Medical ICU, Hôpital Saint-Louis, Assistance-Publique Hôpitaux de Paris, 1 avenue Claude Vellefaux, Paris, France.
Infection. 2011 Jun;39(3):225-30. doi: 10.1007/s15010-011-0114-8. Epub 2011 May 3.
Human herpesvirus 6 (HHV6) is an emerging cause of interstitial pneumonia in immunocompromised hosts. However, the clinical significance of a positive PCR test for HHV6 in respiratory samples from patients with hematological malignancies remains unclear.
We retrospectively studied the features and outcomes of 29 critically ill hematology patients with acute respiratory failure and lung pulmonary infiltrates visible on a chest radiograph, who tested positive for a qualitative PCR for HHV6 in bronchoalveolar lavage fluid.
Of the 29 patients, 18 (62%) were stem cell transplant recipients and 11 (38%) had received chemotherapy. All patients had a fever. Clinical manifestations consistent with extra-pulmonary HHV6 disease were noted in 17 (59%) patients. One or more co-pathogens were found in 25 (86%) patients. The four remaining patients diagnosed with HHV6 pneumonia and subsequently recovered with foscarnet therapy. Antiviral therapy was also given to seven patients with co-infections, of whom two ultimately died.
In most cases, HHV6 recovered from BAL fluid is a co-pathogen whose clinical relevance remains undetermined. However, in some cases, HHV6 is the only pathogen, along with disseminated systemic viral disease, and the patient is likely to benefit from foscarnet therapy.
人类疱疹病毒 6（HHV6）是免疫功能低下宿主间质性肺炎的一种新兴病因。然而，血液恶性肿瘤患者呼吸道样本中 HHV6 聚合酶链反应（PCR）阳性对临床的意义仍不清楚。
我们回顾性研究了 29 例因急性呼吸衰竭和胸部 X 线片可见肺部浸润而入住重症监护病房的血液系统恶性肿瘤患者的特征和结局，这些患者的支气管肺泡灌洗液 HHV6 定性 PCR 检测结果为阳性。
29 例患者中，18 例（62%）为造血干细胞移植受者，11 例（38%）接受过化疗。所有患者均有发热。17 例（59%）患者出现了符合肺外 HHV6 疾病的临床表现。25 例（86%）患者发现了一种或多种混合病原体。其余 4 例诊断为 HHV6 肺炎的患者接受喷昔洛韦治疗后痊愈。7 例合并感染的患者也接受了抗病毒治疗，其中 2 例最终死亡。
大多数情况下，从 BAL 液中分离出的 HHV6 是一种混合病原体，其临床相关性尚未确定。然而，在某些情况下，HHV6 是唯一的病原体，伴有全身性播散性病毒病，患者可能受益于喷昔洛韦治疗。
