Related Experiment Videos
Primary human herpes virus 6 infection transmitted from donor to recipient through bone marrow infusion
1Department of Paediatrics, The University of Hong Kong, Queen Mary Hospital, Pokfulam.
Insights
A bone marrow transplant recipient with Wiskott-Aldrich syndrome developed human herpes virus 6 (HHV-6) infection post-transplant. Prompt treatment with ganciclovir and G-CSF led to a good response, managing the viral reactivation.
Area of Science:
- Pediatric Hematology
- Immunology
- Virology
Background:
- Wiskott-Aldrich syndrome (WAS) is a rare X-linked immunodeficiency.
- Bone marrow transplantation (BMT) is a curative therapy for WAS.
- Donor-derived infections are a potential complication following BMT.
Observation:
- An infant with WAS received a BMT from his non-identical twin donor, who had active human herpes virus 6 (HHV-6) infection.
- The recipient developed hepatitis, fever, and rash, with laboratory confirmation of HHV-6 infection.
- Post-engraftment, the recipient experienced neutropenia and persistent HHV-6 DNAemia.
Findings:
- HHV-6 infection was confirmed by skin biopsy and peripheral blood DNA analysis.
- Graft failure or delayed engraftment was associated with severe HHV-6 reactivation.
- Treatment with G-CSF and ganciclovir resulted in a positive clinical response.
Implications:
- This case highlights the risk of donor-derived HHV-6 transmission in BMT.
- Early diagnosis and management of HHV-6 infection are crucial for BMT outcomes.
- Further research into prophylactic or preemptive strategies for HHV-6 in BMT is warranted.
Abstract:
An 8.5-month-old boy with Wiskott-Aldrich syndrome received a sibling matched bone marrow transplant from his healthy non-identical twin brother. The donor had primary human herpes virus 6 (HHV-6) infection around the time of bone marrow donation. The recipient had hepatitis in the first week and then developed fever and rash on day 18. Skin biopsy was shown to have HHV-6 antigen and his peripheral blood leukocytes were HHV-6 DNA positive. He engrafted on day 18 but the ANC dropped from 5.5 x 10(9)/l (day 23) to 0.48 x 10(9)/l (day 34) with persistent HHV-6 DNAemia. Bone marrow on day 35 was positive for HHV-6 DNA. He was treated with G-CSF and ganciclovir with good response. He later had pneumonitis which was treated empirically with foscarnet, ceftazidime and clarithromycin.