Reduced impact of viral load of HHV-6 in liquor on severity of AESD due to exanthema subitum: A case report and literature review.

BACKGROUND: The most common causative pathogen of acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) was reported as HHV-6. Although excitotoxic injury with delayed neuronal death is considered to be a possible pathogenesis of AESD, the detailed pathophysiology remains unclear. CASE PRESENTATION: We present a twelve-month-old girl with AESD due to HHV-6 primary infection. She was successfully treated for AESD including targeted temperature management and the administration of vitamin B1, B6, and L-carnitine. Although the viral load of HHV-6 in her liquor was high (12,000 copies/mL), she fully recovered without antiviral agent use. DISCUSSION: There has been no study focusing on the HHV-6 viral load in patients with AESD, and only a few case reports have been published. We reviewed the clinical features and viral load in the liquor of our case and four reported infants with AESD due to HHV-6 primary infection who had real-time PCR tests results. Viral loads in the three patients with a poor prognosis were 31.5, negative, and 3,390 copies/mL, respectively. On the other hand, the copy numbers of HHV-6 DNA in the two patients with no sequelae were 12,000 and 106 copies/mL, respectively, and our case had the highest viral load among the five summarized patients.

[Chromosomal integration of the sixth human herpes virus (HHV-6)]. / Chromozomální integrace sestého lidského herpesviru (HHV-6).

Two closely related and commonly found human herpesviruses HHV-6 A and HHV-6 B are classified into the sixth human herpes virus complex (HHV-6). Primary infection with HHV-6 often takes place in early childhood and it can be either asymptomatic or manifests itself as sixth disease (caused by HHV-6 B). HHV-6 remains present in a latent form in the body with the potential for virus reactivation. The article points out the phenomenon of chromosomal integration of HHV-6 (Ci-HHV-6) which is found in about 1% of the population and, unlike the commonly spread HHV-6 infection, has become hereditary, with its pathological potential in Ci-HHV-6 DNA carriers remaining unknown. Therefore, the focus on clinical consequences of Ci-HHV-6 is of high relevance to the therapeutic strategy for patients with high HHV-6 positivity in molecular biological tests.

[Human herpesvirus-6 and human herpesvirus-7 (HHV-6, HHV-7)].

human herpesvirus 6 (HHV-6) is the major causative agent of exanthem subitum which is one of popular diseases in infant, and establishes latent infections in adults of more than 90%. Recently, the encephalitis caused by reactivated- HHV-6 has been shown in patients after transplantation. In addition, the relationship HHV-6 and drug-induced hypersensitivity syndrome has also been reported. human herpesvirus 7 (HHV-7) was isolated from the stimulated-peripheral blood lymphocytes of a healthy individual, and also causes exanthema subitum. Both viruses are related viruses which belong to betaherpesvirus subfamily, and replicate and produce progeny viruses in T cells.

HHV-6 infection - not only tertian fever.

The primary infection with the human herpesvirus (HHV) 6 usually occurs before the age of two (95%) and clinically either presents as tertian fever followed by exanthem subitum (10%) or even more often as febrile disease without an exanthem. In adults an active HHV-6 infection can present as febrile illness. A 19-year-old immunocompetent patient presented with high fever, exanthem, swelling of the lymph nodes and pancytopenia and was serologically diagnosed as active HHV-6 infection with anti- HHV-6-IgM- and -IgG antibodies. Since the antibodies were already detectable on day 5 of disease, with persistence of high IgG and undetectable IgM after 4 weeks, a reactivation seemed most likely. There was no evidence for an underlying immunosuppressive disease or reactivation induced by viral co-infection. Fulminant hepatitis or meningoencephalitis are the most frequent complications in immunocompetent individuals and have to be recognized at an early stage.

De la prevention des maladies infantiles / Concerning prevention of the infantile disease

On peut definir les maladies infantiles comme des maladies aigues qui surviennent preferentiellement pendant l'enfance. Il s'agit donc de maladies infectieuses, endemoepidemiques, immunisantes... (AU)

Les fievres eruptives / The eruptives fevers

L'homeopathie entretient avec la peau des relations particulieres et j'oserai dire privilefiees depuis qu'Hahnemann dans son "Traite des maladies chroniques" a mis en garde le therapeute contre le refoulement d'une dermatose et les risques de transfert morbide. La peau ne constitue qu'un miroir ou se refletent les conflits de l'organisme tout entier.(AU)