Human cytomegalovirus double resistance in a donor-positve/recipient-negative lung transplant patient with an impaired CD4-mediated specific immune response

Research output: Contribution to journalArticle

Abstract

Background: Emergence of human cytomegalovirus (HCMV) resistance to ganciclovir in solid-organ transplant recipients has been found to be mostly associated with primary HCMV infection. Materials and methods: The case of a donor-positive/recipeent-negative (D+/R-) lung transplant patient developing ganciclovir and cidofovir resistance is described. HCMV infection was monitored by weekly determination of antigenaemia, viraemia and DNAaemia. HCMV-specific CD4 cell immunity was determined by cytokine flow cytometry. The emergence of drug-resistant HCMV strains was documented by sequencing of UL97 and UL54 genes of HCMV directly in blood samples. Results: Following primary HCMV infection, the patient showed repeated reactivations for over a year, eventually resulting in the selection of a ganciclovir-resistant HCMV strain with a mutation in the UL97 gene product (A594V). Determination of HCMV-specific CD4 cell immunity showed a persistently impaired immune response. Subsequent foscarnet treatment allowed only transitory virus clearance from blood owing to renal toxicity. Further ganciclovir treatment induced a new mutation in both UL97 (H520Q) and UL54 (P522S) with final emergence of double resistance to both ganciclovir and cidofovir. The patient eventually died of lung failure. Discussion: Determination of HCMV-specific CD4 cell immunity could be of help in predicting the emergence of drug-resistant strains in D+/R-transplant recipients.

Original languageEnglish
Pages (from-to)536-539
Number of pages4
JournalJournal of Antimicrobial Chemotherapy
Volume53
Issue number3
DOIs
Publication statusPublished - Mar 2004

Keywords

  • CD4 cell response
  • DR
  • Drug resistance
  • HCMV

ASJC Scopus subject areas

  • Microbiology
  • Pharmacology

Fingerprint Dive into the research topics of 'Human cytomegalovirus double resistance in a donor-positve/recipient-negative lung transplant patient with an impaired CD4-mediated specific immune response'. Together they form a unique fingerprint.

  • Cite this