

References 6 publications

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“…HHV‐6 infection in adults is not well recognized, but its most common presentation is mononucleosis syndrome. There are reported cases of liver failure probably attributable to HHV‐6, but an interpretation of PCR assays is complicated because DNA detection does not confirm causality 2,7 . In our case, as in previous reports, we cannot establish with certainty that HHV‐6 is the only cause that has led to fulminant liver failure, although it must have at least contributed to its pathogenesis.…”

Section: Figurecontrasting

confidence: 47%

Fulminant HHV‐6 hepatitis requiring liver transplantation

Villa

Catalina

Conthe

2022

Transplant Infectious Dis

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Section: Figurecontrasting

confidence: 47%

Fulminant HHV‐6 hepatitis requiring liver transplantation

Villa

Catalina

Conthe

2022

Transplant Infectious Dis

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Section: Treatmentmentioning

confidence: 99%

“…It is important to point out that the ciHHV-6 status of the recipient/donor should be considered while making management decisions regarding HHV-6 viremia, especially when patients present with persistently high viral load. 70 Treatment options Most of the HHV-6 treatment experience comes from HHV-6 encephalitis. No specific antiviral therapy has been approved for HHV-6 treatment specifically at this time.…”

Section: Diagnosis Of Cihhv-6mentioning

confidence: 99%

Post-allogeneic hematopoietic stem cell transplantation viral reactivations and viremias: a focused review on human herpesvirus-6, BK virus and adenovirus

Wang

Patel

Haddadin

et al. 2021

Therapeutic Advances in Infection

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Human cytomegalovirus and Epstein–Barr virus have been recognized as potential drivers of morbidity and mortality of patients undergoing allogeneic stem cell transplantation for years. Specific protocols for monitoring, prophylaxis and pre-emptive therapy are in place in many transplant settings. In this review, we focus on the next three most frequent viruses, human herpesvirus-6, BK virus and adenovirus, causing reactivation and/or viremia after allogeneic transplant, which are increasingly detected in patients in the post-transplant period owing to emerging techniques of molecular biology, recipients’ characteristics, treatment modalities used for conditioning and factors related donors or stem cell source. Given the less frequent detection of an illness related to these viruses, there are often no specific protocols in place for the management of affected patients. While some patients develop significant morbidity (generally older), others may not need therapy at all (generally younger or children). Furthermore, some of the antiviral therapies used are potentially toxic. With the addition of increased risk of secondary infections, risk of graft failure or increased risk of graft- versus-host disease as well as the relationship with other post-transplant complications, the outcomes of patients with these viremias remain unsatisfactory and even long-term survivors experience increased morbidity.

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“…Interpretation of PCR assays is also complicated by the fact that detection of HHV-6 or HHV-7 DNA does not confirm causality in a given clinical syndrome (81) and may occur even in otherwise immunocompetent patients in the setting of sepsis or other severe disease (82). HHV-6 DNA has been detected in CSF from both immunocompromised and immunocompetent patients in the absence of neurological dysfunction (83,84), thus the diagnosis of HHV-6 encephalitis should be considered in the context of both clinicallycompatible symptoms and detection of HHV-6 DNA in CSF.…”

Section: Accepted Articlementioning

confidence: 99%

Human herpesvirus 6, 7, and 8 in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice

Madan

Hand

2019

Clinical Transplantation

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These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of HHV‐6A, HHV‐6B, HHV‐7, and HHV‐8 in the pre‐ and post‐transplant period. The majority of HHV‐6 (A and B) and HHV‐7 infections in transplant recipients are asymptomatic; symptomatic disease is reported infrequently across organs. Routine screening for HHV‐6 and 7 DNAemia is not recommended in asymptomatic patients, nor is prophylaxis or preemptive therapy. Detection of viral nucleic acid by quantitative PCR in blood or CSF is the preferred method for diagnosis of HHV‐6 and HHV‐7 infection. The possibility of chromosomally integrated HHV‐6 DNA should be considered in individuals with persistently high viral loads. Antiviral therapy should be initiated for HHV‐6 encephalitis and should be considered for other manifestations of disease. HHV‐8 causes Kaposi's sarcoma, primary effusion lymphoma, and multicentric Castleman disease and is also associated with hemophagocytic syndrome and bone marrow failure. HHV‐8 screening and monitoring may be indicated to prevent disease. Treatment of HHV‐8 related disease centers on reduction of immunosuppression and conversion to sirolimus, while chemotherapy may be needed for unresponsive disease. The role of antiviral therapy for HHV‐8 infection has not yet been defined.

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HHV-6 and septic shock: Tenuous proof of causation

Cited by 9 publications

References 6 publications

Fulminant HHV‐6 hepatitis requiring liver transplantation

Fulminant HHV‐6 hepatitis requiring liver transplantation

Post-allogeneic hematopoietic stem cell transplantation viral reactivations and viremias: a focused review on human herpesvirus-6, BK virus and adenovirus

Human herpesvirus 6, 7, and 8 in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice

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