Ganea Oana Alexandra, Tilișcan Cătălin, Streinu-Cercel Anca, Pițigoi Daniela, Drăgănescu Anca Cristina, Lazar Mihai, Mihai Nicoleta, Florea Dragoș, Aramă Sorin Ștefan, Aramă Victoria
Faculty of General Medicine, Department of Infectious Diseases, "Carol Davila" University of Medicine and Pharmacy, Dionisie Lupu Street No. 37, 010458 Bucharest, Romania.
"Matei Bals" National Institute of Infectious Diseases, Dr. Calistrat Grozovici Street No. 1, 021105 Bucharest, Romania.
J Clin Med. 2024 Aug 8;13(16):4660. doi: 10.3390/jcm13164660.
: Human herpesvirus 6 (HHV-6) is considered a ubiquitous virus, with many countries reporting a seroprevalence of more than 80-90% among the general population. However, this virus is unique among herpesviruses in its ability to integrate into the genetic material of the host's cells. Thus, there are three ways by which HHV-6 can cause an active infection-primary infection, reactivation of a latent acquired infection, or activation of iciHHV-6 (inherited chromosomally integrated HHV-6). Whole blood quantitative polymerase chain reaction (qPCR) is very useful in distinguishing between iciHHV-6 and primary infection/reactivation. Our aim is to assess the role of HHV-6 in the aetiology of central nervous system (CNS) infections in adults and children, to describe all HHV-6-positive cases in an attempt to determine the susceptible population and to identify potential risk factors that can be linked to HHV-6 meningoencephalitis. : We performed a retrospective study involving patients that were admitted to Prof. Dr. Matei Bals National Institute of Infectious Diseases, Bucharest, Romania, with a diagnosis of meningitis or encephalitis. We only selected the clinical records of patients that had a multiplex PCR Biofire FilmArray meningitis/encephalitis panel. : We report a 5% HHV-6 positivity in the cerebrospinal fluid (CSF) of patients with CNS infections tested with a commercial multiplex PCR M/E (meningitis/encephalitis) panel. Additionally, 2% to 4% of the total study population ( = 100) had active HHV-6 infections, which denotes 40 to 80% of the HHV-6-positive samples. We did not observe any statistically significant correlation between HHV-6 positivity in the CSF and variables such as age, sex, or comorbidities, including obesity, diabetes, hypertension, immunosuppression, or oncologic disease. Therefore, no risk factors could be linked with HHV-6 positivity in the CSF. : although multiplex qualitative PCR is highly useful for providing rapid results and identifying nearly every pathogen that can cause meningitis/encephalitis, we have to be aware of this type of test's limitations. All patients with HHV-6 detectable in their CSF via a multiplex PCR test should also undergo qPCR testing from both CSF and blood to prevent over-diagnosing HHV-6 CNS infections, to avoid unnecessary antiviral treatments, and ensure the accurate identification of the true diagnosis.
人类疱疹病毒6型（HHV - 6）被认为是一种普遍存在的病毒，许多国家报告普通人群中的血清阳性率超过80% - 90%。然而，这种病毒在疱疹病毒中独具特色，能够整合到宿主细胞的遗传物质中。因此，HHV - 6引发活动性感染有三种方式——原发性感染、潜伏性获得性感染的再激活，或遗传性染色体整合的HHV - 6（iciHHV - 6）的激活。全血定量聚合酶链反应（qPCR）在区分iciHHV - 6与原发性感染/再激活方面非常有用。我们的目的是评估HHV - 6在成人和儿童中枢神经系统（CNS）感染病因中的作用，描述所有HHV - 6阳性病例，以试图确定易感人群，并识别可能与HHV - 6脑膜脑炎相关的潜在风险因素。
我们进行了一项回顾性研究，涉及罗马尼亚布加勒斯特马泰·巴尔什国立传染病研究所收治的诊断为脑膜炎或脑炎的患者。我们仅选取了通过多重PCR Biofire FilmArray脑膜炎/脑炎检测板检测的患者的临床记录。
我们报告，在使用商用多重PCR M/E（脑膜炎/脑炎）检测板检测的CNS感染患者的脑脊液（CSF）中，HHV - 6阳性率为5%。此外，在整个研究人群（n = 100）中，2%至4%的人有活动性HHV - 6感染，这意味着HHV - 6阳性样本占40%至80%。我们未观察到CSF中HHV - 6阳性与年龄、性别或合并症（包括肥胖、糖尿病、高血压、免疫抑制或肿瘤疾病）等变量之间存在任何统计学上的显著相关性。因此，没有风险因素可与CSF中的HHV - 6阳性相关联。
尽管多重定性PCR对于快速得出结果并识别几乎所有可导致脑膜炎/脑炎的病原体非常有用，但我们必须意识到这类检测的局限性。所有通过多重PCR检测在CSF中可检测到HHV - 6的患者，还应接受CSF和血液的qPCR检测，以防止过度诊断HHV - 6 CNS感染，避免不必要的抗病毒治疗，并确保准确识别真正的诊断。
