Polymerase chain reaction diagnosis of primary human herpesvirus-6 infection in the acute care setting
Received 7 November 2005; received in revised form 15 March 2006; accepted 17 May 2006.
Objective
To evaluate the potential utility of identifying primary human herpesvirus (HHV)-6 infection in an emergency department setting by determining the frequency of HHV-6 viremia, diagnostic testing, and empiric treatment of serious bacterial infection (SBI) in HHV-6 viremic children, and concurrent SBI and HHV-6 viremia.
Study design
Children under age 2 years and who had a blood specimen taken for evaluation of fever were tested for HHV-6 by polymerase chain reaction (PCR). HHV-6 viremia was defined as detection of HHV-6 DNA in acute plasma.
Results
A total of 32 of the 181 subjects (18%) had HHV-6 viremia. Children with HHV-6 viremia frequently underwent procedures for diagnosis and empiric treatment of SBI: 60% had bladder catheterizations, 6% had lumbar punctures, 47% had radiographs, 32% received empiric antibiotics, and 34% were hospitalized. Four of the 32 children with HHV-6 viremia (12.5%) were diagnosed with SBI, although none had a positive culture of blood or cerebrospinal fluid.
Conclusions
Rapid diagnosis of HHV-6 viremia may not serve to adequately differentiate infants with and without SBI in acute care settings. Although no children with HHV-6 viremia had bacteremia or meningitis, it appears that additional criteria are needed to increase the specificity of HHV-6 PCR testing before withholding evaluation for SBI.
Departments of Pediatrics and Laboratory Medicine, University of Washington, Children’s Hospital and Regional Medical Center, and Fred Hutchinson Cancer Research Center, Seattle, WA.
Reprint requests: Dr. Danielle M. Zerr, Children’s Hospital, W-8851, 4800 Sand Point Way NE, Seattle, WA 98105.
This clinical research was conducted in accordance with guidelines for human experimentation as specified by the Children’s Hospital Institutional Review Board.
None of the authors has any potential conflict of interest, real or perceived.
Supported by in part by National Institutes of Health grant K23 AI001679 and by a grant from Children’s Hospital Fund for Excellence.
ABSTRACT