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Human herpesvirus 6-induced inflammatory cardiomyopathy in immunocompetent children


1 HHV-6 Foundation, Santa Barbara, CA, USA
2 Department of Pathology & Laboratory Medicine, The University of Texas-Houston Medical School, Houston, TX, USA
3 Departement of Pediatrics, UTSW Medical Center, Dallas, TX, USA

Correspondence Address:
Bibhuti B Das
Department of Pediatrics, UTSW Medical Center, 1935 Medical District Dr, Dallas, TX 75235
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/apc.APC_54_17

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Year : 2017  |  Volume : 10  |  Issue : 3  |  Page : 259-268

 

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Over the last decade, human herpesvirus 6 (HHV-6) has been implicated in the etiology of pediatric myocarditis and subsequent dilated cardiomyopathy (DCM). This review provides an overview of recent literature investigating the pathophysiological relevance of HHV-6 in inflammatory cardiomyopathy. We examined 11 cases of previously published pediatric myocarditis and/or DCM associated with HHV-6 and also our experience of detection of virus particles in vascular endothelium of HHV-6 positive endomyocardial biopsy tissue by electron microscopy. The exact role of the presence of HHV-6 and its load remains controversial as the virus is also found in the heart of healthy controls. Therefore, the question remains open whether and how cardiac HHV-6 may be of pathogenetic importance. Quantitative polymerase chain reaction or mRNA testing allows differentiation between low-level latent virus found in asymptomatic myocardium and active HHV-6 infection. Although only a small number of pediatric cases have been reported in literature, HHV-6 should be considered as a causative agent of inflammatory cardiomyopathy, especially in children under three who might be experiencing a primary infection. Future studies are needed to establish a threshold for determining active infection in biopsy samples and the role of coinfections other cardiotropic viruses.






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1 HHV-6 Foundation, Santa Barbara, CA, USA
2 Department of Pathology & Laboratory Medicine, The University of Texas-Houston Medical School, Houston, TX, USA
3 Departement of Pediatrics, UTSW Medical Center, Dallas, TX, USA

Correspondence Address:
Bibhuti B Das
Department of Pediatrics, UTSW Medical Center, 1935 Medical District Dr, Dallas, TX 75235
USA
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/apc.APC_54_17

Rights and Permissions

Over the last decade, human herpesvirus 6 (HHV-6) has been implicated in the etiology of pediatric myocarditis and subsequent dilated cardiomyopathy (DCM). This review provides an overview of recent literature investigating the pathophysiological relevance of HHV-6 in inflammatory cardiomyopathy. We examined 11 cases of previously published pediatric myocarditis and/or DCM associated with HHV-6 and also our experience of detection of virus particles in vascular endothelium of HHV-6 positive endomyocardial biopsy tissue by electron microscopy. The exact role of the presence of HHV-6 and its load remains controversial as the virus is also found in the heart of healthy controls. Therefore, the question remains open whether and how cardiac HHV-6 may be of pathogenetic importance. Quantitative polymerase chain reaction or mRNA testing allows differentiation between low-level latent virus found in asymptomatic myocardium and active HHV-6 infection. Although only a small number of pediatric cases have been reported in literature, HHV-6 should be considered as a causative agent of inflammatory cardiomyopathy, especially in children under three who might be experiencing a primary infection. Future studies are needed to establish a threshold for determining active infection in biopsy samples and the role of coinfections other cardiotropic viruses.






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