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Primary Human Herpesvirus 8 Infection in Immunocompetent Children
Massimo Andreoni, MD;
Loredana Sarmati, MD;
Emanuele Nicastri, MD;
Gamal El Sawaf, MD;
Mahmoud El Zalabani, MD;
Ilaria Uccella, MD;
Roberto Bugarini, DStat;
Saverio G. Parisi, MD;
Giovanni Rezza, MD
JAMA. 2002;287:1295-1300.
Context Human herpesvirus 8 (HHV-8) infection causes Kaposi sarcoma and lymphoproliferative disorders in immunosuppressed adults. Its manifestations in immunocompetent hosts are unknown.
Objectives To determine whether HHV-8 primary infection is symptomatic in immunocompetent children and to identify the epidemiological and virological correlates of HHV-8 infection.
Design and Setting Prospective cohort study conducted in the pediatric emergency department of a hospital in Alexandria, Egypt, between December 1, 1999, and April 30, 2000.
Patients Eighty-six children aged 1 to 4 years who were evaluated for a febrile syndrome of undetermined origin.
Main Outcome Measures Serological assay and polymerase chain reaction of blood and saliva samples for HHV-8. Information on potential risk factors for HHV-8 infection was also collected.
Results Thirty-six children (41.9%) were seropositive; HHV-8 DNA sequences were detected in 14 (38.9%) of these 36 children (detected in saliva in 11 of 14). Significant associations were found between HHV-8 infection and close contact with at least 2 other children in the community (36 of 63 vs 6 of 23 for <2 children; adjusted odds ratio [OR], 3.50; 95% confidence interval [CI], 1.11-12.22) and admission to the emergency department in December or January (28 of 47 vs 14 of 39 for February-April; adjusted OR, 3.15; 95% CI, 1.23-8.58). Six children had suspected primary HHV-8 infection; all but 1 had a febrile cutaneous craniocaudal maculopapular rash, which was more common among these children (5 of 6 vs 10 of 75; P<.001). For 3 of these 6 children, a second blood sample was obtained after the convalescence phase, and all 3 seroconverted for HHV-8.
Conclusions Primary infection with HHV-8 may be associated with a febrile maculopapular skin rash among immunocompetent children. The finding of HHV-8 DNA sequences in saliva supports the hypothesis that transmission through saliva is the main mode of transmission in the pediatric age group.
Author Affiliations: Department of Public Health, University of Tor Vergata (Drs Andreoni, Sarmati, Uccella, and Parisi), Istituto Nazionale per le Malattie Infettive, IRCCS Lazzaro Spallanzani (Dr Nicastri), AIDS and STD Unit, Laboratory of Epidemiology and Biostatistics, Istituto Superiore di Sanità (Drs Bugarini and Rezza), Rome, Italy; and Medical Research Institute, Alexandria University, Alexandria, Egypt (Drs El Sawaf and El Zalabani).
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