PRIMARY HUMAN HERPESVIRUS-6 INFECTION IN YOUNG-CHILDREN
PRIMARY HUMAN HERPESVIRUS-6 INFECTION IN YOUNG-CHILDREN
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DOI：
10.1056/nejm199205283262201
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发表时间：
1992-05-28
影响因子：
158.5
通讯作者：
STEWART, JA
中科院分区：
文献类型：
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作者：
PRUKSANANONDA, P;HALL, CB;STEWART, JA
背景资料。人类疱疹病毒6型(HHV-6)是最近发现的一种病毒，根据血清学证据，似乎在三岁前感染大多数儿童。然而，HHV-6原发感染的临床表现尚未明确。我们研究了连续两岁或两岁以下的儿童，他们因发烧而来到急诊室。我们的评估包括从外周血单个核细胞中分离HHV-6，免疫荧光抗体检测，聚合酶链式反应(PCR)检测HHV-6，以及HHV-6分离株的限制性内切酶片段图谱。从243名危重儿童中分离出34名HHV-6(14%)。患有病毒血症的儿童有易怒、高温(平均39.7摄氏度)和鼓膜炎症(21例)，但很少有其他局部体征。两名儿童入院治疗，但34名儿童在平均发烧四天后全部康复。红疹的皮疹特征与HHV-6感染有关，仅在三名儿童中发现。在29名儿童(85%)中，在恢复期获得的血清样本中，IgG抗体效价至少增加了四倍；4名三个月以下的婴儿可能有母体抗体，但没有这种增加。只有一名儿童在康复期间的血液中分离到了HHV-6，但在三分之二的儿童中，可以通过聚合酶链式反应检测到病毒。这些分离株具有基因组异质性，表明存在多个菌株。HHV-6原发感染是幼儿急性发热性疾病的主要原因。这种感染与不同的临床表现、病毒血症和病毒基因组在单核细胞中频繁持续存在有关。
Background. Human herpesvirus 6 (HHV-6) is a recently discovered virus that, on the basis of serologic evidence, appears to infect most children by the age of three years. However, the clinical manifestations of primary HHV-6 infection have not been well defined.Methods. We studied consecutive children two years old or younger who presented to an emergency ward with febrile illnesses. Our evaluation included the isolation of HHV-6 from peripheral-blood mononuclear cells, an immunofluorescent-antibody assay, the detection of HHV-6 by the polymerase chain reaction (PCR), and restriction-endonuclease-fragment profiles of HHV-6 isolates.Results. HHV-6 was isolated from 34 of 243 acutely ill children (14 percent). The children with viremia had irritability, high temperatures (mean, 39.7-degrees-C), and inflammation of tympanic membranes (in 21), but few other localizing signs. Two children were hospitalized, but all 34 recovered after an average of four days of fever. The rash characteristic of roseola, which has been associated with HHV-6 infection, was noted in only three children. In 29 children (85 percent), serum samples obtained during convalescence had at least a fourfold increase in IgG antibody titers; 4 infants less than three months old who presumably had maternal antibody did not have this increase. HHV-6 was isolated from blood obtained during convalescence in only one child, but in two thirds of the children the virus could be detected by PCR. The isolates had genomic heterogeneity, indicating the presence of multiple strains.Conclusions. Primary infection with HHV-6 is a major cause of acute febrile illness in young children. Such infection is associated with varied clinical manifestations, viremia, and the frequent persistence of the viral genome in mononuclear cells.