Afenjar A, Rodriguez D, Rozenberg F, Dorison N, Guët A, Mignot C, Doummar D, Billette de Villemeur T, Ponsot G
Service de Neuropédiatrie, Assistance Publique-Hôpitaux de Paris, Hôpital Armand-Trousseau, 26, avenue du Docteur-A.-Netter, 75012 Paris, France.
Arch Pediatr. 2007 May;14(5):472-5. doi: 10.1016/j.arcped.2006.12.020. Epub 2007 Feb 15.
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.
人疱疹病毒6型(HHV-6)的原发性感染会引发典型的幼儿急疹。否则,这种感染在临床上是无症状的,但有时可能会导致中枢神经系统受累。为了说明这种类型的病变,我们报告了一名16个月大患有急性白质脑炎的女孩。疾病开始时体温达40摄氏度,随后出现癫痫发作、躯干出现红斑疹,然后陷入昏迷。脑部磁共振成像(MRI)显示白质有广泛病变。在急性期,通过聚合酶链反应(PCR)在脑脊液和血清中检测到HHV-6 DNA,并且对HHV-6抗体的检测显示急性期和恢复期血清之间IgG抗体滴度显著升高。一个月后观察到临床完全康复,而MRI显示病变部分消失。血清转化以及血清中病毒DNA的检测确定为原发性HHV-6感染,脑脊液中病毒核酸的检测为病毒在发病机制中的作用提供了依据。当面对婴儿急性白质脑炎时,进行详尽的病毒学调查以排除HHV-6以及其他常见致病病原体(EB病毒、巨细胞病毒、支原体、肠道病毒)的影响很重要,以避免错误地指责疫苗。