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
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,
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.