Polymerase chain reaction diagnosis of primary human herpesvirus-6 infection in the acute care setting.
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.


METHODS
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.
Zerr
Danielle M
DM
Department of Pediatrics, University of Washington, Children's Hospital and Regional Medical Center, Seattle, WA 98105, USA. zerr@u.washington.edu
Frenkel
Lisa M
LM
Huang
Meei-Li
ML
Rhoads
Margaret
M
Nguy
Long
L
Del Beccaro
Mark A
MA
Corey
Lawrence
L
D001424:Bacterial Infections / Q000209:etiology; D003422:Critical Care; D004279:DNA, Viral / Q000032:analysis / Q000097:blood; D005260:Female; D015654:Herpesvirus 6, Human / Q000235:genetics; D006801:Humans; D007223:Infant; D008297:Male; D016133:Polymerase Chain Reaction; D019349:Roseolovirus Infections / Q000175:diagnosis* / Q000821:virology*; D012463:Saliva / Q000737:chemistry; D014766:Viremia / Q000209:etiology
D004279:DNA, Viral