Human herpesvirus types 6 and 7 infection in pediatric hematopoietic stem cell transplant recipients
Human herpesvirus types 6 and 7 infection in pediatric hematopoietic stem cell transplant recipients
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DOI：
10.12659/aot.889995
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发表时间：
2014-06-02
影响因子：
1.1
通讯作者：
Chan, Godfrey Chi Fung
中科院分区：
文献类型：
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作者：
Robles, Joseph Delano Fule;Cheuk, Daniel Ka Leung;Chan, Godfrey Chi Fung
背景：接受造血干细胞移植 (HSCT) 的患者处于免疫抑制状态，容易激活潜伏病毒感染，例如 6 型和 7 型疱疹病毒（HHV6 和 HHV7）。我们旨在评估儿科造血干细胞移植后 HHV6 和 HHV7 感染的发生率、表现、结果和危险因素。 材料/方法：2006 年至 2012 年期间，我们对 94 名儿童（56 名男孩，中位年龄 7.1 岁）进行了 106 例 HSCT（86 例同种异体和 20 例自体）。对疑似 HHV6 或 HHV7 感染的患者使用血清和/或脑脊液进行聚合酶链反应检测。 结果：在 63 名接受 HHV 检测的患者中，10 名患者 (15.9%) 在 HSCT 后平均 18 天感染（HHV-6 (n=6)、HHV-7 (n=4)）（1 年累积发病率为 11.5%）。表现包括发烧（90%）、皮疹（70%）、肝炎（80%）、肺炎（50%）、中枢神经系统（CNS）表现（40%）和移植失败（10%）。尽管使用膦甲酸、更昔洛韦和西多福韦治疗，一名患者仍出现持续性中枢神经系统感染。平均 22 天后，7 名患者清除了疱疹病毒。 4 名患者死亡（恶性肿瘤复发 [n=3]、急性移植物抗宿主病 [aGVHD] [n=1]）。疱疹病毒感染与腺病毒感染 (p=0.001) 和严重（III-IV 级）aGVHD (p=0.037) 相关。结论：我们得出结论，HHV6 和 HHV7 感染在儿科 HSCT 后很常见。大多数感染是自限性的，可能与腺病毒感染和严重的aGVHD有关。需要进一步的研究来评估严重发病率或死亡率的预测因素，并确定最佳的预防和治疗。
Background: The immunosuppressed state in patients undergoing hematopoietic stem cell transplantation (HSCT) predisposes them to activation of latent viral infections such as herpesvirus types 6 and 7 (HHV6 and HHV7). We aimed to evaluate the incidence, manifestations, outcomes, and risk factors of HHV6 and HHV7 infections after pediatric hematopoietic stem cell transplantation.Material/Methods: We performed 106 HSCTs (86 allogeneic and 20 autologous) on 94 children (56 boys, median age 7.1 years) during 2006-2012. Patients suspected to have HHV6 or HHV7 infections were tested using polymerase chain reaction on serum and/or cerebrospinal fluid.Results: Among the 63 patients tested for HHV, 10 patients (15.9%) were infected (HHV-6 (n=6), HHV-7 (n=4)) at a median of 18 days post-HSCT (cumulative incidence 11.5% at 1 year). Manifestations included fever (90%), rash (70%), hepatitis (80%), pneumonitis (50%), central nervous system (CNS) manifestations (40%), and graft failure (10%). One patient had persistent CNS infection despite treatment with foscarnet, ganciclovir, and cidofovir. Seven patients cleared herpesvirus after a median of 22 days. Four patients died (relapse of malignancy [n=3], acute graft-versus-host disease [aGVHD] [n=1]). Herpesvirus infections were associated with adenovirus infection (p=0.001) and severe (grade III-IV) aGVHD (p=0.037).Conclusions: We concluded that HHV6 and HHV7 infections are common after pediatric HSCT. Most infections were self-limited and could be associated with adenovirus infection and severe aGVHD. Further studies are needed to evaluate predictors of severe morbidity or mortality, and define optimal prophylaxis and treatment.