Abstract & Commentary
Synopsis: Primary HHV8 infection was identified in 6 immunocompetent children. All but 1 had a febrile illness with a maculopapular rash spreading from the face to the trunk, arms, and legs. HHV8 was detected in saliva in 31% of seropositive children.
Source: Andreoni M, et al. Primary human herpesvirus 8 infection in immunocompetent children. JAMA. 2002;287:1295-1300.
A prospective study in Alexandria, Egypt, of 86 children 1-4 years of age with a febrile illness of undetermined origin identified 36 seropositive for HHV8 infection. HHV8 DNA was detected in saliva of 11 of the 36 children (31%) and also in plasma of 2 of these 11 children, but was detected in plasma in only 3 seropositive patients. Primary HHV8 infection was suspected in 6 seronegative children with detectable HHV8 DNA in saliva; 2 of these 6 also had HHV8 DNA detectable in plasma. Five of these 6 children had an acute illness characterized by a blanching, maculopapular rash with a median duration of 6 days (range, 3-8 days) associated with fever with a median duration of 10 days (range, 2-14 days). None of these 6 children had lymphadenopathy or oral ulcerations. Convalescent serum was available for 3 of these 6 children; all 3 seroconverted. All 6 of the children recovered completely within 3 weeks. There was no serologic evidence among these 6 children of interval infection with another herpesvirus. HHV8 infection was associated with close contact with at least 2 other children in the community (odds ratio, 3.50; 95% CI, 1.11-12.22) and admission to the emergency department during December or January (odds ratio, 3.15; 95% CI, 1.23-8.58).
Comment by Hal B. Jenson, MD, FAAP
The results of this study suggest that primary HHV8 infection in immunocompetent children is associated with a symptomatic illness consisting of a maculopapular rash lasting 2-14 days and a fever lasting 3-8 days. The rash is macular with blanching, discrete macules appearing on the face and gradually spreading centripetally to involve the trunk, arms, and legs. There was no associated lymphadenopathy or oral ulcerations. This illness will be difficult to differentiate from other nondescript childhood infections.
This study also demonstrates the increasingly recognized distribution of HHV8 infection among young children. In low-prevalence areas, such as the United States and Europe, the prevalence of HHV8 infection in the general population is reported to be from 0-15% with highest risk among men who have sex with men, and low prevalence among children. This suggests that sexual transmission is the primary route of HHV8 transmission in North America and Europe. In high-prevalence areas, such as in many African countries, HHV8 infection is common among children, with HHV8 shed from the oral cavity from approximately one third of infected children. Non-sexual transmission of HHV-8 may be more likely in regions with poor public sanitation and overcrowding, particularly in areas where HHV-8 infection in the general population is high. It is also likely that transmission of HHV-8 occurs by intrafamilial transmission, most likely via mother-to-child and by oral transmission among siblings and young children by sharing toys and by poor oral hygiene habits. This study, and others, documenting presence of HHV8 in saliva of young children suggests that saliva is the primary means of inter-community spread of HHV8 in endemic regions.
Dr. Jenson, Chief, Pediatric Infectious Diseases, University of Texas Health Science Center, San Antonio, TX, is Associate Editor of Infectious Disease Alert.
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