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Beta-herpesviruses in febrile children with cancer.

Yee-Guardino S, Gowans K, Yen-Lieberman B, Berk P, Kohn D, Wang FZ, Danziger-Isakov L, Sabella C, Worley S, Pellett PE, Goldfarb J - Emerging Infect. Dis. (2008)

Bottom Line: HHV-6A and HHV-7 were not detected.No other cause was identified in children with HHV-6B or cytomegalovirus DNAemia.Other HHV-6B-positive children had mild "viral" illnesses, as did a child with primary cytomegalovirus infection.

View Article: PubMed Central - PubMed

Affiliation: Cleveland Clinic Children's Hospital, Cleveland, OH, USA.

ABSTRACT
We conducted a cross-sectional study of beta-herpesviruses in febrile pediatric oncology patients (n = 30), with a reference group of febrile pediatric solid-organ transplant recipients (n = 9). One (3.3%) of 30 cancer patients and 3 (33%) of 9 organ recipients were PCR positive for cytomegalovirus. Four (13%) of 30 cancer patients and 3 (33%) of 9 transplant recipients had human herpesvirus 6B (HHV-6B) DNAemia, which was more common within 6 months of initiation of immune suppression (4 of 16 vs. 0 of 14 cancer patients; p = 0.050). HHV-6A and HHV-7 were not detected. No other cause was identified in children with HHV-6B or cytomegalovirus DNAemia. One HHV-6B-positive cancer patient had febrile disease with concomitant hepatitis. Other HHV-6B-positive children had mild "viral" illnesses, as did a child with primary cytomegalovirus infection. Cytomegalovirus and HHV-6B should be included in the differential diagnosis of febrile disease in children with cancer.

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Related in: MedlinePlus

Temporal relationship between detection of β-herpesvirus (βHV) and onset of immune suppression. Time of collection of each study specimen is indicated relative to onset of immune suppression for cancer patients and solid-organ transplant recipients. HHV, human herpesvirus; CMV, cytomegalovirus.
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Figure 1: Temporal relationship between detection of β-herpesvirus (βHV) and onset of immune suppression. Time of collection of each study specimen is indicated relative to onset of immune suppression for cancer patients and solid-organ transplant recipients. HHV, human herpesvirus; CMV, cytomegalovirus.

Mentions: Lymphocyte cultures for HHV-6 and HHV-7 were obtained for 34 of the 39 children. Of these, 15 cultures showed cytopathic effects similar to those commonly reported for HHV-6, but none of these were positive for HHV-6 by PCR. Cultured cells from 1 patient with leukemia (study participant 19) were positive for HHV-6B by PCR, in the absence of a cytopathic effect. Four (13%) of 30 cancer patients and 3 (33%) of 9 transplant recipients (p = 0.19) had HHV-6B DNAemia; HHV-6A was not detected. Viral loads ranged from 50 to 500,000 DNA copies/mL. Of 7 PCR-positive patients, 3 also showed positive results in peripheral blood mononuclear cells (PBMC) and whole blood specimens, 2 in only PBMC, and 1 only in a lymphocyte culture. Patient 40, a transplant recipient, had positive results in all specimens tested including PBMC, whole blood, and plasma, with the highest viral load (>5 × 105 genomes/mL) in PBMC. These results are consistent with either severe acute infection or the child having germline integrated HHV-6B (32,33). PCR positivity was more common in children whose blood was collected within 6 months of initiation of immune suppression compared with children sampled >6 months after initiation of immune suppression (cancer patients: 4 of 16 vs. 0 of 14 after 6 months, p = 0.050; transplant recipients: 2 of 3 vs. 1 of 6, p = 0.26) (Figure). Solid-tumor patients were less likely to be positive for HHV-6B than either leukemic (1 of 20 vs. 3 of 9, p = 0.046) or SOT patients (1 of 20 vs. 3 of 9, p = 0.046). Two of the HHV-6B-positive SOT patients had concurrent CMV DNAemia.


Beta-herpesviruses in febrile children with cancer.

Yee-Guardino S, Gowans K, Yen-Lieberman B, Berk P, Kohn D, Wang FZ, Danziger-Isakov L, Sabella C, Worley S, Pellett PE, Goldfarb J - Emerging Infect. Dis. (2008)

Temporal relationship between detection of β-herpesvirus (βHV) and onset of immune suppression. Time of collection of each study specimen is indicated relative to onset of immune suppression for cancer patients and solid-organ transplant recipients. HHV, human herpesvirus; CMV, cytomegalovirus.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2570945&req=5

Figure 1: Temporal relationship between detection of β-herpesvirus (βHV) and onset of immune suppression. Time of collection of each study specimen is indicated relative to onset of immune suppression for cancer patients and solid-organ transplant recipients. HHV, human herpesvirus; CMV, cytomegalovirus.
Mentions: Lymphocyte cultures for HHV-6 and HHV-7 were obtained for 34 of the 39 children. Of these, 15 cultures showed cytopathic effects similar to those commonly reported for HHV-6, but none of these were positive for HHV-6 by PCR. Cultured cells from 1 patient with leukemia (study participant 19) were positive for HHV-6B by PCR, in the absence of a cytopathic effect. Four (13%) of 30 cancer patients and 3 (33%) of 9 transplant recipients (p = 0.19) had HHV-6B DNAemia; HHV-6A was not detected. Viral loads ranged from 50 to 500,000 DNA copies/mL. Of 7 PCR-positive patients, 3 also showed positive results in peripheral blood mononuclear cells (PBMC) and whole blood specimens, 2 in only PBMC, and 1 only in a lymphocyte culture. Patient 40, a transplant recipient, had positive results in all specimens tested including PBMC, whole blood, and plasma, with the highest viral load (>5 × 105 genomes/mL) in PBMC. These results are consistent with either severe acute infection or the child having germline integrated HHV-6B (32,33). PCR positivity was more common in children whose blood was collected within 6 months of initiation of immune suppression compared with children sampled >6 months after initiation of immune suppression (cancer patients: 4 of 16 vs. 0 of 14 after 6 months, p = 0.050; transplant recipients: 2 of 3 vs. 1 of 6, p = 0.26) (Figure). Solid-tumor patients were less likely to be positive for HHV-6B than either leukemic (1 of 20 vs. 3 of 9, p = 0.046) or SOT patients (1 of 20 vs. 3 of 9, p = 0.046). Two of the HHV-6B-positive SOT patients had concurrent CMV DNAemia.

Bottom Line: HHV-6A and HHV-7 were not detected.No other cause was identified in children with HHV-6B or cytomegalovirus DNAemia.Other HHV-6B-positive children had mild "viral" illnesses, as did a child with primary cytomegalovirus infection.

View Article: PubMed Central - PubMed

Affiliation: Cleveland Clinic Children's Hospital, Cleveland, OH, USA.

ABSTRACT
We conducted a cross-sectional study of beta-herpesviruses in febrile pediatric oncology patients (n = 30), with a reference group of febrile pediatric solid-organ transplant recipients (n = 9). One (3.3%) of 30 cancer patients and 3 (33%) of 9 organ recipients were PCR positive for cytomegalovirus. Four (13%) of 30 cancer patients and 3 (33%) of 9 transplant recipients had human herpesvirus 6B (HHV-6B) DNAemia, which was more common within 6 months of initiation of immune suppression (4 of 16 vs. 0 of 14 cancer patients; p = 0.050). HHV-6A and HHV-7 were not detected. No other cause was identified in children with HHV-6B or cytomegalovirus DNAemia. One HHV-6B-positive cancer patient had febrile disease with concomitant hepatitis. Other HHV-6B-positive children had mild "viral" illnesses, as did a child with primary cytomegalovirus infection. Cytomegalovirus and HHV-6B should be included in the differential diagnosis of febrile disease in children with cancer.

Show MeSH
Related in: MedlinePlus