title: Significance of herpesvirus 6 in BAL fluid of hematology patients with acute respiratory failure.
abstract: OBJECTIVE
  Human herpesvirus 6 (HHV6) is an emerging cause of interstitial pneumonia in immunocompromised hosts. However, the clinical significance of a positive PCR test for HHV6 in respiratory samples from patients with hematological malignancies remains unclear.
  
  
  METHODS
  We retrospectively studied the features and outcomes of 29 critically ill hematology patients with acute respiratory failure and lung pulmonary infiltrates visible on a chest radiograph, who tested positive for a qualitative PCR for HHV6 in bronchoalveolar lavage fluid.
  
  
  RESULTS
  Of the 29 patients, 18 (62%) were stem cell transplant recipients and 11 (38%) had received chemotherapy. All patients had a fever. Clinical manifestations consistent with extra-pulmonary HHV6 disease were noted in 17 (59%) patients. One or more co-pathogens were found in 25 (86%) patients. The four remaining patients diagnosed with HHV6 pneumonia and subsequently recovered with foscarnet therapy. Antiviral therapy was also given to seven patients with co-infections, of whom two ultimately died.
  
  
  CONCLUSIONS
  In most cases, HHV6 recovered from BAL fluid is a co-pathogen whose clinical relevance remains undetermined. However, in some cases, HHV6 is the only pathogen, along with disseminated systemic viral disease, and the patient is likely to benefit from foscarnet therapy.
authors.affiliation: Medical ICU, Hôpital Saint-Louis, Assistance-Publique Hôpitaux de Paris, 1 avenue Claude Vellefaux, Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Mariotte
authors.forename: D
authors.initials: D
authors.lastname: Schnell
authors.forename: C
authors.initials: C
authors.lastname: Scieux
authors.forename: F
authors.initials: F
authors.lastname: Agbalika
authors.forename: J
authors.initials: J
authors.lastname: Legoff
authors.forename: P
authors.initials: P
authors.lastname: Ribaud
authors.forename: N
authors.initials: N
authors.lastname: Boissel
authors.forename: B
authors.initials: B
authors.lastname: Schlemmer
authors.forename: E
authors.initials: E
authors.lastname: Azoulay
mesh_terms: D000328:Adult; D016026:Bone Marrow Transplantation / Q000473:pathology; D001992:Bronchoalveolar Lavage Fluid / Q000821:virology*; D001999:Bronchoscopy / Q000379:methods; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications / Q000821:virology; D006405:Hematology; D015654:Herpesvirus 6, Human / Q000254:growth & development / Q000302:isolation & purification* / Q000472:pathogenicity*; D006801:Humans; D016867:Immunocompromised Host; D007362:Intensive Care Units; D007963:Leukocytes, Mononuclear / Q000821:virology; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000821:virology; D016133:Polymerase Chain Reaction; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000821:virology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult