Emergence and persistence of multiple antiviral-resistant CMV strains in a highly immunocompromised child
Emergence and persistence of multiple antiviral-resistant CMV strains in a highly immunocompromised child
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DOI：
10.1016/j.jcv.2007.07.003
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发表时间：
2007-10-01
影响因子：
8.8
通讯作者：
Rawlinson, William D.
中科院分区：
文献类型：
--
作者：
Iwasenko, Jenna M.;Scott, Gillian A.;Rawlinson, William D.
背景资料：人巨细胞病毒（CMV）抗病毒耐药的出现在接受抗病毒治疗的免疫功能低下患者的疾病进展中起着重要作用。目的：确定高度免疫功能低下儿童抗病毒耐药CMV毒株的模式。研究设计：使用PCR测序对血液和尿液样本进行回顾性分析，以鉴定含有UL97或UL54突变的抗病毒耐药CMV毒株。结果：抗病毒药物耐药的巨细胞病毒株导致X连锁严重联合免疫缺陷（SCID）骨髓移植受者接受更昔洛韦（GCV）和膦甲酸（FOS）治疗的疾病。回顾性分析在疾病进展后采集的标本中检测到GCV耐药CMV（L595S）。这种GCV耐药CMV株持续了1年，此后即使患者继续接受GCV，也不再检测到。一个福斯耐药株（T700A），然后出现，即使没有FOS已在前一年管理。结论：抗病毒耐药CMV的检测没有遵循在其他患者中发现的模式进行抗病毒耐药测试，包括出现一个福斯耐药株在没有抗病毒选择性压力。这些结果表明，患者的基础免疫抑制条件应考虑耐药CMV的诊断和管理。皇冠版权所有（c）2007年出版的爱思唯尔B.V.保留所有权利。
Background: The emergence of human cytomegalovirus (CMV) antiviral resistance plays a significant role in disease progression in immunocompromised patients who have received antiviral therapy.Objectives: To determine the pattern of antiviral-resistant CMV strains in a highly immunocompromised child.Study design: Retrospective specimens of blood and urine were analysed using PCR-sequencing to identify antiviral-resistant CMV strains containing UL97 or UL54 mutations.Results: CMV strains resistant to antiviral agents contributed to disease in a bone marrow transplant recipient with X-linked severe combined immunodeficiency (SCID) treated with ganciclovir (GCV) and foscarnet (FOS). Retrospective analyses detected GCV-resistant CMV (L595S) in a specimen taken after disease progression. This GCV-resistant CMV strain persisted for I year, after which time it was no longer detected even though the patient continued to receive GCV. A FOS-resistant strain (T700A) then emerged even though no FOS had been administered in the preceding year.Conclusion: The detection of antiviral-resistant CMV did not follow the patterns found in other patients tested for antiviral resistance, including emergence of a FOS-resistant strain in the absence of antiviral-selective pressure. These findings indicate the patient's underlying immunosuppressive condition should be considered for diagnosis and management of resistant CMV. Crown Copyright (c) 2007 Published by Elsevier B.V. All rights reserved.