Human herpes 6 virus encephalitis complicating allogeneic hematopoietic stem cell transplantation
Open accessAbstract
OBJECTIVE: To describe the presentation and management of encephalitis due to human herpes 6 virus (HHV-6) in patients who underwent allogeneic hematopoietic stem cell transplant (alloHSCT), via retrospective chart review. METHODS: Of the 243 patients who underwent alloHSCT at the NIH Clinical Center during 2009 to 2011, we retrospectively analyzed 9 diagnosed with HHV-6 encephalitis post-alloHSCT. RESULTS: Eight men and 1 woman (aged 19-60 years) met diagnostic criteria for study inclusion. The median time from HSCT to initial symptoms was 21 days. All patients presented with altered mental status and headaches. Seven patients had amnesia and 2 presented with fever of unknown etiology. Four patients had clinical seizures during the disease course. Brain MRI within 7 days was normal in all patients. Repeat MRI after 7 days showed hyperintensity in the limbic area in 3 patients. On initial testing, CSF analysis indicated acellularity and normal or minimally elevated protein; presence of HHV-6 was detected by PCR. After 7 days, mildly elevated protein and minimal pleocytosis were noted. Ganciclovir, foscarnet, or valganciclovir alone or in combination was initiated with subsequent improvement. Four patients remained alive at 1 year posttransplant; 2 had persistent memory deficits. Presence of encephalitis was associated with higher mortality post-alloHSCT. CONCLUSION: High clinical suspicion and CSF PCR testing are important for early diagnosis of HHV-6 encephalitis post-HSCT. Abnormalities on brain MRI or CSF testing may be minimal and delayed. Diagnosis and management of HHV-6 encephalitis is challenging, and a larger prospective study is needed for further research.
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Both paediatric patients were diagnosed with primary HHV-6 infection.
“Both paediatric patients were diagnosed with primary HHV-6 infection.”
From Human Herpesvirus 6—A Rare Aetiologic Agent for CNS Infections in Immunocompetent Individuals or an Underestimation? (2024) · cites this paper as [14]
The Results report that all nine patients with HHV-6 encephalitis were aged 19–60 years, so the study had no paediatric patients. The Abstract describes HHV-6 reactivation after stem cell transplantation, not a diagnosis of primary infection in two children. (LLM, conf=0.90)
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Human herpesvirus 6 encephalitis in immunocompetent and immunocompromised hosts
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“For the definition of meningoencephalitis caused by primary infection with HHV-6, we used the following criteria [14]: age 18 years with clinical features that are suggestive for meningoencephalitis, HHV-6 DNA detectable in the CSF, and the exclusion of other alternative diagnoses.”
Method
- Authors
- Bhanushali, M. J., Kranick, S. M., Freeman, A. F., Cuellar-Rodriguez, J. M., Battiwalla, M., Gea-Banacloche, J. C., Hickstein, D. D., Pavletic, S., Fahle, G., & Nath, A.
- Affiliations
- National Institutes of Health (US)
- From the National Institute of Neurological Disorders and Stroke (NINDS) (M.J.B., S.M.K., A.N.); National Institute of Allergy and Infectious Diseases (NIAID) (A.F.F., J.M.C.-R.); National Institute of Heart, Lung and Blood Institute (NHLBI) (M.B.); National Cancer Institute (NCI) (J.C.G.-B., D.D.H., S.P.), Experimental Transplantation and Immunology Branch; and Department of Laboratory Medicine (G.F.), National Institutes of Health, Bethesda, MD.
- Venue
- Neurology
- Published
- 2013-04-16
- Volume
- 80
- Issue
- 16
- Pages
- 1494-1500
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- PMC
- PMC3662358
- OpenAlex
- W2022000054
- Cited by
- 97
- References
- 16
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 8 · 2023: 2 · 2022: 6 · 2021: 8 · 2020: 4 · 2019: 7 · 2018: 8 · 2017: 11 · 2016: 12 · 2015: 11 · 2014: 6 · 2013: 4
- FWCI
- 8.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Neurology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Heart, Lung, and Blood Institute
- National Cancer Institute
- National Institute of Allergy and Infectious Diseases
- National Institute of Neurological Disorders and Stroke
- NIH Clinical Center
- Topics
- Health Sciences › Medicine › Epidemiology › Cytomegalovirus and herpesvirus research
- Health Sciences › Medicine › Oncology › Viral-associated cancers and disorders
- Health Sciences › Medicine › Epidemiology › Herpesvirus Infections and Treatments
- Keywords
- HHV-6 encephalitis, allogeneic hematopoietic stem cell transplantation, herpesvirus infection, central nervous system infection, ganciclovir, foscarnet, valganciclovir, cerebrospinal fluid PCR, memory impairment, post-transplant mortality, opportunistic infections
- MeSH terms
- Adult, Aged, Antiviral Agents, Brain, Female, Follow-Up Studies, Headache, Humans, Image Processing, Computer-Assisted, Magnetic Resonance Imaging, Male, Middle Aged, Prognosis, Retrospective Studies, Seizures, Survival, Herpesvirus 6, Human, Hematopoietic Stem Cell Transplantation, Disease Progression, Hematologic Neoplasms, Roseolovirus Infections, Viral Load, Young Adult, Neuroimaging
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