Congenital human herpesvirus 6 infection in a full-term newborn: literature review and case report
https://doi.org/10.17749/2313-7347/ob.gyn.rep.2025.635
Abstract
Neonatal human herpesvirus type 6 (HHV-6) infection is an extremely rare disease. HHV-6 is a unique virus because it is able to integrate into human chromosomes to be further transmitted vertically from parent to offspring. In humans, HHV-6 is associated with a wide range of clinical manifestations and, in children, may present as roseola infantum, febrile seizures, aphthous stomatitis, mononucleosis-like syndrome, or fever of unknown origin. This article reports a rare case of congenital HHV-6 infection in a newborn. To date, both Russian and international publications provide very limited descriptions of such cases, which, in our opinion, reflects a significant knowledge gap among neonatologists regarding this condition. We discuss the clinical forms of HHV-6 infection in neonates, rare case presentations, and current approaches to diagnosis and treatment.
About the Authors
A. L. KarpovaRussian Federation
Anna L. Karpova, MD, PhD.
Scopus Author ID: 57197280474.
2/44 Salyama Adilya Str., Moscow 123423;
2/1 bldg. 1, Barrikadnaya Str., Moscow 123993;
5 Revolutsionnaya Str., Yaroslavl 150000
A. V. Mostovoi
Russian Federation
Aleksei V. Mostovoi, MD, PhD.
Scopus Author ID: 57201723894.
Wos ResearcherID: AAR-7908-2021.
2/44 Salyama Adilya Str., Moscow 123423;
2/1 bldg. 1, Barrikadnaya Str., Moscow 123993;
5 Revolutsionnaya Str., Yaroslavl 150000
A. A. Baranov
Russian Federation
Andrei A. Baranov, MD, Dr Sci Med, Prof.
Scopus Author ID: 7201565006.
5 Revolutsionnaya Str., Yaroslavl 150000
L. A. Anikeeva
Russian Federation
Lyubov A. Anikeeva, MD.
2/44 Salyama Adilya Str., Moscow 123423
E. V. Klubnichkina
Russian Federation
Ekaterina V. Klubnichkina, MD.
2/44 Salyama Adilya Str., Moscow 123423
A. L. Zaplatnikov
Russian Federation
Andrei L. Zaplatnikov, MD, Dr Sci Med, Prof.
2/1 bldg. 1, Barrikadnaya Str., Moscow 123993
L. N. Karpov
Russian Federation
Leonid N. Karpov, MD.
135 Rublevskoe Shosse, Moscow 121552
References
1. Melehina E.V., Muzyka A.D., Kalugina M.Yu. et al. Current concept of human herpesvirus type 6 infection. [Sovremennye predstavleniya ob infekcii, vyzvannoj virusom gerpesa cheloveka 6 tipa]. Arhiv" vnutrennej mediciny. 2016;6(1):13–9. (In Russ.). https://doi.org/10.20514/2226-6704-2016-6-1-13-19.
2. Oikawa J., Tanaka J., Yoshikawa T. et al. An immunocompetent child with chromosomally integrated human herpesvirus 6B accidentally identified during the care of Mycoplasma pneumoniae infection. J Infect Chemother. 2014;20(1):65–7. https://doi.org/10.1016/j.jiac.2013.07.004.
3. De Bolle L., Naesens L., De Clercq E. Update on human herpesvirus 6 biology, clinical features, and therapy. Clin Microbiol Rev. 2005;18(1):217–45. https://doi.org/10.1128/CMR.18.1.217-245.2005.
4. Nikolskiy M.A., Golubtsova V.S. Chromosomally integrated human herpesvirus type 6. [Hromosomno-integrirovannyj virus gerpesa cheloveka 6 tipa]. Infekciya i immunitet. 2015;5(1):7–14. (In Russ.). https://doi.org/10.15789/2220-7619-2015-1-7-14.
5. King O., Al Khalili Y. Herpes virus type 6. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2025 Jan. 2023 Aug 8.
6. Ganea O.A., Tilican C., Streinu-Cercel A. et al. Human herpesvirus 6 – a rare aetiologic agent for CNS infections in immunocompetent individuals or an underestimation? J Clin Med. 2024;13(16):4660. https://doi.org/10.3390/jcm13164660.
7. Melehina E.V., Chugunova O.L., Muzyka A.D. et al. The role of herpesvirus infections in the formation of pathology in children. Features of the course, diagnosis and treatment of infection associated with human herpes virus type 6 in children. Guidelines. [Rol' gerpesvirusnyh infekcij v formirovanii patologii u detej. Osobennosti techeniya, diagnostika i lechenie infekcii, associirovannoj s virusom gerpesa cheloveka 6 tipa u detej. Metodicheskie rekomendacii]. Moscow, 2014. 50 p. (In Russ.).
8. Henderson T.A. Valacyclovir treatment of chronic fatigue in adolescents. Adv Mind Body Med. 2014;28(1):4–14.
9. Jeulin H., Agrinier N., Guery M. et al. Human herpesvirus 6 infection after allogeneic stem cell transplantation: incidence, outcome, and factors associated with HHV-6 reactivation. Transplantation. 2013;95(10):1292–8. https://doi.org/10.1097/TP.0b013e318289958b.
10. Harberts E., Yao K., Wohler J.E. et al. Human herpesvirus-6 entry into the central nervous system through the olfactory pathway. Proc Natl Acad Sci USA. 2011;108(33):13734–9. https://doi.org/10.1073/pnas.1105143108.
11. Dunn N., Kharlamova N., Fogdell-Hahn A. The role of herpesvirus 6A and 6B in multiple sclerosis and epilepsy. Scand J Immunol. 2020;92(6):e12984. https://doi.org/10.1111/sji.12984.
12. Libbey J.E., Cusick M.F., Fujinami R.S. Role of pathogens in multiple sclerosis. Int Rev Immunol. 2014;33(4):266–83. https://doi.org/10.3109/08830185.2013.823422.
13. Collin V., Flamand L. HHV-6A/B Integration and the pathogenesis associated with the reactivation of chromosomally integrated HHV-6A/B. Viruses. 2017;9(7):160. https://doi.org/10.3390/v9070160.
14. Morse S.A., Mietzner T.A., Miller S., Riedel S. Jawetz, Melnick & Adelberg’s Medical Microbiology 28 E. McGraw-Hill Education, 2019. 880 p.
15. Ablashi D., Agut H., Alvarez-Lafuente R. et al. Classification of HHV-6A and HHV-6B as distinct viruses. Arch Virol. 2014;159(5):863–70. https://doi.org/10.1007/s00705-013-1902-5.
16. Lundström W., Gustafsson R. Human herpesvirus 6A is a risk factor for multiple sclerosis. Front Immunol. 2022;13:840753. https://doi.org/10.3389/fimmu.2022.840753.
17. Alvarez-Lafuente R., Martinez A., Garcia-Montojo M. et al. MHC2TA rs4774C and HHV-6A active replication in multiple sclerosis patients. Eur J Neurol. 2010;17(1):129–35. https://doi.org/10.1111/j.1468-1331.2009.02758.x.
18. Jasirwan C., Furusawa Y., Tang H. et al. Human herpesvirus-6A gQ1 and gQ2 are critical for human CD46 usage. Microbiol Immunol. 2014;58(1):22–30. https://doi.org/10.1111/1348-0421.12110.
19. Arbuckle J.H., Medveczky P.G. The molecular biology of human herpesvirus-6 latency and telomere integration. Microbes Infect. 2011;13(8–9):731–41. https://doi.org/10.1016/j.micinf.2011.03.006.
20. Drago F., Broccolo F., Javor S. et al. Evidence of human herpesvirus-6 and -7 reactivation in miscarrying women with pityriasis rosea. J Am Acad Dermatol. 2014;71(1):198–9. https://doi.org/10.1016/j.jaad.2014.02.023.
21. Hall C.B., Caserta M.T., Schnabel K. et al. Chromosomal integration of human herpesvirus 6 is the major mode of congenital human herpesvirus 6 infection. Pediatrics. 2008;122(3):513–20. https://doi.org/10.1542/peds.2007-2838.
22. Hill J.A., Boeckh M.J., Sedlak R.H. et al. Human herpesvirus 6 can be detected in cerebrospinal fluid without associated symptoms after allogeneic hematopoietic cell transplantation. J Clin Virol. 2014;61(2):289–92. https://doi.org/10.1016/j.jcv.2014.07.001.
23. Ogata M., Satou T., Kadota J. et al. Human herpesvirus 6 (HHV-6) reactivation and HHV-6 encephalitis after allogeneic hematopoietic cell transplantation: a multicenter, prospective study. Clin Infect Dis. 2013;57(5):671–81. https://doi.org/10.1093/cid/cit358.
24. Mori T., Tanaka-Taya K., Satoh H. et al. Transmission of chromosomally integrated human herpesvirsus 6 (HHV-6) variant A from a parent to children leading to misdiagnosis of active HHV-6 infection. Transpl Infect Dis. 2009;11(6):503–6. https://doi.org/10.1111/j.1399-3062.2009.00430.x.
25. Pandey U., Greninger A.L., Levin G.R. et al. Pathogen or bystander: clinical significance of detecting human herpesvirus 6 in pediatric cerebrospinal fluid. J Clin Microbiol. 2020;58(5):e00313–20. https://doi.org/10.1128/JCM.00313-20.
26. Hudnall S.D., Chen T., Allison P. et al. Herpesvirus prevalence and viral load in healthy blood donors by quantitative real-time polymerase chain reaction. Transfusion. 2008;48(6):1180–7. https://doi.org/10.1111/j.1537-2995.2008.01685.x.
27. Leong H.N., Tuke P.W., Tedder R.S. et al. The prevalence of chromosomally integrated human herpesvirus 6 genomes in the blood of UK blood donors. J Med Virol. 2007;79(1):45–51. https://doi.org/10.1002/jmv.20760.
28. Pellett P.E., Ablashi D.V., Ambros P.F. et al. Chromosomally integrated human herpesvirus 6: questions and answers. Rev Med Virol. 2012;22(3):144–55. https://doi.org/10.1002/rmv.715.
29. Morissette G., Flamand L. Herpesviruses and chromosomal integration. J Virol. 2010;84(23):12100–9. https://doi.org/10.1128/JVI.01169-10.
30. Ganea O.A., Tilican C., Streinu-Cercel A. et al. Human herpesvirus 6 – a rare aetiologic agent for CNS infections in immunocompetent individuals or an underestimation? J Clin Med. 2024;13(16):4660. https://doi.org/10.3390/jcm13164660.
31. Domonova E.A., Silvejstrova O.Yu., Shipulina O.Yu. et al. Method for detecting and laboratory confirmation of inherited chromosomally-integrating human herpes virus 6A/B. Patent RF 2739997 C1 dated of 30.12.2020. Bull. No. 1. 16 p. Available at: https://patents.s3.yandex.net/RU2739997C1_20201230.pdf. [Accessed: 15.03.2025].
32. Luppi M., Marasca R., Barozzi P. et al. Three cases of human herpesvirus-6 latent infection: Integration of viral genome in peripheral blood mononuclear cell DNA. J Med Virol. 1993;40(1):44–52. https://doi.org/10.1002/jmv.1890400110.
33. Pugni L., Pietrasanta C., Ronchi A. et al. Inherited chromosomally integrated human herpesvirus 6: an unexpected finding in a septic neonate. Pediatr Infect Dis J. 2021;40(1):74–5. https://doi.org/10.1097/INF.0000000000002905.
34. Kim F., Reichman V., Hooven T.A. Human herpesvirus-6 meningitis in a premature infant with fevers: a case and literature review. Clin Med Insights Case Rep. 2020;13:1179547620912952. https://doi.org/10.1177/1179547620912952.
35. Bounaadja L., Piret J., Goyette N., Boivin G. Analysis of HHV-6 mutations in solid organ transplant recipients at the onset of cytomegalovirus disease and following treatment with intravenous ganciclovir or oral valganciclovir. J Clin Virol. 2013;58(1):279–82. https://doi.org/10.1016/j.jcv.2013.06.024.
36. Piret J., Boivin G. Antiviral drug resistance in herpesviruses other than cytomegalovirus. Rev Med Virol. 2014;24(3):186.218. https://doi.org/10.1002/rmv.1787.
37. Pöhlmann C., Schetelig J., Reuner U. et al. Cidofovir and foscarnet for treatment of human herpesvirus 6 encephalitis in a neutropenic stem cell transplant recipient. Clin Infect Dis. 2007;44(12):e118–20. https://doi.org/10.1086/518282.
38. Hennus M.P., van Montfrans J.M., van Vught A.J. et al. Life-threatening human herpes virus-6 infection in early childhood: presenting symptom of a primary immunodeficiency? Pediatr Crit Care Med. 2009;10(2):e16–8. https://doi.org/10.1097/PCC.0b013e31819bb956.
39. Kharbat A.F., Lakshmi-Narasimhan M., Bhaskaran S., Parat S. Incidental detection of human herpesvirus-6 in cerebrospinal fluid analysis: to treat or not to treat? Cureus. 2022;14(6):e25629. https://doi.org/10.7759/cureus.25629.
40. Najima Y., Ohashi K., Ando M. et al. Salt-wasting nephropathy induced by foscarnet treatment for HHV-6 encephalitis in a hematopoietic stem cell transplant. Rinsho Ketsueki. 2008;49(1):40–5. (In Japanese).
41. Vashura L.V., Savenkova M.S. Herpes of the 6th type (epidemiology, diagnosis, clinical variations of the disease). [Gerpes 6-go tipa (epidemiologiya, diagnostika, klinika)]. Lechashchij vrach. 2014;(11):18–25. (In Russ.).
42. Caserta M.T., Hall C.B., Canfield R.L. et al. Early developmental outcomes of children with congenital HHV-6 infection. Pediatrics. 2014;134(6):1111–8. https://doi.org/10.1542/peds.2014-0886.
43. Sevilla-Acosta F., Araya-Amador J., Ulate-Campos A. Human herpesvirus 6 associated encephalitis with fulminant brain edema in a previously healthy child. Cureus. 2020;12(5):e8018. https://doi.org/10.7759/cureus.8018.
44. Zhetishev R.A., Arkhestova D.R., Pacheva O.A., et al. Viral encephalitis (human herpes virus type 6) after COVID-19 in a child: clinical case. [Encefalit virusnoj etiologii (virus gerpesa cheloveka 6-go tipa) posle COVID-19 u rebenka: klinicheskij sluchaj]. Voprosy sovremennoj pediatrii. 2023;22(3):263–70. (In Russ.). https://doi.org/10.15690/vsp.v22i3.2588.
45. Eliassen E., Hemond C.C., Santoro J.D. HHV-6-associated neurological disease in children: epidemiologic, clinical, diagnostic, and treatment considerations. Pediatr Neurol. 2020;105:10–20. https://doi.org/10.1016/j.pediatrneurol.2019.10.004.
Review
For citations:
Karpova A.L., Mostovoi A.V., Baranov A.A., Anikeeva L.A., Klubnichkina E.V., Zaplatnikov A.L., Karpov L.N. Congenital human herpesvirus 6 infection in a full-term newborn: literature review and case report. Obstetrics, Gynecology and Reproduction. (In Russ.) https://doi.org/10.17749/2313-7347/ob.gyn.rep.2025.635

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