Dr. Derek Enlander on HHV-6 and Chronic Fatigue
February 21, 2002
CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 69
NUMBER 1 JANUARY 2002
Human herpesvirus 6
TO THE EDITOR: The article by Drs. Chemaly and
Rehm on human herpesvirus 6 (HHV-6)
infection 1 was very interesting but left out
one particular associated symptom of this
insidious virus. This symptom is chronic
fatigue, which is markedly debilitating.
When HHV-6 was first defined by
Salahuddin et al in 1986, 2 the virus was
ubiquitous and the symptoms of the disease it
causes were nebulous. Although little knowledge
about HHV-6 has been added over the
years, it seems that more than 90% of the
population is exposed, most exposure does
not lead to prolonged disease, and its common
manifestations are low-grade infection,
usually mild, accompanied by lymphadenopathy,
debilitating fatigue, and retro-orbital
headache. In some patients the malaise can
be prolonged and can be the initial manifestation
of chronic fatigue syndrome, the exact
cause of which is still unknown.
It is possible that the HHV-6 virus, like
its fellow herpesviruses, lurks in tissues or
that in sensitized patients it produces elevated
cytokines or other immune system effects
that can manifest in prolonged symptoms.
DEREK ENLANDER, MD, MRCS, LRCP
1. Chemaly RF, Rehm SJ. A young woman with fever,
headache, and lymphadenopathy. Cleve Clin J
Med 2001; 68:584593.
2. Salahuddin SZ, Ablashi DV, Markham PD, et al. Isolation
of a new virus, HBLV, in patients with lymphopro-liferative
disorders. Science 1986; 234:596601.
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