Bland R M, Mackie P L, Shorts T, Pate S, Paton J Y
Department of Child Health, University of Glasgow, UK.
J Infect. 1998 Mar;36(2):161-5. doi: 10.1016/s0163-4453(98)80006-6.
Since human herpesvirus 6 (HHV6) was first linked with exanthem subitum in 1988 there has been increasing evidence that the morbidity associated with acute HHV6 infection may be more significant and variable. However, the clinical appreciation of HHV6 infection has been hampered by the lack of rapid and clinically useful diagnostic methods. In this prospective study of hospitalized febrile children under 3 years of age we compared three rapid viral diagnostic methods, (polymerase chain reaction assay (PCR), IgM serology and direct antigen detection), with conventional serology on paired serum samples. In addition, we documented the range of clinical features associated with acute HHV6 infection. Of 67 children recruited, 11 (16%) had evidence of acute HHV6 infection: six had detectable, specific, IgM; four were PCR positive; and one was PCR positive with IgM. Direct antigen testing on batched frozen samples detected no infections. Apart from high fever (median peak 38.5 degrees C), common features were non-specific. Two children had febrile convulsions and only one child had a non-specific rash. We conclude that rapid microbiological diagnosis at present requires two tests (IgM and PCR). HHV6 is a common cause of febrile illness in hospitalized infants with no rash and should be considered in their diagnosis.
自1988年人类疱疹病毒6型（HHV6）首次与幼儿急疹相关联以来，越来越多的证据表明，急性HHV6感染相关的发病率可能更高且具有变异性。然而，由于缺乏快速且临床实用的诊断方法，对HHV6感染的临床认识受到了阻碍。在这项针对3岁以下住院发热儿童的前瞻性研究中，我们将三种快速病毒诊断方法（聚合酶链反应检测（PCR）、IgM血清学检测和直接抗原检测）与配对血清样本的传统血清学检测进行了比较。此外，我们记录了与急性HHV6感染相关的一系列临床特征。在招募的67名儿童中，11名（16%）有急性HHV6感染的证据：6名检测到特异性IgM；4名PCR检测呈阳性；1名PCR检测呈阳性且IgM检测也呈阳性。对批量冷冻样本进行的直接抗原检测未发现感染病例。除高热（中位峰值38.5摄氏度）外，常见特征均不具特异性。两名儿童出现热性惊厥，只有一名儿童出现非特异性皮疹。我们得出结论，目前快速微生物学诊断需要进行两项检测（IgM和PCR）。HHV6是住院无皮疹婴儿发热性疾病的常见病因，在其诊断中应予以考虑。
