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Fever present in HHV-6 reactivation after pediatric stem cell transplant
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The reactivation of human herpesvirus-6 after pediatric allogenic stem cell transplantation may explain the previously unknown origin of fever in 30% of patients, according to a recent study.
“Hematopoietic stem cell transplantation is an established treatment for patients with hematopoietic malignancies who cannot be cured by chemotherapy and for patients with certain inherited or acquired nonmalignant diseases,” Dirk H.J. Verhoeven, MD, department of pediatrics at Leiden University Medical Center, and colleagues wrote. “The results of this study suggest that human herpesvirus-6 reactivation is a transient, self-limiting, infection in most pediatric stem cell transplantation patients, and the onset of infection is correlated with engraftment of mononuclear cells.”
The researchers studied clinical symptoms, timing and consequences of human herpesvirus-6 (HHV-6) reactivation after stem cell transplantation (SCT) in a cohort of 106 pediatric patients. They analyzed 735 patient samples by using real-time PCR to identify HHV-6 DNA.
Study results showed that 48% of the SCT recipients had reactivation of HHV-6. In focusing on the timing of HHV-6 reactivation, the researchers said the most frequently occurring infectious agents were detected 3 to 4 weeks after SCT.
Fever and rash early after SCT were not associated with HHV-6; however, HHV-6 was detected in 30% of patients with fever of unexplained origin. There also was an increased presence of fever in patients with HHV-6 reactivation vs. uninfected patients.
The investigators said the onset of HHV-6 reactivation corresponded with a rise in lymphocyte and monocyte levels in peripheral blood, suggesting the use of monoclonal antibodies to delay lymphocyte and monocyte engraftment, and ultimately HHV-6.
By evaluating HHV-6 in febrile pediatric patients after SCT, it may aid physicians in conducting bacterial, fungal, and other viral surveillance, according to the researchers.
“The observations presented in the current study that the onset of HHV-6 reactivation correlates with engraftment of mononuclear cells and that HHV-6 reactivation contributes to symptoms as fever and rash early after SCT may help to correctly diagnose patients with HHV-6 reactivation during the first weeks post-SCT,” Verhoeven and colleagues wrote. – by David Costill
Disclosure: The researchers report no relevant financial disclosures.
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