Table 3:
Clinical features of patients with HHV-6 DNA detected in CSF
| Case | Age/Sex | iciH HV-6 D/R status (species) | Symptom(s) prompting HHV-6 testing | Number of LPs | Number of HHV-6 plasma tests | Engraftment Day | Peak plasma HHV-6, copies/mL (day) | Peak CSFHHV-6, copies/mL (day) | Additional explanation for symptoms | Clinical course and comments |
|---|---|---|---|---|---|---|---|---|---|---|
| Donor negative, recipient positive (D+/R−) iciHHV-6pos patients | ||||||||||
| 1 | 52 M | D−/R+ (A) | Confusion, hallucinations | 3 | 0 | +17 | N/A | 2,500 (+12) | Steroid-induced psychosis; possible encephalitis on autopsy | Foscarnet x 2 weeks, stopped due to acute renal failure |
| 2 | 49 F | D−/R+ (A) | Encephalopathy | 1 | 1 | +26 | 670 (+38) | 190 (+40) | Hyperamm onemia, sepsis due to E. faecium and E. cloacae bacteremia | Ganciclovir x 2 weeks, up to day of death from septic shock and multiorgan failure in the context of recurrent E. cloacae bacteremia |
| 3 | 23 F | D−/R+ (B) | Hallucinations | 1 | 8 | +27 | 2,100 (+18) | 28 (+21) | ICU delirium, self-resolved without intervention | LP performed in response to positive plasma PCR despite resolution of symptoms prior to LP. No treatment as HHV-6 was not felt to be clinically significant. Serial plasma HHV-6 monitoring performed |
| Donor positive, recipient negative (D−/R+) iciHHV-6pos patients | ||||||||||
| 4 | 61 M | D+/R− (A) | Agitation, confusion, seizures | 2 | 8 | +28 | 7,500 (+65) | 1,600 (+98) | Calcineurin inhibitory toxicity | IV ganciclovir x 2 weeks. LP performed in response to positive plasma PCR despite resolution of symptoms prior to LP. Treatment stopped due to unchanged viral load and resolution of symptoms |
| 5 | 20 M | D+/R− (A) | Headache | 2 | 3 | +28 | 20,000 (+78) | 8,000 (+77) | Intrathecal methotrexate | IV ganciclovir x 2 weeks, stopped due to resolution of headaches |
| 6 | 51 M | D+/R− (B) | Irritability, psychosis, argumentativeness | 1 | 1 | +27 | 11,000 (+91) | 760 (+94) | Steroid-induced psychosis | Course of ganciclovir for CMV enteritis was extended by 6 days due to HHV-6 findings |
| 7 | 6 F | D+/R− (B) | Fever | 2 | 12 | +29 | 130,000 (+72) | 15,000 (+70) | Coagulase-negative staphylococcus bacteremia | IV ganciclovir x 2 weeks; stopped due to continued fevers and unchanged HHV-6 DNA level |
| iciHHv-6neg patient | ||||||||||
| 8 | 52 F | iciH HV-6 negative | Headache, hallucinations, encephalopathy | 1 | 3 | +19 | 36,000 (+27) | 300,000 (+26) | None | Ganciclovir x 5 weeks, stopped after resolution of symptoms and CSF viral clearance |
Abbreviations: donor (D), female (F), cerebrospinal fluid (CSF), inherited chromosomally integrated human herpes virus 6 (iciHHV-6), intensive care unit (ICU), intravenous (IV), lumbar puncture (LP), male (M), recipient (R)