Human Herpesvirus 6 (HHV-6) Infection Clinical Presentation

Updated: Aug 16, 2019
  • Author: John L Kiley, MD; Chief Editor: Burke A Cunha, MD  more...
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Presentation

History

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

HHV-6 is a common cause of hospital visits in infants with fever. Some estimates suggest that 20% of HHV-6 infections manifest as roseola, which is characterized by fever for 3-5 days and followed by an erythematous maculopapular rash. [8, 23] 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 alone.

Symptoms reported in children may include the following:

  • Ear symptoms, otitis
  • Upper respiratory tract symptoms
  • Gastrointestinal (GI) symptoms, including liver dysfunction and hepatitis
  • Fever-induced seizures [28]
  • Bulging fontanelles
  • Symptoms of meningoencephalitis [29]

Symptoms reported in adults may include the following:

  • Fever with lymphadenopathy, a mononucleosislike syndrome
  • Symptoms consistent with hepatitis
  • Symptoms consistent with encephalitis (delirium, confusion, amnesia, ataxia, seizure)

Symptoms reported in immunocompromised hosts and transplant recipients may include the following:

  • Fever, usually very high
  • Symptoms of graft versus host disease (GVHD)
  • Symptoms of graft rejection
  • Symptoms of interstitial pneumonitis
  • Symptoms of meningoencephalitis or myelitis [30]
Next:

Physical Examination

Physical findings of HHV-6 infection are those expected with the symptoms described (see History). Very few physical examination findings exist in children who are infected with HHV-6 until skin findings become apparent.

Findings in infants that may suggest HHV-6 infection include the following (see the images below):

  • High-grade fever (>39.5°C [103°F]), typically persisting for 3-5 days and then resolving abruptly; undifferentiated febrile illness without rash or localizing signs is possible
  • Erythematous macular or maculopapular rash on the trunk, arms, neck, and face, and later on the lower extremities; the rash commonly appears during or within a few hours after defervescence; it is nonpruritic and mildly elevated, consists of rose-pink papules, and blanches on pressure; it usually fades in 1-2 days
  • Inflamed tympanic membranes
  • Signs of upper and, occasionally, lower respiratory tract involvement
  • Hepatomegaly (a common GI sign)
  • Central nervous system (CNS) manifestations – Most children are playful despite high-grade fever; however, anorexia, irritability, and listlessness may be presenting signs; febrile seizures occur in 10%-15% of primary infections.
Nine-month-old infant boy presented with one-day h Nine-month-old infant boy presented with one-day history of high-grade fever and irritability. In the emergency department, the patient underwent septic workup, including lumbar puncture, with normal cerebrospinal fluid analysis results. He was admitted to the hospital. High-grade fever abruptly resolved on day 3 of hospitalization. Within a few hours, erythematous, pink papular (roseola) nonpruritic rash appeared, mainly on trunk.
N-month-old infant boy presented with one-day hist N-month-old infant boy presented with one-day history of high-grade fever and irritability. In the emergency department, the patient underwent septic workup, including lumbar puncture, with normal cerebrospinal fluid analysis results. He was admitted to the hospital. High-grade fever abruptly resolved on day 3 of hospitalization. Within a few hours, erythematous, pink papular (roseola) nonpruritic rash appeared, mainly on trunk. Patient was playful after supportive therapy. Antibiotics were discontinued after 2 days of negative cultures.

HHV-6 infection in adults can have a wide variety of manifestations, which may range from mild to severe. Findings in healthy adults may include the following:

  • Fever
  • Lymphadenopathy
  • Hepatosplenomegaly
  • CNS manifestations (eg, meningismus and mental status changes)

Findings in immunocompromised individuals may include the following:

  • Fever
  • Rash
  • Signs of pneumonitis
  • Mental status changes
  • Anterograde amnesia
  • Hepatosplenomegaly
  • Encephalitis
  • Meningitis
  • Seizure
  • Myelosuppression
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