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JAMA Dermatol. 2013 May;149(5):565-9. doi: 10.1001/jamadermatol.2013.2018.

Saliva polymerase chain reaction assay for detection and follow-up of herpesvirus reactivation in patients with drug reaction with eosinophilia and systemic symptoms (DRESS).

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  • 1Department of Dermatology, Bichat-Claude Bernard Hospital, Assistance Publique des Hôpitaux de Paris, 46 rue Henri Huchard, 75018 Paris, France. vincent.descamps@bch.aphp.fr

Abstract

IMPORTANCE:

Reactivations of human herpesviruses (HHVs) contribute to the development of drug reaction with eosinophilia and systemic symptoms (DRESS). Diagnosis of HHV reactivation is conventionally based on quantitative real-time polymerase chain reaction (PCR) analysis of blood samples, but these viruses are present in the oropharynx and are shed in saliva.

OBJECTIVE:

To evaluate the use of a saliva PCR assay for demonstrating HHV shedding in patients with DRESS.

DESIGN:

Shedding of HHV in saliva was prospectively studied in patients with DRESS. Reactivations of HHV, including HHV-6, HHV-7, cytomegalovirus (CMV), and Epstein-Barr virus (EBV), were studied by performing quantitative real-time PCR analysis of blood samples obtained at admission) and serial samples of saliva obtained within the first 2 weeks of DRESS; saliva samples from controls were compared.

PARTICIPANTS:

The study included 5 patients who met definite criteria for DRESS and 15 controls (5 immunosuppressed patients and 10 healthy adults).

MAIN OUTCOME MEASURES:

DNA viral loads of HHV, including HHV-6, HHV-7, CMV, and EBV as measured with real-time PCR in blood and saliva samples from patients with DRESS and saliva samples from immunosuppressed and healthy controls.

RESULTS:

The PCR assay demonstrated shedding of HHV-7, EBV, HHV-6, and CMV, listed by order of magnitude. The DNA viral loads in blood and saliva samples, also measured with real-time PCR, were found to be close. In 1 patient, reactivations in saliva preceded clinical manifestations of CMV disease. Significant production of HHV-7 and EBV was demonstrated in saliva samples from the controls, but neither HHV-6 nor CMV were detected.

CONCLUSIONS AND RELEVANCE:

The saliva PCR assay is a useful tool for demonstration and follow-up of HHV reactivation. The interpretation of HHV viral loads in saliva differs according to HHV type.

PMID:
23426332
DOI:
10.1001/jamadermatol.2013.2018
[PubMed - indexed for MEDLINE]
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