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New Information About Infections with Human Herpesviruses 6 and 7
http://infectious-diseases.jwatch.org/cgi/content/full/2004/1105/6
Robert S. Baltimore, MD
Published in Journal Watch Infectious Diseases November 5, 2004
Human herpesviruses 6 and 7 (HHV6 and HHV7) are similar in biology and clinical expression. Childhood infection is nearly universal. Although these viruses cause roseola (exanthem subitum) and account for some nonspecific febrile illnesses in young children, infection is generally asymptomatic. HHV6 and HHV7 persist latently following primary infection but often are reactivated in immunocompromised individuals. Now, two studies from a group in Rochester, New York, and an accompanying editorial extend our knowledge regarding mother-to-child transmission and persistent infection.
... Of 46 follow-up samples taken between birth and age 2 from 17 congenitally infected infants, 42 (91%) were positive for HHV6 DNA. Congenital HHV6 infection was asymptomatic,...
... although HHV 6 and 7 are present in body fluids, HHV6 -- but not HHV7 -- can cross the placenta and cause congenital infection. Based on serologic findings, mothers of infected infants appear to have gestational reactivation of infection. ... This is the first report of a similar study of HHV7. These findings do not clarify the proposed association of HHV6 with illnesses such as multiple sclerosis or chronic fatigue syndrome.
Childhood HHV-6 Infection Profiled
http://dermatology.jwatch.org/cgi/content/full/1994/1001/15
Hall CB et al.
Human herpesvirus-6 infection in children:
a prospective study of complications and reactivation.
N Engl J Med 1994 Aug 18 331 432-438.
Human herpesvirus-6 (HHV-6) is one cause of roseola infantum, a common childhood illness. This study investigated the incidence of primary HHV-6 infection in young children with febrile episodes and examined the infection's manifestations and outcomes.
Researchers tested 1653 children less than three years old who presented to an emergency department with acute febrile illness. Ten percent had culture-positive HHV-6 viremia and seroconversion; in contrast, none of 582 children with acute nonfebrile illness and none of 352 healthy controls had HHV-6 viremia.
Most of the 160 children with HHV-6 had fevers above 39°C.
Forty-one percent had upper respiratory symptoms, a third had gastrointestinal symptoms, 17% developed the rash of roseola, and 13% eventually had seizures. Among subgroups of children with HHV-6 who underwent follow-up studies during the next two years, 66% had detectable HHV-6 genome in blood mononuclear cells, and 26% had possible reactivation of infection (as indicated by a fourfold increase in antibody titer).
Comment: Before this study, HHV-6 was known to infect most children in early childhood. This study broadens our understanding of this viral infection and suggests that it can cause considerable morbidity apart from roseola.
NEW DISEASE ASSOCIATIONS FOR HERPES-6.
http://general-medicine.jwatch.org/cgi/content/full/1993/723/4
Since human herpesvirus 6 (HHV-6) was discovered in 1986, it has been shown to cause exanthem subitum and to be associated with a variety of other illnesses. Two new associations can probably be added.
A team at the University of Washington used the polymerase-chain-reaction assay to test lung tissue from 15 immunocompromised patients who developed pneumonitis after bone-marrow transplant and two control groups (15 immunocompetent subjects without pneumonitis, most of whom died from trauma, and 6 fetuses).
Lung tissue from 6 of the 15 immunocompromised patients had HHV-6 DNA levels that were 10 to 500 times higher than levels in all other subjects. These patients had more severe graft-versus-host disease and low levels of HHV-6 antibodies. Five of the six had idiopathic pneumonitis and no evidence of cytomegalovirus or other pulmonary infection.
A second report from Japan describes a 42-year-old man with a severe mononucleosis-like syndrome marked by high fever, a progressive and generalized maculopapular eruption, cervical adenopathy, mild splenomegaly, mild liver-function abnormalities, transiently elevated creatinine, and marked atypical lymphocytosis (40 to 60 percent) with a negative heterophil antibody test. Tests for cytomegalovirus and Epstein-Barr virus (the usual cause of mononucleosis) were unremarkable, but other tests showed HHV-6 infection of lymphocytes, viremia, and rising antibodies to HHV-6.
Comment: It now seems likely that HHV-6, like its "cousin" cytomegalovirus, is an important cause of pneumonitis in immunocompromised patients. It also appears that HHV-6 can cause a mononucleosis-like illness that ranges from mild to quite severe. How to treat HHV-6 infection is not yet clear.
Acquisition and Natural History of Human Herpesvirus 6 Infection
http://pediatrics.jwatch.org/cgi/content/full/2005/314/4
Zerr DM et al.
A population-based study of primary human herpesvirus 6 infection.
N Engl J Med 2005 Feb 24; 352:768-76.
Human herpesvirus 6 (HHV-6) .. Seattle-based researchers .. developed a noninvasive method for parents to collect weekly saliva samples for PCR testing and followed a cohort of 277 infants from birth through 2 years (median follow-up, 60 weeks).
Overall, 130 children developed primary HHV-6 infection (defined by persistent salivary levels of HHV-6 DNA). Acquisition of infection was highest between 9 and 21 months of age; 77% of infected infants acquired the infection by 24 months. Among the 81 children with a well-defined time of acquisition, only 23% had roseola, but 93% were symptomatic, most often with fever, fussiness, and rhinorrhea, and nearly half of the infections led to a physician visit. No infant in this cohort had a febrile seizure. Having older siblings, but not attending day care, was a risk factor for HHV-6 infection.
Human Herpesvirus 6 and Chronic Fatigue
http://psychiatry.jwatch.org/cgi/content/full/1996/101/20
Patnaik M et al.
Prevalence of IgM antibodies to human herpesvirus 6
early antigen (p41/38) in patients with chronic fatigue syndrome.
J Infect Dis 1995 Nov 172 1364-1367.
The authors developed an enzyme immunoassay to detect both IgM and IgG antibodies to HHV-6 early antigen, allowing them to distinguish between latent and active infection. In a blinded manner, they tested sera from 154 patients who met the CDC's case definition of CFS and from 165 healthy controls.
Sixty percent of CFS patients had IgM antibodies to HHV-6 early antigen, and 40% had elevated IgG, as compared with 4% and 8% of the controls -- a highly significant difference. In addition, 23% of the CFS patients were positive for both IgM and IgG, versus none of the controls. There were no significant differences between the two groups when IgM and IgG antibodies to Epstein-Barr virus and cytomegalovirus were assayed.
Abnormalities in an Illness resembling Chronic Fatigue Syndrome.
http://general-medicine.jwatch.org/cgi/content/full/1992/124/5
Buchwald D et al.
A chronic illness characterized by fatigue, neurologic and
immunologic disorders, and active human herpesvirus type 6 infection.
Ann Intern Med 1992 Jan 15 116 103-113.
Specific immunologic, neuroradiologic, and virologic abnormalities have been found in a group of 259 patients from a single practice with an illness resembling chronic fatigue syndrome.
The 121 patients who were tested had a higher mean CD4/CD8 T-cell ratio than that in 54 healthy controls (3.16 vs. 2.3). MRI scans of the brain revealed punctate areas of high signal intensity in the white matter of 113 of 144 patients tested (78 percent), but in only 10 of 47 controls (21 percent). Human herpesvirus type 6 (HHV-6) was actively replicating in 70 percent of tested patients and 20 percent of matched controls. Epstein-Barr virus antibody levels were higher in patients than in controls. All differences were highly significant.
... the abnormalities suggest an organic illness with immunologically or virologically mediated central nervous system manifestations. The authors believe that the active replication of HHV-6 represents a reactivation of latent infection rather than new infection. ..
2007-04-19 Notice of articles on
Complicating Infectious Foci in Patients with S. aureus or Strep Bacteremia, and Diagnosis,
Treatment, and Prevention of Nontuberculous Mycobacterial Diseases
(This ATS/IDSA statement includes updated information on genetic identification, the role of antimicrobial sensitivity testing, and therapy for MAC.), and
Long-Term Efficacy of Adefovir for HBeAg-Negative Chronic HBV Infection (Adefovir is effective for long-term treatment of patients with HBeAg-negative infections, although resistance occurs in 20% by 5 years.)
--- All only available with Subscription!
2007-10-24 Newsletter
MRSA in the U.S.
Using data from population-based surveillance in nine communities, researchers estimate that MRSA caused 94,360 invasive infections and 18,650 deaths in the U.S. in 2005.
By Richard T. Ellison III, MD
October 24, 2007
Covering: Klevens RM et al. JAMA 2007 Oct 17; 298:1763
Bancroft EA. JAMA 2007 Oct 17; 298:1803
... adjusted overall incidence of invasive MRSA disease in 2005 was 24.4 to 35.2 cases per 100,000
... the estimated incidence of MRSA disease in this study is greater than the combined incidence of invasive disease from pneumococci, group A streptococci, meningococci, and Haemophilus influenzae. Moreover, because the researchers investigated cultures only from normally sterile sites, their incidence estimates do not include the skin and soft-tissue infections seen in most outbreaks of community-acquired MRSA disease.
Is "Chronic Lyme Disease" Real?
Mary Wu Chang, MD
Published in Journal Watch Dermatology October 3, 2007
... Objective manifestations of Lyme disease include erythema migrans (the most common presentation of early Lyme disease), certain neurologic and cardiac manifestations, and pauciarticular arthritis (the most common presentation of late Lyme disease). These symptoms respond well to conventional antibiotic therapy. Symptoms of post–Lyme disease include fatigue, musculoskeletal pain, and difficulties with concentration or short-term memory following resolution of objective manifestations of infection. These symptoms are usually mild, typically resolve within months, and antibiotic therapy is not indicated; when the difficulties persist longer than 6 months, the condition is termed post–Lyme disease syndrome. Laboratory testing (usually acute- and convalescent-phase serologies; less commonly, PCR or culture) is a key component of Lyme disease diagnosis; in most cases, the testing allows clinicians to confirm evidence of current or past B. burgdorferi infection. ...
Chronic antibiotic therapy for chronic Lyme disease has resulted in life-threatening anaphylaxis, cholecystectomy after biliary complications from ceftriaxone administration, a fatality due to candidemia from intravenous catheter infection, and other serious adverse events related to intravenous catheters.
2007-11-09 Newsletter
The Neurobiology of Sleep.
A highly detailed review of REM sleep neurobiology and of adenosine, a sleep promoter
By Thomas E. Scammell, MD
September 11, 2007
Covering: McCarley RW. Sleep Med 2007 Jun 8:302-30
... Starting with the evidence from Jouvet’s lesion experiments in the 1960s, McCarley presents a compelling model of the regulation of REM sleep through the interaction of brainstem monoaminergic and cholinergic neurons. He also outlines how adenosine accumulates during wakefulness and inhibits wake-promoting neurons in the basal forebrain. These discoveries help explain many common clinical phenomena, such as the suppression of REM sleep by selective serotonin reuptake inhibitors (serotonin inhibits REM sleep-producing neurons) and the inhibition of sleep by caffeine (caffeine blocks adenosine receptors). In addition, the author acknowledges several issues that remain unresolved or controversial.
Medline Abstract
Neuroscience Laboratory, VA Boston Healthcare System,
940 Belmont St., Brockton, MA 02301, USA. robert_mccarley@hms.harvard.edu
Stroke and Folic Acid: A Meta-Analysis.
An analysis of eight randomized trials indicates that folic acid supplementation is effective for primary prevention of stroke.
September 11, 2007
Covering: Wang X et al. Lancet 2007 Jun 2; 369:1876-82
Carlsson CM. Lancet 2007 Jun 2; 369:1841-2
... In the new analysis, folic acid supplementation significantly reduced the rate of stroke, by 18%. The risk for stroke was significantly lowered in trials in which the interventions lasted longer than 36 months (but not in briefer trials), in studies performed in areas where grain was not fortified with folic acid (but not in areas with fortification), and in trials in which most patients had not had a previous stroke (but not in one trial in which all patients had had strokes).
Helicobacter pylori eradication in patients
with early gastric cancer reduced the risk for subsequent gastric cancer from 40.5/1000 person-years
to 14.1/1000 person-years.
By Mary E. Wilson, MD
August 13, 2008
Covering: Fukase K et al. Lancet 2008 Aug 2; 372:392
Talley NJ. Lancet 2008 Aug 2; 372:350
http://infectious-diseases.jwatch.org/cgi/content/full/2008/813/1?q=etoc_jwhospmed
Helicobacter pylori infection is associated with gastric cancer, the second leading cause of cancer deaths globally. ... The study was performed in Japan, where the usual treatment for early mucosal gastric cancer is endoscopic resection. Because only a small amount of mucosa is resected, patients are at risk for cancer at other gastric sites.
The 544 participants were randomized to receive H. pylori treatment (lansoprazole, amoxicillin, and clarithromycin for 1 week) or standard care but no antibiotics to eradicate H. pylori. They underwent follow-up endoscopic examinations at 6 months and at 1, 2, and 3 years.
H. pylori was eradicated in 80% of treatment-group patients, whereas infection resolved during follow-up in only 5% of controls. ... diarrhea occurred in 7% of treatment-group patients.
Comment: This study, which assessed a population at high risk for recurrence, showed that H. pylori eradication reduced the risk for gastric cancer at a new site. As noted by an editorialist, a recent Asia-Pacific consensus conference concluded that screening and treatment of H. pylori in high-risk populations is recommended. Determining high risk is essential, however, because H. pylori eradication might result in other problems, including gastroesophageal reflux disease, esophageal cancer, and antibiotic resistance.
Cytomegalovirus reactivation was common in immunocompetent ICU patients and
was associated with prolonged hospitalization or death.
By Richard T. Ellison III, MD
August 6, 2008
Covering: Limaye AP et al. JAMA 2008 Jul 23/30; 300:413
http://infectious-diseases.jwatch.org/cgi/content/full/2008/806/5?q=etoc_jwhospmed
Candida infective endocarditis was associated with high morbidity and
mortality; outcomes were better with combination or sequential antifungal
therapy.
By Thomas Gluck, MD
August 6, 2008
Covering: Baddley JW et al. Eur J Clin Microbiol Infect Dis 2008 Jul 27:519
http://infectious-diseases.jwatch.org/cgi/content/full/2008/806/4?q=etoc_jwhospmed
Declarative Memory Consolidation in Sleep
A task must be learned well for subsequent sleep to enhance recall.
By Diler Acar, MD
August 5, 2008
Covering: Tucker MA and Fishbein W. Sleep 2008 Feb 1; 31:197
http://neurology.jwatch.org/cgi/content/full/2008/805/3?q=etoc_jwneuro
Psychic strain might cause cardiac pain!
By Aaron E. Bair, MD, MSc, FAAEM, FACEP
November 14, 2008
Covering: Walters K et al. Eur Heart J 2008 Oct 23;
http://emergency-medicine.jwatch.org/cgi/content/
full/2008/1114/3?q=etoc_jwhospmed
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Smokers were more likely to develop moderate-to-severe PMS
By Diane E. Judge, APN/CNP
December 4, 2008
Bertone-Johnson ER et al. Am J Epidemiol 2008 Oct 15; 168:938
http://womens-health.jwatch.org/cgi/content/full/2008/1204/1?q=etoc_jwwomen
Young women who are not persuaded to quit smoking by the health threats of
breast, lung, and cervical cancer or myocardial infarction might want to
consider another smoking-related consequence: premenstrual syndrome (PMS).
...
Women with incident PMS were younger (mean age, 34 vs. 35), heavier (BMI,
25 vs. 24 kg/m{super 2}), and more likely to have used oral contraceptives
(86% vs. 78%) or antidepressants (12% vs. 5%) at baseline than were
controls ..; analyses that excluded women who reported diagnoses of depression yielded similar results.
Risk rose incrementally with higher total
pack-years and longer duration of smoking prior to diagnosis (P for trend =
0.03). Analysis adjusted for pack-years showed that women who started
smoking before age 15 were nearly twice as likely to develop PMS as were
those who never smoked (RR, 1.9).
Excess risk was seen in women who started
smoking prior to developing menstrual symptoms and in those who started
smoking after symptom onset (RR, 1.7 and 1.4, respectively, compared with
never smokers), which suggested that smoking was a contributor rather than
a response to PMS. ...
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