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• W1976823592 abstract "To the Editor: Pityriasis rosea (PR) is an acute, self-limiting exanthem associated with endogenous reactivation of human herpesvirus (HHV)-6 and HHV-7.1Broccolo F. Drago F. Careddu A.M. Foglieni C. Turbino L. Cocuzza C.E. et al.Additional evidence that pityriasis rosea is associated with reactivation of human herpes virus-6 and -7.J Invest Dermatol. 2005; 124: 1234-1240Crossref PubMed Scopus (158) Google Scholar, 2Watanabe T. Kawamura T. Jacob S.E. Aquilino E.A. Orenstein J.M. Black J.B. et al.Pityriasis rosea is associated with systemic active infection with both human herpesvirus-7 and human herpesvirus-6.J Invest Dermatol. 2002; 119: 793-797Crossref PubMed Scopus (150) Google Scholar States of immunosuppression can favor HHV-6 or HHV-7 reactivation. Because pregnancy is a state of altered immune response and, as such, is a risk for viral reactivation, we studied the intrauterine transmission of HHV-6/73Ohashi M. Yoshikawa T. Ihira M. Suzuki K. Suga S. Tada S. et al.Reactivation of human herpesvirus 6 and 7 in pregnant women.J Med Virol. 2002; 67: 354-358Crossref PubMed Scopus (25) Google Scholar, 4Dahl H. Fjaertoft G. Norsted T. Wang F.Z. Mousavi-Jazi M. Linde A. Reactivation of human herpesvirus 6 during pregnancy.J Infect Dis. 1999; 180: 2035-2038Crossref PubMed Scopus (74) Google Scholar in 38 women in whom PR developed during pregnancy. Sixty-two percent of women in whom PR developed within 15 weeks' gestation miscarried.5Drago F. Broccolo F. Zaccaria E. Malnati M. Cocuzza C. Lusso P. et al.Pregnancy outcome in patients with pityriasis rosea.J Am Acad Dermatol. 2008; 58: 78-83Abstract Full Text Full Text PDF PubMed Scopus (59) Google Scholar We wondered, therefore, whether PR is a predictor of miscarriage or a risk factor for the course of pregnancy. We extended our previous study to embrace 61 women with clinically diagnosed gestational PR. HHV-6/7 DNA was assessed in skin lesions, plasma, and placenta in 14 consenting patients (4 miscarriages, 5 with perinatal problems, 5 without perinatal problems), as well as in fetal tissue, by quantitative calibrated real-time polymerase chain reaction.5Drago F. Broccolo F. Zaccaria E. Malnati M. Cocuzza C. Lusso P. et al.Pregnancy outcome in patients with pityriasis rosea.J Am Acad Dermatol. 2008; 58: 78-83Abstract Full Text Full Text PDF PubMed Scopus (59) Google Scholar Specific HHV-6 and HHV-7 serology was appraised by indirect immunofluorescence in all 61 patients. Of the 61 women, 22 had unfavorable outcomes. Eight miscarried (Table I). All miscarrying women had atypical PR (skin lesions unusually widespread and long duration with constitutional symptoms associated). None of them had risk factors for intrauterine fetal death.Table IUnfavorable outcomes in pregnant women with pityriasis roseaPrevious pregnanciesPityriasis roseaPresent pregnancy outcomeCaseAge (years)NumberOnset (weeks)Duration (weeks)Body area involvedDelivery (week)Newborn weight (g)Apgar scoreHHV-6 DNAHHV-7 DNA13011110#L,T (>70%)18Stillborn—MS,Pl,FTP,MS23201011#L,T (>70%)16Stillborn—P,MS,PlP,MS3280910#L,T17Stillborn—P,MS,Pl,FTP,MS4∗Cases published previously (1 case was assessed virologically, in bold fonts).322158#L,T (>80%)17Stillborn—ndnd5∗Cases published previously (1 case was assessed virologically, in bold fonts).281106#L,T12Stillborn—P,MS,Pl,FTneg6∗Cases published previously (1 case was assessed virologically, in bold fonts).3011113#L,T12Stillborn—ndnd7∗Cases published previously (1 case was assessed virologically, in bold fonts).2911211#L,T16Stillborn—ndnd8∗Cases published previously (1 case was assessed virologically, in bold fonts).280811#L,T11Stillborn—ndnd9∗Cases published previously (1 case was assessed virologically, in bold fonts).311205LL,T (<50%)352900+6ndnd10∗Cases published previously (1 case was assessed virologically, in bold fonts).270195LL,T (<50%)342600+@6ndnd11∗Cases published previously (1 case was assessed virologically, in bold fonts).311156T (<50%)382800+**8ndnd12∗Cases published previously (1 case was assessed virologically, in bold fonts).250185LL,T (<50%)363000@7ndnd13∗Cases published previously (1 case was assessed virologically, in bold fonts).312§194LL,T (<50%)363100**8ndnd14∗Cases published previously (1 case was assessed virologically, in bold fonts).250196L,T (<50%)352700+7ndnd15∗Cases published previously (1 case was assessed virologically, in bold fonts).291164T (<50%)362950+7ndnd16∗Cases published previously (1 case was assessed virologically, in bold fonts).311245#LL,T (50%)382750∼7ndnd17290159L,T342100@8negP,MS18270198#L,T (>70%)321900+8P,Pl,MSneg19331149L,T332100+7negPl,MS20322188#L,T392900§§9negPl,MS21300169#L,T383100§§9negneg22341149T383000+§§8ndndPregnancies with unfavorable outcomes: cases 1 to 8 miscarriages; cases 9 to 22 women with perinatal problems namely:§, 1 miscarried; +, hypotonia; @, weak motion; **, foramen ovale; §§, hydramnios; ∼, low birth weight; #, with constitutional symptoms; L, limbs; T, trunk; LL, lower limbs; P, mother's plasma; Pl, placenta; MS, mother's skin (PR lesions); FT, fetal tissue; neg, negative; nd, not done.∗ Cases published previously (1 case was assessed virologically, in bold fonts). Open table in a new tab Pregnancies with unfavorable outcomes: cases 1 to 8 miscarriages; cases 9 to 22 women with perinatal problems namely: §, 1 miscarried; +, hypotonia; @, weak motion; **, foramen ovale; §§, hydramnios; ∼, low birth weight; #, with constitutional symptoms; L, limbs; T, trunk; LL, lower limbs; P, mother's plasma; Pl, placenta; MS, mother's skin (PR lesions); FT, fetal tissue; neg, negative; nd, not done. All 61 patients carried HHV-6/7 IgG, but none had detectable IgM antibodies. HHV-6 DNA was found in plasma in 3 of 4 women with stillborns, in the placenta and in PR lesions in 4 women, and in fetal tissue in 3 of 4 stillborns (Table I). Only in 1 of 5 women with perinatal problems was HHV-6 DNA found in plasma, PR lesions, and placenta. HHV-6 DNA was detected in plasma in 2 of 5 PR patients with normal pregnancies. Notably, none of the placenta and only 1 of the PR lesions was positive for HHV-6 DNA in the PR patients with normal pregnancies. HHV-7 DNA was detected in plasma and PR lesions in 3 miscarrying women, but never in fetal tissues. In women with perinatal problems, HHV-7 was found in plasma (1 patient), in placenta (2 patients), and in PR lesions (3 patients). HHV-7 was found in women with normal pregnancies as well (3 cases in plasma, 2 in PR lesions, none in placenta). Histopathology revealed villitis, chorioamnionitis, or funisitis in all stillborns, in 3 of 5 women with perinatal problems, and in 1 of 5 women without perinatal problems. No fetal chromosomal abnormalities were present. Our study suggests that PR developing during pregnancy may be followed by premature delivery and even fetal death. On the whole, the total abortion rate we found (8 of 61, 13%) was the same as in our previous study (5 of 38, 13%).5Drago F. Broccolo F. Zaccaria E. Malnati M. Cocuzza C. Lusso P. et al.Pregnancy outcome in patients with pityriasis rosea.J Am Acad Dermatol. 2008; 58: 78-83Abstract Full Text Full Text PDF PubMed Scopus (59) Google Scholar Noteworthy, when PR developed within the 15th gestational week (14 cases), we observed an abortion rate of 57% (8 of 14). This finding is comparable to our previous series (62%),5Drago F. Broccolo F. Zaccaria E. Malnati M. Cocuzza C. Lusso P. et al.Pregnancy outcome in patients with pityriasis rosea.J Am Acad Dermatol. 2008; 58: 78-83Abstract Full Text Full Text PDF PubMed Scopus (59) Google Scholar suggesting that the early reactivation of HHV-6 is critical for the outcome of pregnancy. Therefore, in women in whom PR develops during the first 15 weeks of gestation, especially with atypical PR forms, a closer follow-up should be recommended." @default.
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• W1976823592 title "Evidence of human herpesvirus-6 and -7 reactivation in miscarrying women with pityriasis rosea" @default.
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