Source:Andreoni M, Sarmati L, Nicastri E, et al. Primary human herpesvirus 8 infection in immunocompetent children.
JAMA.
2002
;
287
:
1295
–1300.

Primary human herpesvirus 8 (HHV-8) has been linked to the development of Kaposi sarcoma (a form of lymphoma) and multicentric Castleman disease (a unique type of lymphoid hyperplasia). In areas with a low prevalence of HHV-8 infection, such as the United States, infection occurs almost exclusively among sexually active homosexual men.1 In contrast, evidence of infection is common among children in regions where infection is prevalent, as in many African countries.2 To determine whether human herpesvirus 8 (HHV-8) produces symptomatic infection in immunocompetent children, these investigators identified all children aged 1 to 4 years evaluated for a febrile illness in an emergency department in Alexandria, Egypt, between December 1, 1999 and April 30, 2000. During the study period, 486 children presented with a febrile illness. One hundred and thirty (26.7%) children were excluded because they had a specific identifiable diagnosis. Of the remaining 356, informed consent was obtained for 110. Demographic and clinical information were collected for each child. In addition, both plasma and saliva were obtained to test for HHV-8 DNA using polymerase chain reaction (PCR), and plasma was tested for antilytic antibodies to HHV-8. Children whose PCR tests were positive but who lacked antibodies were considered to have primary HHV-8 infection. This group underwent repeat serological testing 6 months later. Children who were initially seropositive for antibodies were considered non-acutely infected.

Eighty-six of 110 children had adequate saliva samples obtained; they comprised the final study sample. Their median age was 36 months (range, 12 to 46 months) and 48 (55.8%) were males. Presenting symptoms included cough or other respiratory tract symptoms, rash, oral ulcers, watery diarrhea, seizures, or middle ear infection. Thirty-six children (41.9%) had antibodies to HHV-8; in 14 of these PCR was also positive, 11 in saliva and 3 in plasma. HHV-8 DNA sequences were detected by PCR in 6 of 50 children (12%) who lacked antibodies. These 6 children, considered to have primary HHV-8 infection, were 24 to 36 months of age; 5 of the 6 presented with a rash described as consisting of erythematous macules and papules that first appeared on the face and later spread to the trunk and extremities. The rash lasted a median of 6 days (range, 3 to 8 days) and fever (≥39°C in 4 children) was present for a median of 10 days (range, 2 to 14 days). Symptoms of an upper respiratory tract infection occurred in 5 children; lower respiratory tract symptoms developed in 2. The child who did not have a rash developed confusion, seizures, and vomiting 48 hours after the onset of fever. All 6 children recovered uneventfully. The authors conclude that primary HHV-8 infection may be associated with a febrile exanthem in immunocompetent children.

In recent years, viruses have been found to cause a number of exanthems. Human parvovirus B19, for example, is responsible for Fifth disease (erythema infectiosum),...

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