Resistance to combined ganciclovir and foscarnet therapy in a liver transplant recipient with possible dual-strain cytomegalovirus coinfection
| Autor: | Carlos G. Fasola, John Rodriguez, Thomas G. Heffron, Katherine Casper, Gregory Smallwood, Jennifer Lehneman, A. Stieber |
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| Rok vydání: | 2007 |
| Předmět: |
Male
Foscarnet Ganciclovir viruses medicine.medical_treatment Congenital cytomegalovirus infection Cytomegalovirus Gene mutation Liver transplantation Antibodies Viral Antiviral Agents Polymerase Chain Reaction Fatal Outcome Drug Resistance Multiple Viral medicine Humans Transplantation Hepatology business.industry virus diseases Valganciclovir Immunosuppression Middle Aged medicine.disease Virology Liver Transplantation Cytomegalovirus Infections DNA Viral Immunology Coinfection Drug Therapy Combination Surgery business Liver Failure Follow-Up Studies medicine.drug |
| Zdroj: | Liver Transplantation. 13:1396-1400 |
| ISSN: | 1527-6473 1527-6465 |
| Popis: | We present a case report of a cytomegalovirus (CMV)-seronegative, 58-year-old male who received a CMV-seropositive donor liver transplant without CMV prophylaxis. On postoperative day 30, the patient developed primary CMV disease that responded to ganciclovir. On postoperative day 114, however, he was diagnosed with recurrent CMV infection. Despite aggressive, combined antiviral treatment with ganciclovir and foscarnet and reduction of immunosuppression, viral clearance was never achieved. Serum samples were collected throughout the infectious process for viral DNA analysis. Portions of the UL97 and UL54 genes were amplified and compared to the AD169 wild-type strain. Sequencing studies revealed the presence of mutations in viral isolates obtained after clinical resistance was observed. These mutations were not present in samples obtained during the primary CMV infection. Our findings suggest the presence of coinfection with at least 2 different strains of CMV rather than induction of mutations after ganciclovir therapy. |
| Databáze: | OpenAIRE |
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