title: Saliva polymerase chain reaction assay for detection and follow-up of herpesvirus reactivation in patients with drug reaction with eosinophilia and systemic symptoms (DRESS).
abstract: OBJECTIVE
  Reactivations of human herpesviruses (HHVs) contribute to the development of drug reaction with eosinophilia and systemic symptoms (DRESS). Diagnosis of HHV reactivation is conventionally based on quantitative real-time polymerase chain reaction (PCR) analysis of blood samples, but these viruses are present in the oropharynx and are shed in saliva.
  
  
  OBJECTIVE
  To evaluate the use of a saliva PCR assay for demonstrating HHV shedding in patients with DRESS.
  
  
  METHODS
  Shedding of HHV in saliva was prospectively studied in patients with DRESS. Reactivations of HHV, including HHV-6, HHV-7, cytomegalovirus (CMV), and Epstein-Barr virus (EBV), were studied by performing quantitative real-time PCR analysis of blood samples obtained at admission) and serial samples of saliva obtained within the first 2 weeks of DRESS; saliva samples from controls were compared.
  
  
  METHODS
  The study included 5 patients who met definite criteria for DRESS and 15 controls (5 immunosuppressed patients and 10 healthy adults).
  
  
  METHODS
  DNA viral loads of HHV, including HHV-6, HHV-7, CMV, and EBV as measured with real-time PCR in blood and saliva samples from patients with DRESS and saliva samples from immunosuppressed and healthy controls.
  
  
  RESULTS
  The PCR assay demonstrated shedding of HHV-7, EBV, HHV-6, and CMV, listed by order of magnitude. The DNA viral loads in blood and saliva samples, also measured with real-time PCR, were found to be close. In 1 patient, reactivations in saliva preceded clinical manifestations of CMV disease. Significant production of HHV-7 and EBV was demonstrated in saliva samples from the controls, but neither HHV-6 nor CMV were detected.
  
  
  CONCLUSIONS
  The saliva PCR assay is a useful tool for demonstration and follow-up of HHV reactivation. The interpretation of HHV viral loads in saliva differs according to HHV type.
authors: Department of Dermatology, Bichat-Claude Bernard Hospital, Assistance Publique des Hôpitaux de Paris, 46 rue Henri Huchard, 75018 Paris, France. vincent.descamps@bch.aphp.fr
authors: Vincent
authors: V
authors: Descamps
authors: Martine
authors: M
authors: Avenel-Audran
authors: Laurence
authors: L
authors: Valeyrie-Allanore
authors: Benoit
authors: B
authors: Bensaid
authors: Annick
authors: A
authors: Barbaud
authors: Mustafa
authors: M
authors: Al Jawhari
authors: Sylvie
authors: S
authors: Ranger-Rogez
mesh_terms: D016022:Case-Control Studies; D004279:DNA, Viral / Q000032:analysis* / Q000097:blood; D003875:Drug Eruptions / Q000150:complications*; D004802:Eosinophilia / Q000150:complications*; D005260:Female; D006564:Herpesviridae / Q000502:physiology; D006566:Herpesviridae Infections / Q000378:metabolism / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D060888:Real-Time Polymerase Chain Reaction; D012463:Saliva / Q000737:chemistry* / Q000821:virology; D019562:Viral Load; D014775:Virus Activation; D017201:Virus Shedding
chemical_list: D004279:DNA, Viral