Hall C B, Long C E, Schnabel K C, Caserta M T, McIntyre K M, Costanzo M A, Knott A, Dewhurst S, Insel R A, Epstein L G
Department of Pediatrics, University of Rochester School of Medicine and Dentistry, NY.
N Engl J Med. 1994 Aug 18;331(7):432-8. doi: 10.1056/NEJM199408183310703.
Infection with human herpesvirus-6 (HHV-6) is nearly universal in infancy or early childhood. However, the course of this infection, its complications, and its potential for persistence or reactivation remain unclear.
We studied infants and children under the age of three years who presented to our emergency department with acute illnesses. Infants and young children without acute illness were studied as controls. HHV-6 infection was identified by blood-mononuclear-cell culture, serologic testing, and the polymerase chain reaction (PCR).
No primary HHV-6 infection was found among 582 infants and young children with acute nonfebrile illnesses or among 352 controls without acute illness. Of 1653 infants and young children with acute febrile illnesses, 160 (9.7 percent) had primary HHV-6 infection, as documented by viremia and seroconversion. They ranged in age from 2 weeks to 25 months; 23 percent were under the age of 6 months. HHV-6 infections accounted for 20 percent of 365 visits to the emergency department for febrile illnesses among children 6 to 12 months old. Of the 160 infants and young children with acute HHV-6 infections, 21 (13 percent) were hospitalized, and 21 had seizures. Often the seizures appeared late and were prolonged or recurrent. HHV-6 infections accounted for one third of all febrile seizures in children up to the age of two years. In follow-up studies over a period of one to two years, the HHV-6 genome persisted in blood mononuclear cells after primary infection in 37 of 56 children (66 percent). Reactivation, sometimes with febrile illnesses, was suggested by subsequent increases in antibody titers in 16 percent (30 of 187) and by PCR in 6 percent (17 of 278). No recurrent viremia was detected. Of 41 healthy newborns studied, 12 (29 percent) had the HHV-6 genome in their blood mononuclear cells; nevertheless, 6 of these newborns subsequently had primary HHV-6 infections.
In infants and young children HHV-6 infection is a major cause of visits to the emergency department, febrile seizures, and hospitalizations. Perinatal transmission may occur, with possible asymptomatic, transient, or persistent neonatal infection.
人疱疹病毒6型（HHV - 6）感染在婴儿期或幼儿期几乎普遍存在。然而，这种感染的病程、并发症以及持续存在或再激活的可能性仍不清楚。
我们研究了因急性疾病前来我院急诊科就诊的3岁以下婴幼儿。将无急性疾病的婴幼儿作为对照进行研究。通过血液单核细胞培养、血清学检测和聚合酶链反应（PCR）来确定HHV - 6感染。
在582例患有急性非发热性疾病的婴幼儿和352例无急性疾病的对照中，未发现原发性HHV - 6感染。在1653例患有急性发热性疾病的婴幼儿中，160例（9.7%）有原发性HHV - 6感染，病毒血症和血清转化证明了这一点。他们的年龄从2周龄至25个月；23%在6个月龄以下。HHV - 6感染占6至12个月龄儿童因发热性疾病到急诊科就诊365次的20%。在160例患有急性HHV - 6感染的婴幼儿中，21例（13%）住院，21例发生惊厥。惊厥常出现较晚，且持续时间长或反复发作。HHV - 6感染占2岁以下儿童所有热性惊厥的三分之一。在为期1至2年的随访研究中，56例儿童中有37例（66%）在原发性感染后，HHV - 6基因组持续存在于血液单核细胞中。16%（187例中的30例）抗体滴度随后升高以及6%（278例中的17例）通过PCR提示有再激活，有时伴有发热性疾病。未检测到复发性病毒血症。在研究的41例健康新生儿中，12例（29%）血液单核细胞中有HHV - 6基因组；然而，其中6例新生儿随后发生了原发性HHV - 6感染。
在婴幼儿中，HHV - 6感染是到急诊科就诊、热性惊厥和住院的主要原因。可能发生围产期传播，可能有无症状、短暂或持续性新生儿感染。
