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[Human herpes virus type 6, etiology of an acute encephalitis in childhood: case report]
A Afenjar1, D Rodriguez, F Rozenberg
1Service de Neuropédiatrie, Assistance Publique-Hôpitaux de Paris, Hôpital Armand-Trousseau, 26, avenue du Docteur-A.-Netter, 75012 Paris, France. alexandra.afenjar@trs.aphp.fr
Insights
Primary human herpesvirus-6 (HHV-6) infection can cause acute leucoencephalitis in infants, presenting with seizures and coma. Detecting HHV-6 DNA in cerebrospinal fluid confirms its role in this rare but serious neurological complication.
Area of Science:
- Neurology
- Virology
- Pediatrics
Background:
- Primary human herpesvirus-6 (HHV-6) infection typically causes roseola infantum but can lead to severe central nervous system (CNS) complications.
- Acute leucoencephalitis is a rare but serious neurological condition in infants, often with an unclear etiology.
Observation:
- A 16-month-old girl presented with fever, seizures, rash, and coma, indicative of acute leucoencephalitis.
- Brain MRI revealed extensive white matter lesions.
- Human herpesvirus-6 (HHV-6) DNA was detected in cerebrospinal fluid (CSF) and serum during the acute phase.
Findings:
- Serological tests showed a significant increase in HHV-6 IgG antibody titers, confirming primary infection.
- The presence of HHV-6 DNA in CSF strongly suggests the virus's etiological role in the leucoencephalitis.
- The patient experienced complete clinical recovery with partial resolution of brain lesions on MRI within one month.
Implications:
- This case highlights the importance of considering HHV-6 in the differential diagnosis of acute leucoencephalitis in infants.
- Comprehensive virological investigations are crucial to identify HHV-6 and other potential pathogens (e.g., EBV, CMV, enterovirus).
- Accurate diagnosis of HHV-6 encephalitis can prevent misattribution of symptoms to vaccinations and guide appropriate management.
Abstract:
Primary infection with human herpesvirus-6 (HHV-6) causes the classical roseola infantum. Otherwise the infection is clinically silent but it may sometimes be responsible for central nervous system involvement. In order to illustrate such a type of lesions, we report on a 16-month-old girl with acute leucoencephalitis. The disease started with pyrexia 40 degrees C, followed by an episode of seizure, erythematous rash on the trunk and then coma. Brain MRI showed wide lesions on white matter. HHV-6 DNA was detected by PCR in the CSF and serum at the acute stage, and tests for HHV-6 antibody showed a significant increase of IgG antibody titre between acute and convalescent sera. One month later complete clinical recovery was observed while the MRI showed a partial disappearance of the lesions. The sero-conversion associated with the detection of the viral DNA in the serum identified a primary HHV-6 infection and the detection of viral nucleic acid in CSF gives arguments for the responsibility of the virus in the pathogenesis. When facing an acute leuco-encephalitis in infants, it is important to perform exhaustive virology investigations to rule out the implication of HHV-6 as well as other commonly incriminated pathogens (EBV, CMV, mycoplasma, enterovirus) to avoid accusing wrongly the vaccines.
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