Primary human herpesvirus 8 infection in immunocompetent children.
BACKGROUND
Human herpesvirus 8 (HHV-8) infection causes Kaposi sarcoma and lymphoproliferative disorders in immunosuppressed adults. Its manifestations in immunocompetent hosts are unknown.


OBJECTIVE
To determine whether HHV-8 primary infection is symptomatic in immunocompetent children and to identify the epidemiological and virological correlates of HHV-8 infection.


METHODS
Prospective cohort study conducted in the pediatric emergency department of a hospital in Alexandria, Egypt, between December 1, 1999, and April 30, 2000.


METHODS
Eighty-six children aged 1 to 4 years who were evaluated for a febrile syndrome of undetermined origin.


METHODS
Serological assay and polymerase chain reaction of blood and saliva samples for HHV-8. Information on potential risk factors for HHV-8 infection was also collected.


RESULTS
Thirty-six children (41.9%) were seropositive; HHV-8 DNA sequences were detected in 14 (38.9%) of these 36 children (detected in saliva in 11 of 14). Significant associations were found between HHV-8 infection and close contact with at least 2 other children in the community (36 of 63 vs 6 of 23 for <2 children; adjusted odds ratio [OR], 3.50; 95% confidence interval [CI], 1.11-12.22) and admission to the emergency department in December or January (28 of 47 vs 14 of 39 for February-April; adjusted OR, 3.15; 95% CI, 1.23-8.58). Six children had suspected primary HHV-8 infection; all but 1 had a febrile cutaneous craniocaudal maculopapular rash, which was more common among these children (5 of 6 vs 10 of 75; P<.001). For 3 of these 6 children, a second blood sample was obtained after the convalescence phase, and all 3 seroconverted for HHV-8.


CONCLUSIONS
Primary infection with HHV-8 may be associated with a febrile maculopapular skin rash among immunocompetent children. The finding of HHV-8 DNA sequences in saliva supports the hypothesis that transmission through saliva is the main mode of transmission in the pediatric age group.
Andreoni
Massimo
M
Department of Public Health and Cellular Biology, University Tor Vergata, Via Montpellier 1, 00133 Rome, Italy. andreoni@uniroma2.it
Sarmati
Loredana
L
Nicastri
Emanuele
E
El Sawaf
Gamal
G
El Zalabani
Mahmoud
M
Uccella
Ilaria
I
Bugarini
Roberto
R
Parisi
Saverio G
SG
Rezza
Giovanni
G
D000914:Antibodies, Viral; D002675:Child, Preschool; D015331:Cohort Studies; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005335:Fever of Unknown Origin / Q000150:complications / Q000209:etiology; D005455:Fluorescent Antibody Technique; D006566:Herpesviridae Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology; D019288:Herpesvirus 8, Human / Q000302:isolation & purification*; D006801:Humans; D007121:Immunocompetence; D007223:Infant; D008297:Male; D016133:Polymerase Chain Reaction; D012307:Risk Factors; D012463:Saliva / Q000821:virology; D012872:Skin Diseases, Vesiculobullous / Q000150:complications
D000914:Antibodies, Viral; D004279:DNA, Viral