Merve İŞERİ NEPESOV, Murat YAGCİ, Ömer KILIÇ, Ener Çağrı DİNLEYİCİ

A Case of Meningitis İ nvolving Both Enterovirus and Human Herpes Virus 6; Which is the Real Causative Agent?

Being mostly a self-limiting central nervous system infection, viral meningitis can now be diagnosed more easily with the increasing use of polymerase chain reaction method in routine clinical practice. Viruses are being reported in the etiology of meningitis at increasingly higher rates, non-polio enteroviruses being the most common causative agent of viral meningitis. The ability of human herpes virus 6, which is known to be another causative agent for meningitis/encephalitis, to integrate into the chromosomal structure and lead to a genetic transition makes it debatable whether it is a real cause of central nervous system infections. This article discusses, also referring to the literature, a case of viral meningitis associated with enterovirus and human herpes virus-6 detected in a 42-day old patient who had fever and poor feeding.

Enteroviru s ve Human Herpes Viru s 6’nın Birlikte Saptandıg ı Menenjit Olgusu; Hangisi Gerçek Etken?

Viral menenjitler çoğunlukla kendi kendini sınırlayan merkezi sinir sistemi enfeksiyonları olup polimeraz zincir reaksiyonu (PZR) yönteminin rutin klinik uygulamada giderek artan oranda kullanılmaya başlanmasıyla tanı şansı artmıştır. Virüsler, menenjit etiyolojisinde giderek artan oranda bildirilmekte, non polio enterovirüsler en sık viral menenjit etkeni olarak tanımlanmaktadır. Bir diğer menenjit/ensefalit etkeni olarak bilinen HHV-6’ın (human herpes virüs 6) ise kromozom yapısına entegre olup genetik geçişe yol açabilmesi gerçek merkezi sinir sistemi enfeksiyonu etkeni olup olmamasını tartışmalı hale getirmiştir. Aşağıda ateş ve beslenememe yakınmaları ile getirilen 42 günlük hastada Enterovirüs ve Human Herpesvirüs-6 (HHV-6) ilişkili viral menenjit literatür verileri ışığında tartışılmıştır.

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1. McGill F, Griffiths MJ, Solomon T. Viral meningitis: current issues in diagnosis and treatment. Curr Opin Infect Dis 2017;30:248-56.

2. Rudolph H, Schroten H, Tenenbaum T. Enterovirus infections of the central nervous system in children: an update. Pediatr Infect Dis J 2016;35:567-9.

3. Messacar K, Breazeale G, Wei Q, Robinson CC, Dominguez SR, et al. Epidemiology and clinical characteristics of infants with human parechovirus or human herpes virus-6 detected in cerebrospinal fluid tested for enterovirus or herpes simplex virus. J Med Virol 2015;87:829-35.

4. Zhang E, Bell AJ, Wilkie GS, Suárez NM, Batini C, Veal CD, et al. Inherited chromosomally integrated human herpesvirus 6 genomes are ancient, intact, and potentially able to reactivate from telomeres. J Virol 2017;91:e01137-17.

5. Baraff LJ. Management of infants and young children with fever without source. Pediatr Ann 2008;37:673-9.

6. Eichinger A, Hagen A, Meyer-Bühn M, Huebner J, et al. Clinical benefits of introducing real-time multiplex PCR for cerebrospinal fluid as routine diagnostic at a tertiary care pediatric center. Infection 2019;47:51-8.

7. Kadambari S, Okike I, Ribeiro S, Ramsay ME, Heath PT, Sharland M, et al. Seven-fold increase in viral meningo-encephalitis reports in England and Wales during 2004-2013. J Infect 2014;69:326-32.

8. Basmaci R, Mariani P, Delacroix G, Azib S, Faye A, Taha MK, et al. Enteroviral meningitis does not exclude concurrent bacterial meningitis. J Clin Microbiol 2011;49:3442-3.

9. Whitley RJ, Lakeman FD. Human herpesvirus 6 infection of the central nervous system: is it just a case of mistaken association? Clin Infect Dis 2005;40:894-5.