The first two ganciclovir resistant cytomegalovirus isolates from kidney and pediatric stem cell transplant recipients in Turkey

Year 2018, Most Accessed Articles, 53 - 57, 05.06.2018

Aysin Zeytinoglu, Et Al.

https://doi.org/10.5455/jicm.12.2016070

Abstract

Background: The
emergence of cytomegalovirus (CMV) resistance to antivirals causes an
increasing problem in transplant recipients, complicating therapeutic and
clinical management. Widely used antivirals for therapy, preemptive therapy,
and prophylaxis are the causes for resistance. This study aimed to report the
first two transplant recipients who had CMV ganciclovir (GCV) resistance
assessed by UL97 viral gene sequencing in Turkey.

Case presentation: CMV infection was monitored by plasma quantitative viral
DNA real-time polymerase chain reaction (Abbott Molecular Inc., Illınois, USA)
in the transplant recipients. Sequence analysis of CMV UL97 in CMV DNA–positive
cases for GCV resistance was conducted, and while looking for UL97 GCV
resistance in Ege University hospital, the first renal transplantation
recipient with CMV mutation in Turkey was detected. Also, a  stem cell transplant recipient was the first
case for pediatric stem cell transplantation having UL97 GCV-resistant strain
in Turkey. A594V and C603W mutations were the detected mutations, respectively.

Conclusion: Using
GCV/valganciclovir (VGCV) for preemptive therapy, prophylaxis, treatment, and
especially maintenance therapy for a long time with VGCV when CMV DNA is still
detectable in peripheral blood might represent a risk factor for the emergence
of CMV GCV resistance. The present findings indicate that resistance to widely
used GCV as therapy, preemptive therapy, and prophylaxis should be monitored
carefully in transplant recipients routinely for good patient management and
effective antiviral therapy.

Keywords

Cytomegalovirus, ganciclovir resistance, mutation, UL97

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