Selective Reactivation of Human Herpesvirus 6 Variant A Occurs in Critically Ill Immunocompetent Hosts

Raymund R. Razonable,(1) Cara Fanning,(1) Robert A. Brown,(1) Mark J. Espy,(2) Antonio Rivero,(1) Jennie Wilson,(1) Walter Kremers,(3) Thomas F. Smith,(2) and Carlos V. Paya1

(1)Division of Infectious Diseases and Internal Medicine, (2)Department of Pathology and Laboratory Medicine, and (3)Section of Biostatistics, Mayo Clinic and Foundation, Rochester, Minnesota

Reactivation of human-herpesviruses (cytomegalovirus [CMV], human herpesvirus [HHV]6, and HHV-7) in nonimmunocompromised hosts is rare. Because these viruses are susceptible to reactivation by cytokines and stress-related mechanisms, the incidence of their reactivation was investigated among 120 patients during stress related to critical illness and compared with findings among 50 healthy volunteers. Human -herpesvirus DNA was found in 65% of critically ill patients (60% men; mean age, 63 years) who required admission to an intensive care unit for medical (40%) or surgical (53%) indications or trauma (7%). HHV-6 reactivation was higher in critically ill patients than in healthy volunteers (54/101 vs. 0/50; P=.001).

All patients except 1 were confirmed as HHV-6 variant A (mean virus load, 5066 copies/106 peripheral blood leukocytes). The reactivation of HHV-6A did not affect disease severity and outcome. No significant reactivation of HHV-7 or CMV was demonstrated among the critically ill patients. These findings contribute to the less-defined epidemiology of HHV-6A infection.

Received 25 June 2001; revised 10 September 2001; electronically published 14 December 2001.

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