Dados do Trabalho
IS HUMAN HERPESVIRUSES 6/7 DETECTION ALWAYS PATHOLOGICAL?
Apresentação do caso
Case A: 14-year-old female, history of headache, fever, and respiratory symptoms. COVID-19 positive through antigen-based testing. Symptoms persisted for 1 week, when the patient presented with intense headache, vomiting, and drowsiness. Upon evaluation in the emergency room, neck stiffness was noted, and ceftriaxone was initiated. Cerebrospinal fluid (CSF) showed a cell count of 1275/mm³ with predominance of neutrophils, glucose of 30 mg/dL, and protein level of 101 mg/dL. Peripheral blood culture was positive for Streptococcus constellatus. The patient developed subdural empyema and the culture of its drainage confirmed the same pathogen. Viral panel examination revealed a positive PCR result for Human herpesviruses 6/7 (HHV-6/7).
Case B: 8-year-old male, history of irritability associated with ptosis of the right eyelid and altered extrinsic and intrinsic ocular motility of the same eye at around 1 year of age. Brain MRI showed hyperintense right III cranial nerve, and CSF analysis showed no cytological or biochemical changes. Pulse therapy for 5 days was performed, resulting in complete resolution. Subsequently, the CSF PCR test revealed a positive result for HHV-6/7. In the follow-up, the patient was diagnosed with recurrent painful ophthalmoplegic neuropathy, later characterized as associated with episodes of headache. At 5 years old, a repeat CSF examination showed a positive PCR result for HHV-6/7.
Case C: 14-year-old male presented with bilateral visual impairment associated with bilateral ocular pain, worse on the right side, without signs of ocular redness. After 4 days, bilateral amaurosis developed. Investigation with CT angiography of the skull and brain MRI showed no abnormalities. CSF analysis showed no cytological or biochemical changes but a positive PCR result for HHV-6/7.
We present here three cases in which the clinical relevance of HHV-6/7 detection in the CSF is questioned. There is a significant genetic similarity between these two viruses. Both have the ability to cause latency, asymptomatic reactivation, and, in the case of HHV-6, it can be integrated into chromosomal DNA. Therefore, results should be analyzed with caution to not misinterpret a positive HHV-6/7 test.
CSF detection of HHV6/7 is not always pathognomonic of an infection to be treated.
Referências (se houver)
Bharucha T, Houlihan CF, Breuer J. Herpesvirus Infections of the Central Nervous System. Semin Neurol. 2019 Jun;39(3):369-382. doi: 10.1055/s-0039-1687837. Epub 2019 Aug 2. PMID: 31378872.
Clark DA. Clinical and laboratory features of human herpesvirus 6 chromosomal integration. Clin Microbiol Infect. 2016 Apr;22(4):333-339. doi: 10.1016/j.cmi.2015.12.022. Epub 2016 Jan 21. PMID: 26802216.
Pandey U, Greninger AL, Levin GR, Jerome KR, Anand VC, Dien Bard J. Pathogen or Bystander: Clinical Significance of Detecting Human Herpesvirus 6 in Pediatric Cerebrospinal Fluid. J Clin Microbiol. 2020 Apr 23;58(5):e00313-20. doi: 10.1128/JCM.00313-20. PMID: 32102858; PMCID: PMC7180253.
Kharbat AF, Lakshmi-Narasimhan M, Bhaskaran S, Parat S. Incidental Detection of Human Herpesvirus-6 in Cerebrospinal Fluid Analysis: To Treat or Not to Treat? Cureus. 2022 Jun 3;14(6):e25629. doi: 10.7759/cureus.25629. PMID: 35785001; PMCID: PMC9249039.
human herpesvirus-6 (hhv-6), human herpesvirus-7 (hhv-7), pediatric
Fonte de Fomento (se houver)
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HCFMUSP - São Paulo - Brasil
Daniel Shoji Hayashi, Ana Beatriz Arruda Carvalho de Oliveira, Cristiani Rocha Lima Cruz, Mariana Piva da Costa, Murillo Bruno Braz Barbosa, Leandro Alves Mendes, Larissa Baccoli de Souza, Renata Silva de Mendoça, Letícia Pereira de Brito Sampaio