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Detection of human herpesvirus 6 in pediatric CSF samples: causing disease or incidental distraction?

Huanyu Wang1, Cristina Tomatis-Souverbielle2, Kathy Everhart3

  • 1Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Department of Pathology, The Ohio State University, Columbus, OH, USA.

Diagnostic Microbiology and Infectious Disease
|August 1, 2023
PubMed

Insights

Human herpesvirus type 6 (HHV6) detection in cerebrospinal fluid (CSF) can be complex. Incidental chromosomal integration (iciHHV6) is often found in young infants, particularly those evaluated for sepsis, and may not indicate active infection.

Area of Science:

  • Pediatric Infectious Diseases
  • Virology
  • Molecular Diagnostics

Background:

  • Human herpesvirus type 6 (HHV6) detection in cerebrospinal fluid (CSF) poses interpretation challenges.
  • HHV6 can manifest as acute infection, reactivation, or chromosomal integration (iciHHV6).
  • Differentiating these forms is crucial for accurate diagnosis and patient management.

Purpose of the Study:

  • To determine the prevalence of HHV6 and iciHHV6 in pediatric CSF samples.
  • To compare clinical and laboratory characteristics of patients with and without iciHHV6.
  • To clarify the significance of HHV6 detection in CSF, especially in infants.

Main Methods:

  • Retrospective analysis of pediatric CSF samples for HHV6 DNA.
  • Clinical data review including patient demographics, symptoms, and laboratory findings.
  • Comparison of viral loads in CSF and whole blood between iciHHV6 positive and negative groups.

Main Results:

  • Overall prevalence of HHV6 and iciHHV6 in CSF was 2.4% and 0.85%, respectively.
  • Children with iciHHV6 were younger and less likely to have fever; 65.2% were infants evaluated for sepsis.
  • Patients with iciHHV6 showed higher viral loads and incidental detection was common (91.3% vs 33.3%).

Conclusions:

  • Molecular detection of HHV6 in CSF does not always signify active infection.
  • iciHHV6 is a significant finding, particularly in young infants presenting with sepsis symptoms.
  • Distinguishing iciHHV6 from active HHV6 infection is critical for appropriate clinical decision-making.

Keywords:
CSFChromosomal integrationHHV6Multiplex PCRPediatric

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