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HHV-6 found to cause 35% of CNS infections in allo-HSCT transplantation

In All, CNS Disease, Transplant Complications by Kristin Loomis

A retrospective analysis out of the Tokyo Metropolitan Cancer and Infectious Diseases Center reviewed 353 consecutive adult allogeneic hematopoietic stem cell transplant (allo-HSCT) cases and identified 17 cases of CNS infection post-transplant. As determined by PCR on cerebrospinal fluid, HHV-6 was found to be the causative agent in 6 cases, or 1.7% of all transplants.

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New data on HHV-6B levels in CD134+ CD4+ cells

In All, Transplant Complications by Kristin Loomis

A group from the University of Minnesota studied the T cells of umbilical cord blood transplant patients and found that CD4+ T lymphocytes co-expressing CD134 contained more than twice the level of HHV-6B than cells without CD134 expression. Surprisingly, almost 70% of the CD134 negative cells contained HHV-6.

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Does CD134 upregulation explain why HHV-6 reactivates preferentially in DRESS/ DIHS?

In All, Drug Hypersensitivity, Latest Scientific News, Skin Conditions, Transplant Complications by Kristin Loomis

It has long been a mystery why HHV-6 is preferentially reactivated in drug reaction with eosinophilia and systemic symptoms (DRESS), also known as drug induced hypersensitivity syndrome (DIHS). HHV-6 reactivation occurs in over 60% of severe cases and is part of the definition of DIHS in Japan. Investigators in Japan suspect that the explanation may lie with the CD134 receptor on activated CD4 cells.

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Drug-induced liver injury and HHV-6 reactivation without rash or fever

In All, Liver Disease, Transplant Complications by Kristin Loomis

Another case of drug induced liver injury accompanied by HHV-6 reactivation has been reported in Japan, the second such case without exanthema to be described. An earlier case was reported last year (Fujita 2015). The authors suggest that drug-induced liver injury cases be investigated for HHV-6 reactivation when liver dysfunction begins several weeks after the initiation of a new drug typically associated with hypersensitivity syndromes.

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Virus-specific immunotherapy for transplant patients with primary immune deficiencies

In All, Immunology, Transplant Complications, Treatments - Adoptive T cell by Kristin Loomis

A group from Baylor College of Medicine reviewed the efficacy of treating viral infections in transplant patients with primary immunodeficiencies using their viral-specific T lymphocytes. A total of 36 patients were treated with these immunotherapy infusions before or after undergoing hematopoietic stem cell transplantation, and a complete or partial antiviral response were seen in 86% of patients with CMV, 76% of patients with EBV and all patients with adenovirus or HHV-6.

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Stanford uses non-invasive new assay to detect occult infections including HHV-6 after lung transplantion

In All, Heart Disease, News, Transplant Complications by Kristin Loomis

Researchers from Stanford University successfully used circulating cell-free DNA to identify infections in lung transplants that can often be found only with a more invasive transbronchial biopsy. This hypothesis free approach led to find HHV-6 & 7 at high levels in patients with infections, even though these viruses are not generally considered lung pathogens.

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HHV-6 myocarditis, pericarditis following transplantation

In All, Heart Disease, News, Transplant Complications by Kristin Loomis

A hematology group in Australia reported a case of biopsy-proven HHV-6 myocarditis post-hematopoietic stem cell transplantation (HSCT). he post-mortem exam confirmed dilated cardiomyopathy and focal changes consistent with viral myocarditis and cardiac tissue was positive for HHV-6 DNA by nested and quantitative PCR. Separately, A Japanese group reported a worman who developed pericarditis with over 10,000 copies/ml of HHV-6 DNA in the pericardial fluid, after a cord blood transplant.

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HHV-6 the only pathogen identified in early post-transplant CNS dysfunction

In All, CNS Dysfunction, News, Transplant Complications by Kristin Loomis

A group from Sapporo Medical University studied 105 post HSCT patients and determined that 7 developed CNS dysfunction in the first 42 days after transplant. Six out of the 7 were positive for HHV-6, but none of the other 12 pathogens tested. Four patients (3.8%) were diagnosed with HHV-6 encephalitis. The group used a qualitative multiplex PCR and then used a quantitative PCR to confirm the results.

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Delirium associated with HHV-6B reactivation in cord blood transplant patients: time for an antiviral prophylaxis trial?

In All, Chronic Fatigue Syndrome, Cognitive Dysfunction, Encephalitis & Encephalopathy, Showcase, Transplant Complications by Kristin Loomis

A prospective study authored by Joshua Hill and Danielle Zerr determined that higher than average HHV-6B DNA levels increased the odds of developing delirium after cord blood transplantation (CBT) by almost three fold. Patients with DNA loads in the top quartile had a 4.5 fold increase in delirium.

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HSCT patients with HHV-6 reactivation have significantly worse survival rates and higher rates of acute GVHD

In All, GVHD, Transplant Complications by Kristin Loomis

A group from Sapporo Medical University studied 105 post HSCT patients and determined that 7 developed CNS dysfunction in the first 42 days after transplant. Six out of the 7 were positive for HHV-6, but none of the other 12 pathogens tested. Four or 3.8% of the population were diagnosed with HHV-6 encephalitis.