Suga S, Yoshikawa T, Kajita Y, Ozaki T, Asano Y
Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan.
Pediatrics. 1998 Oct;102(4 Pt 1):900-4. doi: 10.1542/peds.102.4.900.
To elucidate persistence of human herpesvirus-6 (HHV-6) in the blood and excretion of the virus into several body fluids of patients with exanthem subitum (ES), and to examine serologic and virologic findings of the parents caring for the patients in the family setting.
During a 15-month period, 20 infants from 20 families (11 boys and 9 girls; mean age, 7.7 months; range, 4-11 months) with primary HHV-6 infection and a typical clinical course of ES, and 15 parents from the 20 families (2 males and 13 females; mean age, 28.2 years; range, 21-34 years) were enrolled in the study and examined clinically and virologically. Primary infection with HHV-6 was confirmed by isolation of the virus from peripheral blood mononuclear cells (MNCs), and seroconversion or a significant increase in the antibody titers to HHV-6 by a neutralization test. Viral persistence or excretion was examined by amplifying the viral deoxyribonucleic acid (DNA) in serially collected peripheral blood MNCs, plasma, saliva, stool, and urine samples with a nested polymerase chain reaction method. Data on saliva from the parents were compared with those of 21 age-matched controls.
Twenty infants with virologically confirmed ES had HHV-6 DNA in MNCs persistently during and after the disease but in plasma only in the first 5 days of ES. The viral DNA was also detected persistently or intermittently in saliva and stool during and after the disease but rarely in urine. On the other hand, the 15 parents examined of the 20 infants had no HHV-6 viremia nor viral DNA in peripheral blood MNCs and plasma except 1, but half of them excreted viral DNA in saliva during and after ES. The frequency of excretion of viral DNA into saliva was not significantly different from that of 21 control parents. Only 1 of the 15 showed a fourfold increase in antibody titers to HHV-6 after possible exposure from their children.
After systemic replication of HHV-6 in the blood of patients with ES during the first 5 days of the disease, the virus is excreted into saliva and stool persistently or intermittently but rarely into urine. The presence of HHV-6 DNA in plasma suggested active infection with the virus. Excretion of the virus into the saliva of infants with ES and their parents suggests the source and transmission route of infection with HHV-6.
阐明幼儿急疹（ES）患者血液中人类疱疹病毒6型（HHV - 6）的持续性以及该病毒向多种体液的排泄情况，并检查在家庭环境中照顾患者的父母的血清学和病毒学检查结果。
在15个月期间，招募了来自20个家庭的20名婴儿（11名男孩和9名女孩；平均年龄7.7个月；范围4 - 11个月），这些婴儿患有原发性HHV - 6感染且具有典型的ES临床病程，以及来自这20个家庭的15名父母（2名男性和13名女性；平均年龄28.2岁；范围21 - 34岁），对他们进行临床和病毒学检查。通过从外周血单个核细胞（MNC）中分离病毒以及通过中和试验检测血清转化或HHV - 6抗体滴度显著升高来确诊原发性HHV - 6感染。采用巢式聚合酶链反应方法扩增连续采集的外周血MNC、血浆、唾液、粪便和尿液样本中的病毒脱氧核糖核酸（DNA），以检查病毒的持续性或排泄情况。将父母唾液的数据与21名年龄匹配的对照者的数据进行比较。
20例经病毒学确诊为ES的婴儿在疾病期间及之后，MNC中持续存在HHV - 6 DNA，但仅在ES的前5天血浆中存在。在疾病期间及之后，唾液和粪便中也持续或间歇性检测到病毒DNA，但尿液中很少检测到。另一方面，在检查的20例婴儿的15名父母中，除1人外，外周血MNC和血浆中均未检测到HHV - 6病毒血症及病毒DNA，但其中一半在ES期间及之后唾液中排泄病毒DNA。病毒DNA排泄到唾液中的频率与21名对照父母的频率无显著差异。15名父母中只有1人在可能接触其子女后，HHV - 6抗体滴度升高了四倍。
在疾病的前5天，ES患者血液中HHV - 6进行全身复制后，该病毒持续或间歇性排泄到唾液和粪便中，但很少排泄到尿液中。血浆中存在HHV - 6 DNA提示病毒的活跃感染。ES婴儿及其父母唾液中病毒的排泄提示了HHV - 6感染的来源和传播途径。
