herpesvirus 6-iT infeqciis roli egzanTemiT mimdinare

daavadebis ganviTarebaSi bavSvTa asakSi

 

g.kamkamiZe, m.buwaSvili, n.gamyreliZe, q.barabaZe, T.WuraZe

 

1. ivane javaxiSvilis sax. Tbilisis saxelmwifo universitetis medicinis fakultetis pediatriis kaTedra

2.Tssu pediatriuli klinika

3. infeqciuri paTologiis, Sidsis da klinikuri imunologiis centri

4. pediatriis samecniero-kvleviTi instituti

 

 

Sesavali

adamianis herpesvirus 6 aRmoaCines salahudinma da misma kolegebma 1986 wels [1]. igi miekuTvneba beta-herpesvirusebs da warmoadgens dnm-is Semcvel viruss. molekuluri struqturiT igi enaTesaveba adamianis citomegalovirussa da herpesvirus 7-s [2]. herpesvirus 6-iT infeqcia upiratesad gvxvdeba 6-dan 24 Tvis asakis bavSvebSi [3]. pirveladi infeqcia ZiriTadad rozeoluri gamonayris saxiT mimdinareobs (e.w. meeqvse daavadeba any egzanTema subitum) [4]. mozrdil asakSi aRniSnuli infeqcia, rogorc wesi, gvxvdeba daTrgunuli imunuri sistemis mqone (imunokomprometirebul) pacientebSi, magaliTad organogadanergil [5] an adamianis imunodeficitis virusiT inficirebul pirebSi [6]. herpesvirus 6-s aqvs unari, urTierTqmedeba moaxdinos citomegalovirusTan da adamianis imunodeficitis virusTan da gamoiwvios imunosupresia da apoptozi [7]. ukanasknel xans mas miaweren gafantuli sklerozis paTogenezSi monawileobis funqcias [8]. garda zemoaRniSnulisa, herpesvirus 6 xSirad aris asocirebuli maRali temperaturis fonze ganviTarebul krunCxvebTan (febriluri gulyrebi) bavSvTa asakSi [9].

wiTelas, wiTurasa da egzanTema subitums Soris diferencialuri diagnostika emyareba im faqts, rom TviTeuli am daavadebis klasikuri klinikuri mimdinareoba erTmaneTisagan sakmaod gansxvavebulia; Tumca es daavadebebi xSirad atipurad mimdinareobs, ramac SesaZloa gamoiwvios araswori diagnozis dasma mxolod klinikur suraTze dayrdnobiT [10].  

 

Cveni Sromis mizans Seadgenda herpesvirus-6-iT infeqciis rolis garkveva egzanTemiT mimdinare daavadebis ganviTarebaSi.

 

 

masala da meTodebi

 

gamovikvlieT 6 Tvidan 5 wlamde asakis 32 bavSvi (sakvlevi jgufi), romelTac Tavdapirvelad, mxolod klinikuri Sefasebis safuZvelze, daesvaT  wiTuras an wiTelas diagnozi, magram laboratoriulad (specifikuri antisxeulebis gamokvleviT) es diagnozebi ar daudasturaT. garda amisa,  kvlevaSi CarTvis kriteriumebi moicavda Semdegs: 3 dReze meti xangrZlivobis generalizebuli egzanTema; temperaturis momateba 38 oC-ze metad; xvela, surdo an koniunqtiviti. vawarmoebdiT -20 oC-ze Senaxuli Sratis gamoyinvas da mis gamokvlevas imunofermentuli analizis gziT herpesvirus-6-is sawinaaRmdgo IgG da IgM tipis antisxeulebze. orive tipis antisxeulebze uaryofiTi Sedegis miRebis SemTxvevaSi damatebiT viRebdiT venur sisxls virusis dnm-is aRmosaCenad polimerizaciis jaWvuri reaqciis gamoyenebiT. analogiuri gamokvlevebi utardebodaT igive asakobrivi jgufis 10 bavSvs, romelTac ar aReniSnebodaT raime saxis gamonayari.  

 

 

miRebuli Sedegebi da maTi analizi

 

herpesvirus 6-iT pirveladi infeqciis markeris - virus-specifikuri IgM arseboba dafiqsirda sakvlevi jgufis 9 bavSvis SratSi (28,1%), 2 bavSvs aReniSneboda herpesvirus 6-is dnm-is arseboba uaryofiTi virus-specifikuri IgG-is fonze, rac aseve miuTiTebda pirveladi herpesvirus-6-iT infeqciis mimdinareobaze. amgvarad, jamSi, sakvlevi jgufis 32 bavSvidan 11-s (34.4%) daudasturda herpesvirus-6-iT pirveladi infeqciis arseboba.

      sakvlev jgufis bavSvebidan 18 (56,3%) dadebiTi iyo mxolod virus-specifikur IgG tipis antisxeulebze, rac gadatanil herpesvirus-6 infeqciaze miuTiTebda.

      sakvlevi jgufis 3 bavSvi (9,4%) uaryofoTi iyo herpesvirus-6 infeqciis yvela markerze.

      sakontrolo jgufSi mwvave infeqciis arcerTi SemTxveva ar aRiniSna. laboratoriuli markerebis mixedviT 8 bavSvs 10-dan (80%) ukve gadatanili hqonda es infeqcia.

      Catarebulma gamokvlevebma aCvena, rom bavSvTa asakSi egzanTemiT mimdinare daavadebaTa mniSvnelovani procenti herpesvirus-6-iT infeqciiTaa ganpirobebuli. am infeqciis gaTvaliswineba aucilebelia bavsvTa asakSi egzanTemiT mimdinare daavadebebis diferencialur diagnostikaSi.

 

 

literatura

1.      Salahuddin SZ, Ablashi DV, Markham PD, et al. Isolation of a new virus, HBLV, in patients with lymphoproliferative disorders. Science 1986; 234: 509-601.

2.      Gompels UA, Nicholas J, Lawrence G, et al. The DNA sequence of human herpesvirus 6: structure, coding content, and genome evolution. Virology 1995; 209: 29-51.

3.      Robinson WS. Human herpesvirus 6. Curr Clin Top Infect Dis 1994; 14: 159-169.

4.      Yamanishi K, Okuno T, Shiraki K, et al. Identification of human herpesvirus 6 as a causal agent for exanthem subitum. Lancet 1988; 1: 1065-1067.

5.      Singh N, Carrigan DR. Human herpesvirus-6 in transplantation: an emerging pathogen. Ann Intern Med 1996; 124: 1065-1071.

6.      Fairfax MR, Schacker T, Cone RW, ea al. Human herpesvirus 6 DNA in blood cells of human immunodeficiency virus-infected men: correlation of high levels with high CD4 counts. J Infect Dis 1994; 169: 1342-1345.

7.      Dockrell DH, Smith TF, Carlos V. Human Herpesvirus 6. Mayo Clinic Proceedings 1999; 74(2): 163-170.

8.      Soldan SS, Berti R, Salem N, et al. Association of human herpes virus 6 (HHV-6) with multiple sclerosis: increased IgM response to HHV-6 early antigen and detection of serum HHV-6 DNA. Nature Medicine 1997; 3: 1394-1397.

9.      Hall CB, Long CE, Schnabel KC, et al. Human herpesvirus-6 infection in children: a prospective study of complications and reactivation. N Engl J Med 1994; 331: 432-438.

10.  Black JB, Durigon E, Kite-Powell K, et al. Seroconversion to human herpesvirus 6 and human herpesvirus 7 among Brazilian children with clinical diagnoses of measles or rubella. Clinical Infectious Diseases 1996; 23: 1156-8.

 

 

 

Summary

Role of human herpesvirus-6 infection in children with fever and rash

 

G. Kamkamidze1,2, M. Butsashvili2, N. Gamkrelidze3, K. Barabadze3, T.Churadze3

 

1 Pediatric Clinic of the Tbilisi State Medical University

2 Infectious Diseases, AIDS and Clinical Immunology Research Center

3  Research Institute of Pediatrics

 

Human herpesvirus-6 (HHV-6) is one of the recently discovered herpesviruses. Primary HHV-6 infection is causative agent of roseola infantum, one of the diseases of childhood characterized by the development of fever and rash. The goal of our study was the evaluation of the role of primary HHV-6 infection in children with fever and rash. 32 children 6 months – 5 years of age with fever and generalized rash who have been tested to be negative on measles and rubella antibodies were enrolled in the study. Anti-HHV-6 IgM and IgG antibodies as well as HHV-6 DNA were detected in these groups by ELISA and PCR methods correspondingly. Primary HHV-6 infection has been found in 11 out of 32 patients  (34,4%) from the study group vs. none in the control group (p<0.001). Primary HHV-6 infection is associated with fever and rash in the early childhood and it has to be considered during the differential diagnosis of the diseases with rash.