Human herpesvirus 6 associated post-transplant acute limbic encephalitis: Clinical observations of biomarkers for risk of seizure in a pediatric population

2018 ◽  
Vol 21 (1) ◽  
pp. e13003 ◽  
Author(s):  
Jonathan D. Santoro ◽  
Christopher C. Hemond
Keyword(s):  
Limbic Encephalitis ◽  
Pediatric Population ◽  
Human Herpesvirus ◽  
Human Herpesvirus 6 ◽  
Post Transplant ◽  
Clinical Observations ◽  
Herpesvirus 6

scholarly journals Post-allogeneic hematopoietic stem cell transplantation viral reactivations and viremias: a focused review on human herpesvirus-6, BK virus and adenovirus

2021 ◽  
Vol 8 ◽  
pp. 204993612110180
Author(s):  
Xin Wang ◽  
Shyam A. Patel ◽  
Michael Haddadin ◽  
Jan Cerny
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Human Herpesvirus ◽  
Bk Virus ◽  
Human Herpesvirus 6 ◽  
Hematopoietic Stem ◽  
Post Transplant ◽  
Increased Risk ◽  
Herpesvirus 6

Human cytomegalovirus and Epstein–Barr virus have been recognized as potential drivers of morbidity and mortality of patients undergoing allogeneic stem cell transplantation for years. Specific protocols for monitoring, prophylaxis and pre-emptive therapy are in place in many transplant settings. In this review, we focus on the next three most frequent viruses, human herpesvirus-6, BK virus and adenovirus, causing reactivation and/or viremia after allogeneic transplant, which are increasingly detected in patients in the post-transplant period owing to emerging techniques of molecular biology, recipients’ characteristics, treatment modalities used for conditioning and factors related donors or stem cell source. Given the less frequent detection of an illness related to these viruses, there are often no specific protocols in place for the management of affected patients. While some patients develop significant morbidity (generally older), others may not need therapy at all (generally younger or children). Furthermore, some of the antiviral therapies used are potentially toxic. With the addition of increased risk of secondary infections, risk of graft failure or increased risk of graft- versus-host disease as well as the relationship with other post-transplant complications, the outcomes of patients with these viremias remain unsatisfactory and even long-term survivors experience increased morbidity.

Human herpesvirus 6 limbic encephalitis after stem cell transplantation

2001 ◽  
Vol 50 (5) ◽  
pp. 612-619 ◽  
Author(s):  
Mark S. Wainwright ◽  
Paul L. Martin ◽  
Richard P. Morse ◽  
Mary Lacaze ◽  
James M. Provenzale ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Limbic Encephalitis ◽  
Human Herpesvirus ◽  
Human Herpesvirus 6 ◽  
Herpesvirus 6

scholarly journals 51. A Review of Human Herpesvirus 6 and Central Nervous System Disease in Oncology Patients

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S155-S156
Author(s):  
Guy H Handley ◽  
Rodrigo Hasbun ◽  
Pablo C Okhuysen
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
T Cell ◽  
Cell Therapy ◽  
Human Herpesvirus ◽  
Human Herpesvirus 6 ◽  
T Cell Therapy ◽  
Cns Disease ◽  
Post Transplant ◽  
Herpesvirus 6

Abstract Background Human herpesvirus 6 (HHV-6) infects most of the human population. With immunosuppression it can reactivate and cause clinical syndromes of central nervous system (CNS) dysfunction. Much of the literature describes cases after hematopoietic stem cell transplantation (HSCT), ranging from encephalitis to a defined post-transplant acute limbic encephalitis syndrome (PALE). Outside of HSCT, studies of HHV-6 encephalitis in cancer patients are limited to case reports. Methods In this retrospective review, we present data from all patients admitted to MD Anderson Cancer Center between March 2016 and December 2018 that met established definitions for encephalitis, aseptic meningitis or HHV-6 PALE with detectable HHV-6 DNA in the cerebrospinal fluid (CSF) detected using either the Viracor or Biofire® Meningitis Encephalitis (ME) Panel testing platforms and no other identified etiology. We extracted demographic features, known risk factors, imaging findings, CSF analysis, treatments and patient outcomes from medical records. Results 725 patients underwent HHV-6 testing during the study timeframe, with 19 (2.6%) cases of HHV-6 mediated CNS disease identified. Most patients, 13/19 (68%), had undergone HSCT. Median time to presentation was 31 days post-transplant. Survival at 240 days after transplant was 62% often with long-term neurologic sequelae. CSF tended to have lymphocyte predominance and nearly all patients had peripheral lymphopenia. Other at risk populations identified included 2/19 (11%) patients who received chimeric antigen receptor (CAR) T-cell therapy, 2/19 (11%) who received biologic immunotherapy, and 2/19 (11%) who had non-HSCT hematologic malignancy. Notable discordance among testing platforms was found in 5/9 (55%) of patients receiving both testing platforms. CSF and Laboratory Analytes Findings and Outcomes in HSCT Patients Findings and Outcomes in Non-HSCT Patients Conclusion In addition to HSCT patients, HHV-6 reactivation leading to CNS disease also occurs in settings such as following adoptive T cell therapy or biologic immunotherapy. Significant diagnostic discordance exists between testing platforms. Disclosures Rodrigo Hasbun, MD, MPH, Biofire (Consultant)

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