Human Herpesvirus Type 6 Clinical Presentation

  • Author: Michelle R Salvaggio, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Dec 5, 2011
 

History

Human herpesvirus 6 (HHV-6) infection is often asymptomatic. Symptomatic manifestations occur predominately after primary infection in infants and after either primary or reactivation disease in immunocompromised adults.

  • Children: Approximately 20% of HHV-6 infections manifest as roseola, with an abrupt onset of high fever that lasts 3-5 days. This is followed by an erythematous maculopapular rash that appears when the temperature normalizes. The rash starts at the trunk and spreads centrifugally to the face and limbs. More commonly, the infection presents as an acute nonspecific febrile illness in a child younger than 2 years. HHV-6 infection may also manifest as a rash and no fever.
    • Irritability
    • Ear symptoms, otitis
    • Upper respiratory tract symptoms
    • Gastrointestinal symptoms, including liver dysfunction and hepatitis
    • Fever-induced seizures
    • Bulging fontanelles
    • Symptoms of meningoencephalitis
  • Adults
    • Fever with lymphadenopathy, a mononucleosislike disease with negative test results for acute CMV and EBV infection
    • Symptoms consistent with hepatitis
    • Symptoms consistent with encephalitis
    • Possible role for HHV-6 in MS (HHV-6 antigen has been demonstrated in the oligodendrocytes of patients with MS. In addition, HHV-6 DNA and high rates of IgM antibody to HHV-6 have been detected in patients with relapsing-remitting type MS, but not chronic progressive MS disease or controls.)
  • Immunocompromised hosts and transplant recipients (bone marrow and solid organ)
    • Fever, usually very high
    • Cytopenia, in particular leukopenia
    • Symptoms of graft versus host disease
    • Symptoms of graft rejection
    • Symptoms of interstitial pneumonitis
    • Symptoms of meningoencephalitis or myelitis[10]
    • Rash
  • HIV infection
    • Fever
    • Rash
    • Symptoms of interstitial pneumonitis
    • Symptoms of meningoencephalitis
    • Rising HIV viral load
    • Falling CD4 count
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Physical

Physical findings of HHV-6 infection are those expected with the symptoms listed above. Most cases of HHV-6 infection are asymptomatic. The following findings may suggest HHV-6 infection.

  • Infants
    • High fever
    • Erythematous macular or maculopapular rash on trunk and face and, later, lower extremities
    • Inflamed tympanic membranes
    • Signs of upper and, occasionally, lower respiratory tract involvement
    • Hepatomegaly (common GI sign)
    • CNS symptoms - May include bulging fontanelles, irritability, stupor, meningismus, and/or seizures
  • Adults
    • Fever
    • Lymphadenopathy
    • Hepatosplenomegaly
    • CNS symptoms - Meningismus and mental status changes
  • Immunocompromised individuals
    • Fever
    • Rash
    • Signs of pneumonitis
    • Hepatosplenomegaly
    • Mental status changes or meningismus
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Contributor Information and Disclosures
Author

Michelle R Salvaggio, MD  Assistant Professor, Department of Internal Medicine, Section of Infectious Diseases, University of Oklahoma College of Medicine; Medical Director of Infectious Diseases Institute, University of Oklahoma Health Sciences Center

Michelle R Salvaggio, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Merck Honoraria Speaking and teaching

Coauthor(s)

Peter S Miele  MD, Medical Officer, Division of Antiviral Products, U.S. Food and Drug Administration

Peter S Miele is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Margo A Smith, MD  Associate Program Director, Department of Medicine, Washington Hospital Center; Assistant Professor, Department of Internal Medicine, Section of Infectious Diseases, George Washington University

Margo A Smith, MD is a member of the following medical societies: American Society for Microbiology

Disclosure: Nothing to disclose.

Specialty Editor Board

Thomas J Marrie, MD  Dean of Faculty of Medicine, Dalhousie University Faculty of Medicine, Canada

Thomas J Marrie, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society for Microbiology, Canadian Infectious Disease Society, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Ronald A Greenfield, MD  Professor, Department of Internal Medicine, University of Oklahoma College of Medicine

Ronald A Greenfield, MD is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Central Society for Clinical Research, Infectious Diseases Society of America, Medical Mycology Society of the Americas, Phi Beta Kappa, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology

Disclosure: Pfizer Honoraria Speaking and teaching; Gilead Honoraria Speaking and teaching; Ortho McNeil Honoraria Speaking and teaching; Abbott Honoraria Speaking and teaching; Astellas Honoraria Speaking and teaching; Cubist Honoraria Speaking and teaching; Forest Pharmaceuticals Speaking and teaching

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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