Human Herpesvirus 6 Encephalitis in Immunocompetent and Immunocompromised Hosts

被引：32

作者：

Berzero, Giulia ^{[1
]}

Campanini, Giulia ^{[3
]}

Vegezzi, Elisa ^{[1
]}

Paoletti, Matteo ^{[2
]}

Pichiecchio, Anna ^{[2
,9
]}

Simoncelli, Anna Maria ^{[4
]}

Colombo, Anna Amelia ^{[5
]}

Bernasconi, Paolo ^{[5
,10
]}

Borsani, Oscar ^{[5
,10
]}

Di Matteo, Angela ^{[6
]}

Rossi, Virginia ^{[7
]}

Foiadelli, Thomas ^{[7
]}

Savasta, Salvatore ^{[7
]}

Compagno, Francesca ^{[8
]}

Zecca, Marco ^{[8
]}

Baldanti, Fausto ^{[3
,11
]}

Marchioni, Enrico ^{[1
]}

机构：

[1] IRCCS Mondino Fdn, Neuroncol Unit, Pavia, Italy

[2] IRCCS Mondino Fdn, Neuroradiol Unit, Pavia, Italy

[3] Fdn IRCCS Policlin San Matteo, Mol Virol Unit, Pavia, Italy

[4] Fdn IRCCS Policlin San Matteo, Microbiol & Virol Dept, Diagnost Radiol Intervent Radiol & Neuroradiol Un, Pavia, Italy

[5] Fdn IRCCS Policlin San Matteo, Bone Marrow Transplantat Unit, Pavia, Italy

[6] Fdn IRCCS Policlin San Matteo, Infect & Trop Dis Unit, Pavia, Italy

[7] Fdn IRCCS Policlin San Matteo, Pediat Clin, Pavia, Italy

[8] Fdn IRCCS Policlin San Matteo, Pediat Hematol Oncol, Pavia, Italy

[9] Univ Pavia, Dept Brain & Behav Sci, Pavia, Italy

[10] Univ Pavia, Dept Mol Med, Pavia, Italy

[11] Univ Pavia, Dept Clin Surg Diagnost & Paediat Sci, Pavia, Italy

来源：

NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION | 2021年 / 8卷 / 02期

关键词：

CEREBROSPINAL-FLUID; TRANSPLANTATION; REACTIVATION; INFECTION; FEATURES; CHILDREN; BRITAIN; BLOOD; DNA;

D O I：

10.1212/NXI.0000000000000942

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Objective The aim of this study was to analyze the clinical, radiologic, and biological features associated with human herpesvirus 6 (HHV-6) encephalitis in immunocompetent and immunocompromised hosts to establish which clinical settings should prompt HHV-6 testing. Methods We performed a retrospective research in the virology database of Fondazione IRCCS Policlinico San Matteo (Pavia, Italy) for all patients who tested positive for HHV-6 DNA in the CSF and/or in blood from January 2008 to September 2018 and separately assessed the number of patients meeting the criteria for HHV-6 encephalitis in the group of immunocompetent and immunocompromised hosts. Results Of the 926 patients tested for HHV-6 during the period of interest, 45 met the study criteria. Among immunocompetent hosts (n = 17), HHV-6 encephalitis was diagnosed to 4 infants or children presenting with seizures or mild encephalopathy during primary HHV-6 infection (CSF/blood replication ratio <<1 in all cases). Among immunocompromised hosts (n = 28), HHV-6 encephalitis was diagnosed to 7 adolescents/adults with hematologic conditions presenting with altered mental status (7/7), seizures (3/7), vigilance impairment (3/7), behavioral changes (2/7), hyponatremia (2/7), and anterograde amnesia (1/7). Initial brain MRI was altered only in 2 patients, but 6 of the 7 had a CSF/blood replication ratio >1. Conclusions The detection of a CSF/blood replication ratio >1 represented a specific feature of immunocompromised patients with HHV-6 encephalitis and could be of special help to establish a diagnosis of HHV-6 encephalitis in hematopoietic stem cell transplant recipients lacking radiologic evidence of limbic involvement.

引用

页数：9