HHV-6 encephalitis
Encephalitis
An inflammation of the brain usually caused due to infection.
What are the treatment options for human herpesvirus 6 (HHV-6) encephalitis?
Antiviral therapy using foscarnet or ganciclovir is recommended for the treatment of HHV-6 encephalitis (Ogata 2015). The incidence of HHV-6 encephalitis during HSCT in children is thought to be less than that in adults (Kouzuki 2014).
What is the best treatment for HHV 6?
HHV-6 Treatment. Although no internationally approved guidelines currently exist for the clinical treatment of HHV-6, the International Herpesvirus Management Forum and American Society of Transplantation Infectious Disease Community of Practice have recommended the initiation of antiviral therapy in cases of HHV-6 encephalitis.
How is HHV-6 acute limbic encephalitis treated after unrelated cord blood transplantation?
HHV-6 acute limbic encephalitis after unrelated cord blood transplantation has been successfully treated with ganciclovir ( Hirabayashi 2013, Camus 2015 ).
What are the international guidelines on the treatment of herpes zoster virus-6 (HHV-6)?
Although no internationally approved guidelines currently exist for the clinical treatment of HHV-6, the International Herpesvirus Management Forum and American Society of Transplantation Infectious Disease Community of Practice have recommended the initiation of antiviral therapy in cases of HHV-6 encephalitis.
Is there a cure for HHV-6?
However, no compound has yet been approved exclusively for the treatment of HHV-6. Thus, clinicians most often utilize the anti-cytomegalovirus (CMV) agents ganciclovir (Cytovene® IV), cidofovir (Vistide® IV), and foscarnet (Foscavir® IV) for the clinical treatment of HHV-6 (Table below).
Can HHV be cured?
Currently, there is no cure. Most people with herpes do not show symptoms, but the infection can also cause painful ulcers and blisters. Those without symptoms can still pass the infection on to others.
What is HHV therapy?
HHV mission is to enrich the lives of veterans and military personnel. HHV provides therapeutic arts & crafts kits to veterans and active duty patients receiving health care (at federal, state and private hospitals and nursing homes).
Does acyclovir treat HHV-6?
Serum acyclovir levels (1.8 to 3.6 ug/ml) following low-dose oral acyclovir (200 mg) are inadequate to suppress HHV-6. However, high dose oral acyclovir (800 mg) can achieve plasma concentrations of approximately 1.6 ug/ml, which may be at least partially suppressive for HHV-6A strains.
How common is HHV-6 viral encephalitis?
The incidence of HHV-6 encephalitis is reportedly 0-11.6% after bone marrow or peripheral blood stem cell transplantation and 4.9-21.4% after cord blood transplantation (Ogata 2015).
How is HHV-6 diagnosed?
The diagnosis of HHV-6 infection is performed by both serologic and direct methods. The most prominent technique is the quantification of viral DNA in blood, other body fluids, and organs by means of real-time PCR.
What disease is caused by HHV-6?
Roseola, also called exanthem subitum and sixth disease, is a common, contagious viral infection caused by the human herpesvirus (HHV) 6. This strain of the herpes virus is different than the one that causes cold sores or genital herpes infections.
What does it mean if your HHV-6 IGG is high?
Elevated antibody levels may indicate an active infection but results will need to be interpreted by a doctor. An HHV-6 IgM Antibody test can be more accurate at detecting an active or recent infection.
How do you know if you have HHV 8?
Clinical Manifestations Primary infection with HHV-8 in young, immunocompetent children may be asymptomatic or may present as a self-limited mononucleosis-like illness consisting of fever, mild upper respiratory symptoms, and a maculopapular rash. A similar presentation has been described in immunocompetent adults.
What are the symptoms of HHV-6?
HHV-6B infects nearly 100% of human beings, typically before the age of three and often results in fever, diarrhea, sometimes with a rash known as roseola. Although rare, this initial infection HHV-6B infection can also cause febrile seizures, encephalitis or intractable seizures.
What is foscarnet used to treat?
Foscarnet is principally used for the treatment of ganciclovir-resistant cytomegalovirus (CMV) infections in patients with the acquired immunodeficiency syndrome (AIDS) or in transplant recipients.
What is Brincidofovir used for?
Brincidofovir is an antiviral medication from Chimerix that was already in a Phase III clinical trial for its use to prevent cytomegalovirus in renal transplant patients. It is the prodrug of cidofovir. Thus, it already had safety data in over 1000 human cases.
What is HHV 6?
Human herpesvirus 6 (HHV-6) is a member of the Herpesviridaefamily. Like other members of this family, the virus remains in a latent state after primary infection has resolved and can reactivate. HHV-6 encephalomyelitis is an uncommon clinical manifestation in immuncompetent adults.
Why is Cidofovir followed by Ganciclovir?
Cidofovir was used followed by ganciclovir because of an adverse effect to probenecid. The patient recovered. HHV-6 should be recognized as one of the causes of encephalomyelitis. Keywords: HHV-6, encephalomyelitis, cidofovir, ganciclovir, adult, immunocompetent, neurologic disease, encephalitis.
Is HHV-6A a disease?
Humans are widely exposed to HHV-6 during childhood, and the seroprevalence is up to 100% in adults. Two types of HHV-6 (A and B) can be identified; no diseases have clearly been linked to HHV-6A infection, whereas HHV-6B is responsible for the childhood disease exanthem subitum.
Is HHV-6 positive or negative?
HHV-6 PCR performed on peripheral blood mononuclear cells was positive, although it was negative in the serum samples. The same woman was admitted to the emergency room 1 month after discharge because of dysethesia of the lower limbs, tonsillitis, asthenia, and low-grade fever.
Does HHV-6 DNA come back after cidofovir?
We note, however, that after cidofovir therapy was stopped, HHV-6 DNA was again detected in the CSF, concurrent with an increase in neurologic symptoms. She began to recover after starting ganciclovir therapy. As a result, we think that the antiherpesvirus drugs led to her recovery.
What is HHV-6 in childhood?
Humans are widely exposed to HHV-6 during childhood, and the seroprevalence is up to 100% in adults. Two types of HHV-6 (A and B) can be identified; no diseases have clearly been linked to HHV-6A infection, whereas HHV-6B is responsible for the childhood disease exanthem subitum. Exanthem subitum complications, including seizures, hemiplegia, meningoencephalitis, or residual encephalopathy, illustrate HHV-6 neurotropism; HHV-6 commonly invades the brain during ES, even in cases of clinically asymptomatic infections. The virus then persists in brain tissues in a latent form ( 4 ).
Why is Cidofovir followed by Ganciclovir?
Cidofovir was used followed by ganciclovir because of an adverse effect to probenecid. The patient recovered. HHV-6 should be recognized as one of the causes of encephalomyelitis. Human herpesvirus 6 (HHV-6) is a member of the Herpesviridae family.
Does HHV-6 DNA come back after cidofovir?
We note, however, that after cidofovir therapy was stopped, HHV-6 DNA was again detected in the CSF, concurrent with an increase in neurologic symptoms. She began to recover after starting ganciclovir therapy. As a result, we think that the antiherpesvirus drugs led to her recovery.
What is HHV-6?
HHV-6 is the etiological agent of exanthema subitum-associated encephalopathy, which usually occurs in children younger than 3 years. However, primary HHV-6 infection can cause acute encephalopathy without exanthema subitum.
Is HHV 6 a transplant?
HHV-6 encephalitis is a significant consequence of transplant immunosuppression, although it is seen in immun ocompetent patients as well. Interestingly, the characteristics of HHV-6 encephalitis differ between patients who develop the condition through primary infection compared to viral reactivation ( Kawamura 2011 ).
Is HHV-6 a encephalitis?
HHV-6 encephalitis should be considered even among immunocompetent patients presenting with encephalitis and having signs of temporal lobe involvement ( Shahani 2014 ). A NINDS study found HHV-6 DNA in the CSF of 40% of 35 immunocompetent patients with encephalitis of unknown etiology ( Yao 2009 ). HHV-6 encephalitis/encephalopathy associated with primary infection in infants has an unexpectedly poor outcome. In a nationwide survey in Japan, 46.9% of 81 cases resulted in neurological sequelae or death ( Yoshikawa 2009 ). One study found that out of 983 cases of acute encephalopathy in Japan, 17% were caused by HHV-6. 64% of the severe cases with biphasic seizures in this study were attributed to HHV-6, only half of which survived without permanent neurological sequelae ( Hoshino 2012 ).
What is HHV 6?
HHV-6 encephalitis refers to inflammation of the brain due to an infection with human herpesvirus 6. People who have undergone allogeneic hematopoietic cell transplantation are at an increased risk for developing HHV-6 encephalitis, particularly when umbilical cord blood stem cells are used. People with immune system disorders may also be at an increased risk for developing this infection. Signs and symptoms vary, but often include confusion, anterograde amnesia (difficulty learning new information following the onset of amnesia), short-term memory loss, and seizures . Diagnosis often involves lumbar puncture, virus testing, and MRI. EEG 's may also be recommended when seizures are suspected. HHV-6 encephalitis is treated with an antiviral agent with activity against HHV-6. Long term outlook (chance of full recovery) can vary considerably depending individual patient factors. [1]
Can EEG be used for HHV-6?
EEG 's may also be recommended when seizures are suspected. HHV-6 encephalitis is treated with an antiviral agent with activity against HHV-6. Long term outlook (chance of full recovery) can vary considerably depending individual patient factors. [1] Last updated: 9/30/2013.
What is the best treatment for HHV-6?
Supportive therapy, including acetaminophen for fever and adequate hydration, is indicated in all patients with symptomatic HHV-6 infection. Decisions regarding antiviral therapy should carefully weigh the clinical scenario with the degree of diagnostic certainty, likelihood of a response or benefit, and the risk of systemic therapeutics.
Is Brincidofovir a controlled drug?
Brincidofovir may offer an additional mode of therapy with less toxicity in the future, but this has not been studied. There are no in vivo or randomized controlled trials that provide supporting evidence for any of these therapies, and use of them in this clinical scenarios is considered off-label.
What is HHV 6?
Human herpesvirus 6 (HHV-6) is a ubiquitous herpesvirus that commonly infects children younger than 3 years. #N#1#N#Primary infection sometimes causes exanthema subitum, a common exanthematic disease among infants that may be accompanied by neurologic manifestations such as febrile seizures and encephalitis.#N#2#N#,#N#–#N#,#N#4
What are the clinical features of HHV-6?
The main clinical and biological features in the 4 immunocompetent individuals meeting the diagnostic criteria for febrile seizures/encephalitis during primary HHV-6 infection are summarized in table 2. All 4 patients were infants or children younger than 2 years presenting with fever, with or without rash. Neurologic manifestations included seizures in 2 patients and irritability in other 2. All 4 patients tested positive for HHV-6 in both blood and CSF, with a median viral load of 410 copies/mL in the CSF (range: 40–14,060 copies/mL) and 85,230 copies/mL in blood (range: 4,750–495,540 copies/mL), resulting in a CSF/blood replication ratio <<1 in all cases. CSF pleocytosis was present in 1 case of 3. A single patient underwent brain MRI (patient 1 in table 2 ), which showed normal findings. None of the patients received specific antiviral treatment. All of them recovered completely within a week from hospital admission.
What is the purpose of the HHV 6 study?
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 .
How many patients tested positive for HHV 6?
In this study, we reviewed all patients tested for HHV-6 in the CSF at Fondazione IRCCS Policlinico San Matteo during a period of 10 years. Of the 926 patients tested during this period, only 43 tested positive for HHV-6 in the CSF (43/926, 4.6%), and a much lower number received a diagnosis of febrile seizures/encephalitis during primary HHV-6 infection (3/926, 0.4%) or a diagnosis of HHV-6 encephalitis due to viral reactivation (7/926, 0.8%). These proportions confirm that there is ample room for improvement when it comes to choosing which patients to test. Chromosomal integration was detected in nearly 1% of patients tested (7/926, 0.8%), a proportion similar to the one reported in the literature for the general population.#N#6
